Understanding Vaginal Itching and Dryness: Causes, Symptoms, and Effective Treatments

Many women feel uncomfortable discussing vaginal dryness and itching, but it's important to address these common concerns. What exactly does vaginal dryness feel like? What leads to this condition? And most importantly, how can it be treated?

Approximately 15% of women have symptoms of vaginal dryness before menopause, and this number jumps to around 57% after menopause. Yet, almost 70% of women with these symptoms neither talk to their doctor about it nor seek treatment.⁽¹⁾⁽²⁾

Even when dryness and itching are hard to ignore, it can be difficult for some women to seek help from their healthcare provider due to embarrassment. But it’s important to have the conversation and put an end to the unnecessary pain and discomfort.

What causes vaginal dryness and itching?

During menopause, the decline in hormones estrogen, progesterone, and testosterone can lead to significant changes in the vagina and vulva, including discomfort and pain during sex. As these hormone levels drop, the vaginal lining becomes thinner and less elastic, and the glands produce less lubrication, leading to inflammation of the vaginal walls. This condition is known as vaginal atrophy, or genitourinary syndrome of menopause (GSM).⁽³⁾⁽⁴⁾

Vaginal atrophy can cause discomfort not only during sex but also in everyday activities like sitting, standing, exercising, and urinating. While this symptom can occur at any age, it’s most common during menopause due to the drop in hormone levels.⁽²⁾⁽⁵⁾

Other factors that can also contribute to dryness include the following:⁽⁵⁾

• Yeast infections

• Hormonal contraceptives

• Urinary tract infections (UTIs)

• Sexually transmitted diseases (STDs)

• Skin irritation from waxing or shaving

• Medications

Emotional stress and anxiety can also play a role because insufficient blood flow to the vaginal area during anxious states can lead to decreased lubrication.⁽⁶⁾⁽⁷⁾

While hot flashes may subside as menopause progresses, vaginal atrophy tends to worsen, yet many women don’t know it’s treatable. It’s crucial to address these symptoms early, as they can impact not only physical comfort but also sexual health and overall quality of life.

What are the symptoms of vaginal dryness?

These are the common symptoms associated with vaginal dryness and atrophy:⁽⁵⁾⁽⁸⁾

• Thinning, dryness, and reduced elasticity of vaginal tissues

• Decreased lubrication during intercourse

• Burning, itching, or stinging sensations in and around the vagina

• Soreness in the vaginal area

• Frequent urinary tract infections

• Increased urgency and frequency of urination

• Urinary incontinence

• Pain or burning during urination (dysuria)

• Low libido

• Vaginal pain or bleeding during sexual intercourse

• Higher frequency of vaginal infections

How is vaginal dryness diagnosed?

Healthcare providers can often diagnose vaginal dryness based on a woman’s medical history and symptoms. To find the cause, the doctor may ask about symptoms and any medications.

During a pelvic exam, a doctor can evaluate if the vaginal tissue is thin and dry due to decreased estrogen. In some cases, they may also use a blood test to check hormone levels or rule out other medical conditions that could contribute to dryness.⁽²⁾

Treatments for Vaginal Itching and Dryness

Prescription Options

The most common and effective way to treat vaginal dryness is to replenish estrogen levels using topical creams, patches, or oral medications. 

Topical estrogen cream, applied directly to the vaginal area, acts as a moisturizer and helps restore healthy tissue. Estrogen creams work locally to alleviate symptoms of dryness. Some women experience improvements in as little as a few weeks and full relief within several months. Vaginal estrogen cream is an effective and safe treatment used two to three nights a week. With topical treatment, because estrogen is applied locally, it can be used at a lower dose than when taken orally or through a patch. If topical treatments are ineffective, estrogen patches or pills can be added. Oral estrogen can address both vaginal dryness and other menopausal symptoms like hot flashes.^(2)(3)(5)

DHEA is another prescription option that can help alleviate pain during intercourse caused by vaginal atrophy. In the body, DHEA is converted into testosterone, and supplementing with it may increase testosterone levels in women, potentially slowing the signs of aging, promoting vaginal health, and enhancing sexual arousal.⁽²⁾

Alternative Treatments for Vaginal Dryness

If estrogen creams or prescriptions are not an option, there are alternative ways to help treat vaginal dryness:^{(1)(2)(3)(5)(8)(9)}

• OTC Lubricants: Vaginal-specific, hydrating lubricants or moisturizers can reduce dryness and discomfort while maintaining pH balance.

• Regular Sex: Sex helps maintain vaginal elasticity and prevents narrowing and muscle tightening, especially with proper lubrication.

• Better Blood Flow: Regular sex and pelvic floor exercises improve blood flow, reducing the risk of vaginal injury and promoting elasticity.

• Vitamins: Vitamins A, B, D, and E, along with calcium, can support overall vaginal health. Multivitamins are a good option to promote vaginal health, especially during menopause.

• A Balanced Diet: Fatty acids (such as those found in fish and seeds) and isoflavones (found in soybeans and chickpeas) promote lubrication and regulate estrogen levels.

• Hydration: Drinking plenty of water is important to prevent dehydration, which contributes to vaginal dryness and irritation.

• Adequate Sleep: Sleep improves overall health and helps prevent vaginal irritation.

• Fragrance-Free Products: Avoiding douching and products with perfumes or artificial colors can prevent irritation and contact dermatitis.

• Prompt Treatment of Infection: It’s best to consult a doctor for yeast infections, bacterial vaginosis, and persistent issues like STDs, eczema, or psoriasis.

• Regular Exercise: Pelvic floor exercises strengthen vaginal muscles and help alleviate discomfort.

Herbal Treatments and Supplements for Vaginal Dryness

Many women use herbal supplements to manage their menopause symptoms. While these supplements are widely available, it’s important not to use them without first discussing them thoroughly with a physician.⁽²⁾

Botanicals and herbs may have side effects, lack proper oversight, or change how other medications, supplements, and vitamins work. If herbal treatments are the therapy of choice, it's recommended to make a treatment plan with guidance from a medical professional. 

HRT for Vaginal Dryness During Menopause

Hormone replacement therapy (HRT) is highly effective in treating vaginal dryness associated with menopause. It can prevent and alleviate vaginal symptoms, with topical estrogen creams being the most commonly used treatment.⁽¹⁾⁽⁵⁾

Estrogen replacement can also help reduce bladder problems, infections, and other urogenital symptoms, which in turn limits vaginal irritation. Estrogen creams have been shown to relieve symptoms, reduce urinary tract infections and incontinence, and improve the quality of life for many women.⁽³⁾⁽⁵⁾

Final Thoughts on Easing Vaginal Discomfort 

Vaginal dryness and itching can be uncomfortable, but they are both common and treatable. Rather than suffering in silence, it's important for women to seek help and explore options like hormone replacement therapy, lubricants, and lifestyle changes. By addressing these symptoms early, women can restore their comfort, confidence, and quality of life.