What Causes Vaginal Dryness

Vaginal Dryness and the Vaginal Flora

Dr. Jolene BrightenPublished: Last Reviewed: Gut-Hormone Connection, Perimenopause/ Menopause, Sexual Health Leave a Comment

Vaginal dryness is a women’s health symptom that often goes overlooked. Women may feel uncomfortable discussing dryness with their partner or provider and suffer in silence. Or they may believe vaginal dryness to be a normal part of being a woman or getting older. 

If you are experiencing vaginal dryness, you are not alone. It is widespread, affecting up to 20 percent of cycling women and up to 83 percent of women post-menopause.

The truth is that there are real, effective solutions to vaginal dryness. 

The first step is understanding what causes vaginal dryness and how it’s related to hormonal changes we experience through life. With this understanding, we can employ lifestyle and hormone-supportive therapies to support the root cause of vaginal dryness symptoms. 

Keep reading to learn more about vaginal dryness and supportive solutions, including the answers to these common questions: 

  • What causes vaginal dryness?
  • What does menopause have to do with vaginal dryness?
  • How do I address hormone balance to improve symptoms?
  • What role does the microbiome play in vaginal dryness and health? 
  • What are the benefits of probiotics for women? And what are the best probiotics for vaginal health?
  • Can vaginal dryness cause a urinary tract infection (UTI)?

Let’s get started! 

What Causes Vaginal Dryness?

The number one vaginal dryness cause is low estrogen levels. While I often discuss elevated estrogen in cases of estrogen dominance, driver of some endometriosis symptoms, and a culprit in PMS, today we will focus on the other side of the spectrum and what happens when estrogen levels are too low. 

Estrogen, the dominant hormone during the first half of the menstrual cycle, is not only responsible for your feminine curves and the building of the uterine lining but is critical for the health of the vagina. 

Estrogen helps to maintain the thickness and lubrication of the vaginal walls and maintain a strong tone in the vaginal muscles. In women who cycle, estrogen helps you make fertile cervical mucus prior to ovulation. It also helps keep the vaginal flora

balanced and the vagina at a healthy, acidic pH. 

When estrogen levels are low, the vaginal lining thins and loses lubrication and elasticity. Vaginal dryness and itching can increase, which affects sexual function and quality of life.  

The most common time that women experience low estrogen is in menopause. Without the cycling hormones of the menstrual cycle, estrogen levels settle at a new, much lower level than during the fertile years. 

Low estrogen may also be associated with:

  • The postpartum period
  • Perimenopause (the years leading up to menopause when hormones are fluctuating)
  • Estrogen-blocking medication
  • Chemotherapy 
  • Removal of the ovaries (oophorectomy)
  • Amenorrhea
vaginal dryness and hormonal imbalance

Menopause and Vaginal Dryness

Vaginal dryness is a symptom of a broader condition called vaginal atrophy—thinning of the vaginal walls—more recently referred to as the genitourinary syndrome of menopause (GSM). This term encompasses estrogen’s role throughout the entire genitourinary system (vulva, bladder, pelvic floor), and isn’t isolated to just the vagina

Symptoms of GSM may include:

  • Vaginal dryness and decreased lubrication
  • Burning, itching, and pain of the vulva or vagina
  • Painful sex
  • Tearing of the vulva or vaginal tissues
  • Increased bladder urgency and frequency
  • Incontinence 
  • Pelvic floor weakness
  • Prolapse of the vagina, bladder, or rectum
  • Increase in urinary and vaginal infections

Many women who experience vaginal dryness may also experience other uncomfortable symptoms that share a common root cause. 

Importance of Female Hormone Balance

The vaginal tissue is very sensitive to hormones. When you experience vaginal dryness, it may signify a hormonal imbalance, specifically lower estrogen. 

Since low estrogen is a primary cause of GSM symptoms, restoring a natural hormone balance helps alleviate symptoms. 

Let’s discuss how to balance hormones and vaginal dryness treatment approaches. 

How to Balance Hormones Naturally

At a foundational level, diet and lifestyle play a role. Eating enough whole food to meet your daily nutrient needs, managing stress, balancing blood sugar, and taking a multivitamin is important.

Because all hormonal systems are related, addressing any additional underlying imbalances, including thyroid and adrenal health, provide support to estrogen levels. (Read How to Balance Hormones Naturally for more information.)

In addition, many women will require targeted supplements to balance hormones, such as Balance – Women's Hormone Support. This formula combines key nutrients, antioxidants, and botanical extracts to support estrogen balance, metabolism, and detoxification. 

Estrogen and Phytoestrogen Therapy

An estrogen-containing vaginal cream for dryness is an effective solution in many cases. An estrogen cream, ideally using bioidentical or body-identical estrogen, is applied externally to the vulva or internally to the vagina. For most people, estrogen creams are quite safe and address vaginal dryness and other related GSM symptoms. 

Other hormonal options include bioidentical hormone replacement therapy taken internally for systemic or body-wide effects. Estrogen rings or suppositories may be inserted into the vagina for local effects. Estrogen use does require a prescription, so be sure to discuss options with your doctor.

Phytoestrogen supplements or topical preparations are popular natural remedies for vaginal dryness and offer another option. Phytoestrogens are natural estrogens found in certain plants like fennel, red clover, flax, and Pueraria mirifica that offer a gentle, non-pharmaceutical option. While natural, they still warrant a discussion with your provider before beginning.

Laser Therapy for Vaginal Dryness

Laser therapy is yet another option to address vaginal dryness and associated symptoms. In one study, six months of CO2 laser treatment produced similar results as vaginal estrogen, with no adverse effects and high satisfaction among participants. 

Another larger study showed similar results with laser therapy and a reduction of painful sex, vaginal pain, vaginal dryness, itching, and burning as well as an improvement in vaginal pH. 

@drjolenebrighten Reply to @teatessier be mindful about what goes down there #bodyliteracy #isthisnormal #casatiktok #lube #coconutoil #bestfriends #unboxing ♬ Forever – Labrinth

Vaginal Moisturizers and Lubricants

Vaginal moisturizers can provide relief for the day-to-day and can provide some support for vaginal dryness during sex. However, when engaging in intercourse, lubricants that are designed for this work best. Personal lubricants may be helpful and necessary for more pleasurable sex. Many vaginal moisturizers contain potentially harmful ingredients and fragrances, including endocrine disruptors, that absorb into the body and alter the delicate balance of the vagina. 

Be sure to choose body-similar products for moisturizing and lubrication. The use of coconut oil for vaginal dryness is popular but not compatible with condoms. For use with condoms, be sure to choose a water-based product. When it comes to navigating lube, it can feel a bit overwhelming, which is why I wrote a guide on what to look for in a lube.

And in case you need reminding, lube is for everyone and no one should ever feel shamed for using it. 

The Vaginal Microbiome

The vaginal microbiome includes all the bacteria and microorganisms living in the vagina and plays a critical role in fertility, reproduction, and vaginal health. The vaginal microbiome constantly adapts to the environment and body changes, including pregnancy, the menstrual cycle, sexual activity, age, use of contraceptives, diet, and other factors. 

The Lactobacillus species dominates the normal vaginal flora which help maintain the acidic pH of the vagina. Estrogen plays a crucial role in the health of the vaginal microbiome. Estrogen stimulates the epithelial cells that line the vaginal canal to produce glycogen, a food source for the Lactobacillus. Lactobacillus consume the glycogen, producing lactic acid critical for maintaining pH in the healthy range of 3.5 to 4.5. 

When estrogen levels drop, such as in menopause, there is a shift in vaginal flora. Without as much to feed the Lactobacillus, these bacteria decline, and the vagina becomes more alkaline. This shift increases the chances of infections such as bacterial vaginosis or urinary tract infections. 

The estrobolome refers to a subset of the gut microbiome and microbial chemistry involved in estrogen metabolism and detoxification. An estrobolome imbalance affects estrogen levels in the body and, therefore, the vaginal microbiome. 

For example, the estrobolome produces an enzyme called beta-glucuronidase that allows estrogen to reabsorb into the body instead of leaving the body via the gut. Beta-glucuronidase is easily measured via a stool test, providing insight into estrogen balance.

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How to Improve Vaginal Flora

Improving vaginal flora is an essential consideration for vaginal dryness and related symptoms. 

First, since the gut microbiome informs the vaginal microbiome (they are in proximity), it is critical to support gut health and the gut microbiome. For general support, consider eating fiber-rich plant foods and fermented foods to support beneficial bacteria. You can find these foods and more in my free meal plan for hormone balance. If you’re needing more personalized microbiome help, work with a functional medicine provider for gut testing and a targeted protocol.  

Third, consider adding a women-specific probiotic rich in Lactobacillus to support the gut and the vaginal microbiomes. 

Second, supporting balanced estrogen levels will also help improve vaginal flora and vaginal pH balance because it promotes Lactobacillus dominance. Interventions discussed above including supplements to balance estrogen, bioidentical estrogen replacement, and phytoestrogen creams are options. 

Benefits of Probiotics for Women

Probiotic supplements are safe and effective for balancing vaginal flora to decrease vaginal dryness and other symptoms of low estrogen.

Women’s Probiotic is a formula that supports a healthy vaginal microbiome. It is rich in Lactobacillus probiotic strains, antioxidants, and prebiotic fiber to feed beneficial organisms. This combination promotes a healthy acidic pH in the vagina. 

Probiotics for women can be taken orally to support the vaginal microbiome by way of the gut microbiome. They can also be used as vaginal probiotics by inserting the capsule vaginally for localized benefits. 

Can Vaginal Dryness Cause a UTI?

While vaginal dryness isn’t the cause of a urinary tract infection (UTI), both vaginal dryness and UTIs may share the same root cause: low estrogen. 

Urinary tract symptoms, including increased urgency, increased frequency, incontinence, and UTIs all fall under the umbrella of genitourinary syndrome of menopause. After cycles end, many women experience an increase in these symptoms. 

The conventional approach to UTIs is to treat them with antibiotics, which can damage the microbiome and encourage the conditions that promote chronic infections. 

Luckily, addressing the root causes of vaginal dryness by supporting estrogen balance and the vaginal microbiome, as discussed in this article, are also effective strategies for decreasing or eliminating UTIs and other urinary symptoms over the long-term. 

In Conclusion: Estrogen Balance and Probiotics

If you are experiencing vaginal dryness, chronic UTIs, or painful sex, consider the role of hormone balance and vaginal flora. Supporting estrogen and balancing the microbiome are my go-to strategies and Balance- Women’s Hormone Support and Women’s Probiotic are my most recommended supplements for these reasons. 

While vaginal dryness and related symptoms are more common for women in menopause, they can also happen at other times of life. Think of vaginal dryness as a message from the body and a clue to take a deeper look at hormonal health.

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.