Dry down there?

Our gynaecologist answers your questions about vaginal dryness so you don’t have to suffer in silence

Even the most healthy, satisfying sex life can be knocked off course by vaginal dryness, whether it’s temporary or long-lasting. Lack of lubrication – and the itching, burning, irritation and painful intercourse that often follow – can happen for a variety of reasons and at various life stages.

It’s a particular problem after menopause, but breastfeeding, chemotherapy and radiation can each result in cellular damage and low oestrogen levels, which in turn sabotage the ability of vaginal tissue to stay lubricated and elastic. And some medications (antihistamines and decongestants, for example) can have a negative impact as well.

Too many women, though, suffer silently, not realising that this is a highly fixable issue. And doctors often don’t broach the topic or aren’t familiar with treatment options. So to help you, here are answers to some common questions.

My doctor suggested I try a vaginal lubricant. Which one is best?

Silicone lubricants are more slippery and last much longer than water-based ones (so you don’t need to use as much) and don’t irritate the area. While water-based lubricants are less expensive, many are gloopy and sticky, and they may contain a propylene glycol preservative, which can be irritating. Apply the lubricant on your partner and on the opening of your vagina before intercourse.

What are vaginal moisturisers, and how are they different?

Lubricants don’t alter vaginal tissues; they just make them more slippery. A long-acting over-the- counter moisturiser, on the other hand, increases the water content of the cells, making vaginal tissues thicker, more elastic, and better able to produce lubrication. They need to be used two to five times a week and should be inserted in the vagina and applied around the vaginal opening.

Two with proven clinical results: polycarbophil gel (Replens Long-lasting Vaginal Moisturiser) and hyaluronic acid vaginal gel (Vagisil ProHydrate Plus).

What are the options if I need more help?

Sometimes a woman’s vaginal walls are so thin and dry that a prescription med is needed. One option: local vaginal oestrogens. Before you think, ‘Oh, no, oestrogens! Breast cancer, blood clots, bad stuff…’, know that there are no proven safety issues with these products.

There are three types to choose from: vaginal creams (inserted and spread on outer areas); vaginal tablets (inserted twice weekly); and vaginal rings (which can last up to three months).

Are there treatments for women who want to avoid oestrogen?

There are several options available. One is a prescription pill, taken orally, that activates oestrogen receptors in vaginal tissue to alleviate painful intercourse in post-menopausal women.

And some clinics now offer CO2 vaginal laser treatments to stimulate and regenerate vaginal and vulvar cells. These treatments should be performed only by a gynaecologist, not by a plastic surgeon or dermatologist and you’ll need a referral from your GP.