Dear Doc | What causes vaginal dryness?
Q I have a concern and wanted to ask why my wife’s vagina is now dry when we have sex. I am wondering if she no longer wants me because it was not that way before. Is there anything I can do to help her get it back to how it was before?
A I am not aware of your wife’s age. However, vaginal dryness is a common condition in postmenopausal women (women who have already gone through menopause). This condition is also common in women who have had both of their ovaries surgically removed for medical reasons. It may also be due to certain medications she may be taking, as well as a lack of sexual stimulation.
The most common cause of vaginal dryness is hormonal in origin. The hormone oestrogen helps to keep the vagina moist, as well as helping maintain the thickness and elasticity of the vaginal lining. Vaginal dryness occurs when your body produces a decreased amount of oestrogen. This reduced level of oestrogen can be permanent or temporary and can occur at different times throughout life, such as:
- At the time of menopause (one year after regular monthly periods stop);
- After surgical removal of the ovaries; treatments that may affect ovarian function, such as chemotherapy; or radiation therapy of the pelvis to treat cancer;
- After one has a baby and is breastfeeding. In this case, oestrogen levels will return to normal when breastfeeding becomes less frequent or is stopped.
- While using certain medications, such as some forms of birth control, and treatments for some gynaecologic conditions, e.g. , endometriosis. When these medications are stopped, oestrogen levels will return to normal.
However, the cause of vaginal dryness that you are more concerned about is the psychological component, particularly desire.
Now, in the sexual-response cycle, desire is the first of four phases. Desire may occur spontaneously or in response to a partner, sexual thoughts, or sensory stimuli. Spontaneous desire is more common in new relationships, while desire in response to an erotic stimulus or from physical or emotional closeness to a partner is more typical of long-term relationships. Responsive desire does not occur until after sexual activity has started.
I have noted that men associate vaginal dryness with a lack of desire for them from their partner. However, desire is not essential to having a satisfactory sex life. A woman can not have thoughts of, or initiate, sex and not necessarily have a problem.
What, however, is more associated with vaginal dryness is lack of arousal. Arousal, which is the second phase of the sexual-response cycle, is a sense of sexual pleasure, often accompanied by an increase in blood flow to the genitals, increased lubrication, and an increased heart rate, blood pressure, and respiratory rate.
Now that we have explained that, here are ways to help.
There are many vaginal lubricants and vaginal moisturisers that are available without a prescription.
Vaginal lubricants are designed to reduce the friction and discomfort that results from vaginal dryness during sexual intercourse. It can be applied inside the vagina, as well as on the penis or fingers just before sex. Products sold specifically as vaginal lubricants are more effective than lubricants that are not designed for this purpose, for example, petroleum jelly. Additionally, oil-based lubricants like petroleum jelly, baby oil, or mineral oil can damage latex condoms, making them less effective in preventing pregnancy and sexually transmitted infections. Lubricants that are made with water or silicones are better for use with latex condoms.
Natural lubricants, such as olive oil, coconut oil, avocado oil, and peanut oil, are easily available products that may be used as a lubricant with sex. However, just like the oil-based lubricants, natural oils are not recommended for use with latex condoms as they can damage the material.
Vaginal moisturisers are formulated to allow the vaginal tissues to retain moisture more effectively. Moisturisers are applied into the vagina approximately three times weekly to allow a more continuous moisturising effect compared to lubricants.
Hand and body lotions and moisturisers should not be used to relieve vaginal dryness since they can be irritating to the vaginal tissues.
Vaginal oestrogen is one of the most effective treatment options for vaginal dryness. Vaginal oestrogen, however, requires a prescription from your healthcare provider, so ask about this if lubricants and moisturisers are not doing enough to relieve your symptoms. This option is usually for females with an identifiable hormonal cause for their vaginal dryness.
Very low doses of oestrogen can be used to treat vaginal dryness and are available in the form of vaginal creams or an insertable tablet, capsule, or ring.
Vaginal prasterone, also known as dehydroepiandrosterone, is also an option for women with vaginal dryness due to menopause. It comes in the form of a suppository that you insert into your vagina once a day. Vaginal oestrogen is more commonly used than prasterone because it has been studied more thoroughly and the dosing schedule may be more convenient. However, prasterone is an option for women who cannot take oestrogen or prefer to avoid it.
As explained above, arousal is very important to a woman’s sexual pleasure and vaginal lubrication (wetness). Therefore, it is particularly important for women to have successful foreplay. Foreplay serves a physical and emotional purpose, helping prepare both mind and body for sex. Many women need to be kissed, hugged, and caressed to create lubrication in the vagina, which is important for comfortable intercourse. Additionally, a woman especially needs emotional assurance that her man really wants to be with her. The time and attention given during foreplay can communicate that message.
I suggest you start with foreplay, and if that does not help, you can have a discussion with your wife and visit the doctor together.
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