VAGINAL DRYNESS: WHAT IT MEANS & HOW TO MANAGE IT

Guest Written by Domina Franco, a sex educator, coach, and writer who has been studying Human Sexuality for over 20 years and holds a Masters degree in Human Sexuality from Widener University. Domina has guest lectured on BDSM/kink, sexual health, consent and body autonomy at institutions such as New York, Johns Hopkins, Kansas State, Rutgers, Widener and Kean Universities. She has been featured in publications such as Refinery29, Playboy, Yahoo News, Medium, NY Magazine, Esquire, Bustle, and Paper Magazines amongst others.

Not everyone can say they have been blessed with a Cardi B/Megan Thee Stallion level W.A.P. There might be a multitude of reasons why your vulva/vaginal canal isn’t a drenched crevice ready for sexual spelunking. Many people think as long as someone is sexually excited, they will “get wet” or in more technical terms that the vaginal canal will lubricate itself…and while that is true for a lot of folks- it’s not true for everyone. Lube is the answer, right? Well yes and also maybe no…. but more on lube later.

The work around shame and not taking that on is sometimes far more challenging than the condition itself.

First let’s talk about the possible medical reasons why things might feel tender…. vaginal dryness tends to occur when there is a significant drop in levels of estrogen which is the hormone that helps maintain levels of vaginal lubrication, tissue elasticity and acidity. Vaginal dryness can occur for several reasons due to medical conditions or as a part of the process of perimenopause or menopause. The “love hormone”, oxytocin, flooding one’s system when they birth a child can give you all those warm and fuzzies but estrogen can also drop during this time if you are chest feeding. Estrogen also drops if someone has surgical removal of their ovaries or if they are receiving radiation or chemotherapy for cancer treatment. There are also some medications which effect estrogen levels and immune disorders, anxiety and depression have also been known to sap a vulva/vagina dry.

Vaginal dryness can further be classified as either simple or complex. The simple version suggests that the vagina and neurovascular of the person’s body are healthy and functional and that simply resolving the dryness resolves the problem itself. Complex vaginal dryness is indicated as having multiple factors and these additional considerations often interfere with therapeutic attempts to solve the dryness. Complex issues can be conditions such as diabetes, hypertension, vaginal atrophy or certain pelvic floor dysfunctions or inflexible pelvic floor muscles.

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If you are experiencing dryness and possibly pain during sex due to it- the first thing to do is to consult your medical provider. There are a variety of oral, topical and vaginal treatment options to help relieve symptoms.

One option is vaginal estrogen which is a topical treatment that helps with the thickness and elasticity of the vulva and vagina. Estrogen can be formulated in different ways to deliver it to the vagina and vulva - without the slight risks that come with taking systemic estrogen. There are creams, vaginal tablets and the vaginal ring. All of these treatments can be highly effective, and you should choose based on your personal preference and lifestyle.

There are also oral tablets. Ospemifene is a selective estrogen receptor modulator (SERM), meaning that it is not estrogen, but acts on estrogen receptors, causing an estrogen effect. A DHEA tablet is a vaginal tablet taken nightly for pain with sex which often happens as the body changes during perimenopause or menopause and dryness becomes more of an issue. Stopping these medications will cause the symptoms to return, so unfortunately the medications need to be continued to keep the symptoms from returning. You should always discuss all your medications with your medical provider to determine what your best options are. This is especially true if you are a breast cancer survivor as some of the options have not been studied with people who have had breast cancer.

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Other non-medication based options to address dryness include vaginal stimulation, which can help keep these delicate tissues healthy by increasing blood flow. Over-the-counter options include vaginal moisturizers that help with vaginal and vulvar dryness, and some lubricants that can be used during sexual intercourse or masturbation.

Now what if none of the above applies to you but you still find yourself less than lush in your proverbial lowlands? The thing is vaginal dryness can be a lot more than simply medical. It’s not only estrogen that’s either making you all “slip and slide” vs “Sahara camel ride”. Your brain and your mood, even the soap you use, can also be reasons why things are less than dewy.

Certain irritants like perfumed soaps or detergents and even smoking can be tied to uncomfortable vaginal dryness. Never a better time to go fragrance free at the laundromat and put down that pack of cigarettes! I don’t think it goes amiss to remind dear readers that the vagina is a self-cleaning machine…. douching is not only unnecessary it can be detrimental, throwing off your Ph balance and cause irritation and dryness. Vaginas were not meant to smell like lavender. If they were….well, they would be lavender…or cottony-fresh towels or some other such nonsense smell other than the natural, healthy aroma of a healthy vulva/vagina.

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When talking about vaginal dryness I think it’s also really important to bring up arousal non-concordance which plainly put means you can mentally be ready for sex and even want it, but physically, you’re not becoming lubricated and blood flow hasn’t increased in the genitals. Societal expectations and trauma have a lot to answer for here where culturally we tend to assume that wet equals aroused, both physically and mentally. Of course, when that doesn’t go to plan as we imagine folks often assume something is wrong…. namely that either they’re not interested in sex right now, or worse, they’re not interested in their partner(s) and something is wrong in their relationship. Emily Nagoski’s book Come As You Are talks in depth about arousal non-concordance, the reasons behind it, and how to manage it if you are experiencing it.

And here is where we deep dive, headfirst, into the conversation around lube. Lube is your friend. It is not shameful to need lubricant even if you do naturally find yourself getting wet. Sometimes it’s best to be as slippery as possible. This is especially true if your partner is well endowed and/or you’ve enjoyed playing with the insertion of larger toys. Slow Sex Finger Play Gel by Bijoux Indiscrets, Simply Aqua or Aqua Sensitive by Wicked and Med Repair Glide by Pjur are great places to start. This is not the place to be sparing. Use the lube on your fingers, on all toys, on the vulva itself. Buy yourself multiple bottles of lube. You might find you prefer the smell or taste of certain brands over others. There are also CBD lubes which have been shown to be effective in offsetting some pain people experience during sex when facing chronic vaginal dryness. Some folks also find it useful to insert some lube directly into the vaginal canal with what are called “lube launchers” before they even begin to play. Lube launchers are simply thin body safe plastic applicators with a plunger so you can get that slippery stuff further up inside the body where it is needed most in these cases.

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A self-care tip around vaginal dryness is to ensure you wear comfortable underwear made of natural fibers that allow your skin to breathe. Some nutritionists and other medical professionals even suggest eating foods with phytoestrogens which is typically found in things like soymilk, tofu, nuts and seeds. Most important of all is to be gentle with yourself and to allow yourself time and space to process and try out different approaches to this challenge. If all of the self-help measures aren’t effective, symptoms become more severe, or are interfering with normal activities or it effects your lifestyle, sex life and relationships it might be time to go back and consult with your medical professionals again. The work around shame and not taking that on is sometimes far more challenging than the condition itself. There is no need to rush anything, don’t rush solo or partnered sex and make sure to prioritize yourself first and foremost. You’re worth the gentle self-compassion as you navigate possible solutions to this not uncommon condition.

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Further Readings:

Beyond the Basics of Vaginal Dryness: Up to Date
The Impact of Endometriosis & Why It's Hard to Diagnose: Medical News Today
Life After Menopause-- Living with Vaginal Dryness: Mass General

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