Vaginal Dryness: Causes, Symptoms, and Treatment Options
Vaginal dryness is not just a menopause problem — and it is far more common, and far more treatable, than most women are told.
By Kelly Clinning, ND | Women's Hormonal Health
Vaginal dryness is something I see regularly in practice. Women mention it almost in passing, often after we have moved on to other topics, as though they are not sure it warrants its own conversation. It does. It is one of the most under-treated symptoms in women's health, and one of the most consistently responsive to treatment when it is actually addressed.
This post covers what vaginal dryness is, why it happens, who it affects, and what the current evidence says about treatment — including both non-hormonal and hormonal options.
Who Experiences Vaginal Dryness?
Vaginal dryness can show up at many different ages and stages of a woman's life. While it is most commonly associated with menopause, it is not exclusive to it. States that can cause vaginal dryness include:
Perimenopause, the 5 to 10 years before menopause, when estrogen levels begin to fluctuate and decline
Menopause and postmenopause, when estrogen levels are consistently low
The postpartum period while breastfeeding, due to suppressed estrogen during lactation
With use of the oral contraceptive pill, which lowers the bodies own estrogen production
Alongside anti-estrogen medications used to treat conditions like breast cancer or endometriosis
Hypothalamic amenorrhea, the loss of menstrual cycles due to undereating or intense exercise, which suppresses estrogen production
What all of these states have in common is low estrogen, and that is the driving factor. When estrogen drops, the tissues of the vagina become thinner, drier, and less elastic — a process that leads to the symptoms many women experience but rarely discuss.
What Is Genitourinary Syndrome of Menopause (GSM)?
When vaginal dryness and related symptoms develop specifically in the context of perimenopause and menopause, this is referred to clinically as Genitourinary Syndrome of Menopause (GSM). The term reflects the fact that low estrogen affects not only vaginal tissue but also the bladder and urethra.
Common symptoms of GSM include vaginal dryness, itchiness, burning, pain with intercourse, and recurrent urinary tract infections. For some women, urinary symptoms like increased urgency or frequency are also present, because estrogen is essential for bladder health and the same tissue changes that affect the vagina affect the bladder and urethra as well.
One of the most important things to understand about GSM is that, unlike hot flashes and night sweats which tend to improve on their own over time, vaginal dryness tends to persist or worsen with age without treatment. This is why early intervention matters.
Treatment Options for Vaginal Dryness
Current evidence supports a stepwise approach to treatment based on symptom severity. The good news is that there are effective options at every level.
For mild symptoms, non-hormonal vaginal lubricants and long-acting moisturizers are a good starting point and are available without a prescription. These are used differently: lubricants are applied during sexual activity to reduce friction and discomfort, while moisturizers are used regularly several times per week to support vaginal tissue health over time.
For moderate to severe symptoms, or for women whose symptoms have not improved adequately with non-hormonal options, prescription therapies are available. Low-dose vaginal estrogen is the most well-studied and effective option. Research shows it improves symptoms in 60 to 80% of patients. Because it is applied locally, very little estrogen is absorbed into the bloodstream, making it a safe option for most women. It can also reduce urinary urgency and lower the risk of recurrent UTIs.
As a naturopathic doctor with an additional prescribing qualification for hormonal therapies, I can prescribe low-dose vaginal estrogen and work with you to find the right approach for your body and your history.
Practical Steps You Can Take Now
Start a non-hormonal vaginal moisturizer used regularly 2 to 3 times per week. Good options include Rehydrate Ultra Moisturizing Vaginal Gel with Hyaluronic Acid or Gynatrof Vaginal Moisturizer
Use a vagina-friendly lubricant during sexual activity. Good Clean Love BioNude Ultra Sensitive Personal Lubricant is designed specifically for sensitive vaginal tissue
If dryness comes alongside urinary symptoms like incontinence or increased frequency, consider seeing a pelvic floor physiotherapist — they are an excellent and underutilized resource
If symptoms are persistent or affecting your quality of life, speak with a healthcare provider. Effective prescription options are available and earlier treatment tends to get better results
If you would like to explore what is driving your symptoms and discuss your treatment options, I offer virtual naturopathic care across Ontario. Book a free 15-minute introductory call to see if we are a good fit.
Dr. Kelly Clinning, ND
Dr. Kelly is a licensed naturopathic doctor practicing virtually across Ontario, with a focus on women's hormonal health — including perimenopause, menopause, premature ovarian insufficiency, pregnancy and fertility.