Dr Morton's - vaginal dryness
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Vaginal Dryness

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Vaginal dryness most commonly affects women who have been through the menopause. It happens because of oestrogen deficiency, and can make sex unbearably sore. There are treatments available, so don't put up with it!

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Changes to the vagina and vulva after menopause

Oestrogen deficiency causes vaginal dryness

Oestrogen is a female hormone that keeps your vaginal tissues plump and pink. After the menopause, your oestrogen levels fall. This causes the vaginal blood supply and natural lubrication to reduce. The vagina then becomes thin, fragile and dry. The medical term for this is 'vaginal atrophy'. It is easily treated with oestrogen cream. This is not HRT.

Vaginal dryness before the menopause

Vaginal dryness doesn't just happen after the menopause – it can affect women of any age, and can happen for many different reasons.

The most common causes of vaginal dryness in younger women include breastfeeding, childbirth, low libido (arousal levels), and some medications, including contraception and some cancer treatments. A doctor would be able to advise you on the appropriate course of treatment for you.

What is dyspareunia and why does vaginal dryness cause it?

The word 'dyspareunia' simply means painful sex. It is usually divided into two categories: pain at the entrance of the vagina (superficial dyspareunia) and pain deep inside the vagina or lower abdomen (deep dyspareunia). Alternatively, painful sex can be caused by vaginitis.

Superficial Dyspareunia
  • Superficial pain in menopausal women is most commonly caused by the lack of oestrogen. For women who have gone through 'the change' (menopause), unless they are taking Hormone Replacement Therapy (HRT), they will be oestrogen deficient. This can be treated with oestrogen cream. It may be caused by a small split at six o'clock in the vagina. This can require a small operation.
Deep dyspareunia
  • Deep vaginal pain happens usually because your partner is pushing against something in the pelvis that shouldn't be there. For example, this could be infection, or endometriosis, or an ovarian cyst. If you are experiencing deep pain during intercourse, you can talk to one of our gynaecologists to discuss whether it could be anything that needs further investigation.
  • The term vaginitis is a general term meaning inflammation in the vagina. It could be due to infection such as thrush (which usually causes cottage cheese-like discharge and itching or burning), bacterial vaginosis (which usually causes a mucous discharge) or simply thinning and rawness due to oestrogen deficiency (atrophic vaginitis).

If you are suffering from any of these conditions and need to speak to a doctor, our GPs are on hand to take your calls.

When should I contact a doctor?

You should definitely speak to a doctor if you are having pain during sex. It might be easily remedied by a simple treatment, or it might require examination and investigation. Let our doctors help solve the problem before it becomes an issue in your relationship.

How do I find out why sex is painful?

Very often, a doctor can work out the cause just by asking you some simple questions.

If sex is causing 'deep' pain in the abdomen or pelvis, you may additionally need a physical examination and an ultrasound scan. Sometimes an operation called a laparoscopy is required, during which a telescope is inserted into the abdomen under a general anaesthetic.

Treatment of painful sex after the menopause

If the reason for your pain and vaginal dryness is oestrogen deficiency, using a lubricant may help, but using oestrogen cream is the best option. It takes up to three months of using the cream for a new healthy layer of tissue to grow, so be patient. And don't worry, this is not 'HRT', and can be used safely even if you have had breast cancer in the past.

If it is not better by three months, it might be worth speaking to a doctor in case there is some other skin condition or a problem with the ovaries.

Bleeding after sex

Bleeding after sex is important at any age. In young, premenopausal women it can be due to the cervix having a fragile outer surface ('an ectropion'), but this is never the explanation in a postmenopausal woman. It could be a polyp coming from the canal of the cervix, or it could simply be due to the vagina being thin and fragile. However cervical cancer also causes bleeding after sex, so if you experience it, you absolutely must tell your doctor.

If you are at all worried and would like some advice from an expert, our gynaecologists would be delighted to help.

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This page was last updated on 13/12/2016.