Intimate Dryness After Menopause: What Actually Helps

It is one of the most common changes of midlife, and one of the least discussed. As oestrogen falls through perimenopause and after menopause, the skin of the vulva and vagina changes, just as the skin on the face does. It becomes thinner, drier and less elastic. For many women, this means discomfort day to day, and for some it means intimacy becomes painful.

Women rarely raise this, even with their doctors. We think that is a shame, because it is very treatable. This is our guide to what is happening and what helps.

What is happening

The tissues of the vulva and vagina are rich in oestrogen receptors. When oestrogen declines, those tissues become thinner and more fragile, produce less natural lubrication, and lose some of their elasticity. The medical term is genitourinary syndrome of menopause, sometimes still called vaginal atrophy.

Common signs include:

• dryness, itching or a burning sensation;
• discomfort when sitting, exercising or wearing certain fabrics;
• pain or discomfort during sex;
• needing to urinate more often, or more frequent urinary tract infections.

Unlike hot flushes, which usually settle with time, these changes tend to continue or progress without treatment. That is the most important reason not to simply put up with them.

See your GP: this is very treatable

We will say it first because it matters most. If you have these symptoms, speak to your GP. Vaginal oestrogen, in the form of a cream, pessary or tablet, is a highly effective treatment. It works locally, restoring the thickness and natural lubrication of the tissue. It uses a very low dose, and is a different decision from systemic menopause hormone therapy. Your doctor can talk you through whether it is right for you.

Any bleeding after menopause, new lumps, sores or persistent itching should always be checked.

Jean Hailes for Women's Health publishes clear, reliable information on this, and is a good place to read more before your appointment.

Three kinds of product, three different jobs

Alongside medical treatment, or for milder symptoms, over-the-counter products make a real difference. They are often confused, so it helps to know what each one is for.

Vaginal moisturisers

Designed to be used internally, regularly, a few times a week, regardless of sexual activity. They help the tissue hold water over time. Your pharmacist can recommend one.

Lubricants

Used at the time of intimacy to reduce friction and discomfort. They come in water-based, silicone-based and oil-based forms. Water-based and silicone-based lubricants are compatible with latex condoms. Oil-based products are not: oils weaken latex and can cause condoms to fail. If you use condoms, choose a water- or silicone-based lubricant.

External vulval oils and balms

For the outer skin of the vulva, which becomes dry and uncomfortable in its own right. These are about everyday comfort: the skin that rubs, chafes or feels tight. This is the category we stock.

The one we stock

San Margo Glorioso Botanical Intimate Oil is made in New Zealand for the external intimate area. It is a blend of plant oils, including apricot kernel, jojoba, rosehip, pomegranate seed, argan and sweet almond, with squalane, vitamin E and coenzyme Q10. It is fragrance-free and free of essential oils, which matters for skin this delicate.

How to use it: once or twice a day, massage a few drops into the external intimate area, including the outer and inner labia and the perineum. Patch test first on the inner arm. It is for external use and daily comfort.

Because it is oil-based, it is not compatible with latex condoms.

Everyday habits that help

• Wash with water only, or a very gentle, fragrance-free cleanser. Avoid soaps, bubble baths, scented washes and douches, all of which strip an already fragile area.
• Choose breathable cotton underwear and avoid tight synthetic fabrics where you can.
• Skip fragranced products, including scented pads, liners and laundry products, if you notice irritation.
• Stay sexually active, if you wish to. Regular arousal and activity, with or without a partner, supports blood flow to the tissue.
• Consider pelvic floor physiotherapy if you have pain, tightness or bladder changes. A women's health physiotherapist can help considerably.

The conversation worth having

Many women assume this is simply part of getting older and that nothing can be done. Neither is true. It is common, it is a normal consequence of hormonal change, and it responds well to treatment. If it is affecting your comfort or your relationships, it deserves the same attention you would give any other change in your health.

For more on the wider changes of this stage, read our guide to perimenopause, skin and supplements.