Vaginal Dryness

WHEN TO SEE YOUR DOCTOR

* You are approaching the age of menopause.

* Vaginal dryness is accompanied by itching.

What Your Symptom Is Telling You

Many women of all ages run into vaginal dryness now and then. But common or not, a dry vagina feels uncomfortable and can make sex downright painful.

The amount of vaginal lubrication varies from woman to woman, with a wide range of normal, says Theresa Crenshaw, M.D., a sex therapy specialist and author of Bedside Manners. The fluid itself is clear and relatively odorless. Apart from its gentle blessing when you're sexually aroused, you may not take much notice of your vaginal fluid most of the time. But when it's absent, you may start to feel dry as a desert.

Vaginal dryness can have a variety of causes. Your sensitive vaginal chemistry may be reacting to another kind of chemistry—in harsh alkaline soaps, for example. Or you may be drying up as part of an allergic response to perfumes or dyes. As you get closer to the years of menopause, lowered estrogen levels may also cause dryness of the vagina. And certain skin conditions may interfere with vaginal lubrication.

Symptom Relief

Here's how to get that gentle lubrication flowing again.

Scrutinize your soap. "The vagina wasn't designed to be sterile," says John Grossman, M.D., a gynecologist at George Washington University Hospital and Medical Center in Washington, D.C. "It has its own biologically normal, natural method of bacterial control—mainly by maintaining a natural level of acidity (pH of 4 to 4.5)."

His advice? "Use a superfatted hypoallergenic soap with no dyes or fragrances—one that is nonalkaline and pH-balanced."

Avoid those allergens. If your dryness is a reaction to a substance that you are allergic to—an allergen—you may have to do a little detection to pinpoint the culprits. Two common allergens are the fragrances and dyes in laundry detergent and toilet paper, Dr. Grossman says.

Toss out the designer-patterned and perfumed paper in favor of a soft, white, unscented variety, he suggests. If laundry detergent seems to be a problem, you may not need to switch brands. Just send your underwear through a second rinse cycle. You might also try switching to white cotton underpants.

Learn where you lubricate. It's normal for some women not to lubricate copiously when they're sexually aroused. It's also possible to lubricate without realizing it, says Dr. Crenshaw. If you're lying on your back, the moisture may pool in the back of your vagina, too far away to make sexual intercourse comfortable. The solution? Before intercourse, try dipping a finger into the vagina and drawing some of the lubrication out to coat the dry surface, she suggests.

Try a healthy substitute. If your dryness is only occasional, use a water-based lubricant like K-Y Jelly or Surgilube during sexual intercourse, says Roger Smith, M.D., a professor of obstetrics and gynecology at the Medical College of Georgia Hospital and Clinics in Augusta.

"Avoid Vaseline and oils," he says. "They tend to plug up pores, and if you're using a condom, the oil-based products will eat holes in it."

Although K-Y and Surgilube are fine for occasional dryness, Dr. Smith recommends Replens for safe and continuous relief. Replens contains a special molecule that draws water into vaginal tissues. After using it daily for about a week, you should be able to decrease your usage to two to three times a week, as needed, he says.

Check with your doctor. Your doctor may determine that a dermatologic problem is causing your vaginal dryness, Dr. Grossman says. A wide range of skin conditions can cause vaginal dryness. Your doctor may take a tiny tissue sample and treat you with a prescription cream or antibiotic, he says.

Harness help from your honey. The nicest advice may be this: When you have sex on a regular basis, you naturally make more lubrication, says Mary Beard, M.D., an assistant clinical professor in the Department of Obstetrics and Gynecology at the University of Utah Latter Day Saints Hospital in Salt Lake City. Continuing sexual activity is an important help in holding back the thinning and drying effects of menopause on vaginal tissues, she says.

Ask about hormones. If you have reached menopause and your vaginal dryness just won't let up, you may want to discuss hormone replacement therapy with your doctor, says Dr. Beard.

The dryness, thinning and tenderness of vaginal tissues after menopause can be relieved by estrogen, which you can take orally, by using a transdermal patch or by inserting a vaginal cream.