Menopause can reduce the body’s production of the hormone oestrogen. Oestrogen is important for maintaining the moisture and elasticity (stretch) of the vagina.
When oestrogen levels are lower, vaginal dryness and loss of vaginal elasticity can make sexual intercourse uncomfortable or painful. Unlike hot flushes, vaginal dryness does not improve with time and may be a long-term problem unless treated.
What to do about vaginal dryness?
The most effective solution for vaginal dryness is to use a product that will add moisture to the vaginal tissue. There are three types of vaginal moisturisers. All are applied directly into the vagina.
Non-hormonal vaginal moisturisers
Non-hormonal vaginal moisturisers provide relief from the uncomfortable symptoms of vaginal dryness. These products come in a semi- liquid form and are usually applied twice a week. They are available from most pharmacies.
Vaginal gels and lubricants
Vaginal pH-balanced gels are used to prevent and treat vaginal dryness. With a pH similar to that of normal vaginal discharge, these gels have been found to improve vaginal dryness and vaginal pH in women after breast cancer.
Vaginal lubricants provide lubrication to enhance the comfort and ease of sexual intercourse. If you use a vaginal lubricant choose a water-based or silicon-based lubricant rather than oil-based lubricants which may increase the risk of getting yeast infections. These products come as ‘semi-gel’ creams and are available from pharmacies.
Applying a gel containing a local anaesthetic to the area around the vulva immediately before sexual intercourse may reduce pain and discomfort associated with penetration.
Vaginal oestrogens are creams, rings or tablets containing low doses of the hormone oestrogen that are inserted directly in the vagina. They are designed to help reduce symptoms associated with vaginal dryness and discomfort with sexual activity.
Small amounts of vaginal oestrogen may be absorbed into the body. For women taking aromatase inhibitors this may result in measurable increases in circulating oestrogens. The clinical significance of systemic absorption is uncertain, and for this reason some oncologists advise that some women avoid vaginal oestrogens after breast cancer. It has not been shown that vaginal oestrogens increase the risk of breast cancer recurrence or spread. Vaginal oestrogens should only be prescribed by a medical practitioner who is aware of your history of breast cancer and use of vaginal oestrogens should be discussed with your treatment team.
We don’t yet know whether vaginal oestrogens are safe after breast cancer. It is important to talk to your oncologist or general practitioner about your options.
Other ways of managing vulvovaginal dryness
- Avoid substances that can irritate or dry the vaginal region, such as soap, or products containing alcohol or perfume. Products containing petroleum jelly and baby oil can also cause irritation. Use a soap-free product to wash the vaginal area.
- Wear cotton underwear and avoid nylon underwear, tight underwear, or tight clothing.
- If you’re sexually active, discuss your concerns with your partner. If your partner is aware of how you feel, they are more likely to help you explore alternatives.
- Simple strategies, such as changing the position for intercourse, can relieve discomfort. Pain during sex can make you tense, and that tension can cause more pain. Try exploring alternative ways to be intimate so you and your partner can maintain a pleasurable and satisfying sexual relationship.