Vaginal dryness is estimated to affect about half of all women at some stage in their lives. Vaginal dryness is not just about painful sex; it can cause constant discomfort and may also increase the risk of infection.

The healthy vagina is a complex micro-environment where lactobacilli bacteria thrive, keeping the pH of the vagina acidic. The vagina will normally “perspire” to keep itself moist, it is particularly wet at mid-cycle, when cervical mucus combines with fluid from the Bartholin’s glands at the base of the cervix. This fluid contains a number of agents to keep the vagina healthy, including a natural antiseptic from the vulval skin glands. Should the bacteria-rich fluid dry up, the vagina’s acid balance is altered and its surface cells are destroyed in a “burn”, causing soreness.

Women who suffer this imbalance are also more prone to infections such a bacterial vaginosis - the common reasons for excessive vaginal discharge and thrush. Vaginal lubrication or the lack of it is closely linked to hormonal changes. The female hormone oestrogen is a water-retention vehicle which plumps up tissue. The depletion in oestrogen accompanies the menopause and can cause thinning of the vaginal walls. Childbirth and breast-feeding also trigger hormonal fluctuations which can result in vaginal dryness, as do some contraceptive pills, while sanitary tampons may aggravate the problem (Try not to use tampons for more than 4 days in a row and not at night). Just as hair and skin can suffer during or after an illness, vaginal lubrication may also be temporarily interrupted.

One of the commonest complaints about vaginal dryness relates to lack of sexual arousal, many men and women are ill-informed about the complexities of arousal - many couples rush into sexual intercourse after five minutes, but up to 20 mins of foreplay may be needed for women to lubricate properly. If a woman is not ready it can set up a vicious circle of anxiety, insufficient lubrication and painful intercourse. The problem is further complicated when anxiety or relationship problems make it difficult to relax. If you are tense or worried you will not lubricate, even if you think you want to make love.

What can be done?

Menopausal women may wish to consider treatment with oestrogen, such as Hormone Replacement Therapy (HRT), there are various types of pills or patches that can be used. Some give you a monthly period (unless you have had a hysterectomy) others can be used once you have been period free for a year, that don’t give you a period. HRT can lessen other side effects of the menopause, such as hot flushes and thinning of the bones. However, some ladies may want use hormones only in the vagina, rather than taking hormones that affect the whole body. For this there are vaginal creams (dienoestrol cream) or tiny pessaries with an applicator (vagifem), that can be used. These vaginal hormones should only be used for 6 months, then a non hormonal product used for 2 months before returning to the vagifem or dienoestrol.

Non- hormonal lubricants

KY jelly (this product can damage condoms) - some women find this traditional jelly off-putting, but there are a range of lubricants which imitate the consistency of vaginal mucus, which may be helpful. They work more like a “moisturising cream”. For example, Senselle or Replens. The non-hormonal products are available from over the counter at chemists. The hormonal products require a prescription, further advice about these products are available from your nurse practitioner, practice nurse or GP.