There's pretty much no topic off limits in my clinic, and believe it or not, vaginal dryness is a common topic I discuss with my patients. Women of all ages complain of it, and for lots of different reasons. There's no one-size-fits-all treatment that works, but luckily, some basic understanding of your hormones and how they effect the body usually helps to get to the bottom of why you're experiencing this discomfort.
Normal changes throughout the cycle
If you get a regular period, it's common for cervical fluids to be more copious in the days leading up to ovulation, as levels of estrogen rise and peak. For a 28 day cycle ovulation is usually estimated at around cycle day 14 (if you start counting day 1 on the first day of the period.) That means roughly cycle day 7-15 are usually when the vagina is at it's most lubricated. All other days of the month can feel more dry in comparison.
Especially in the pre-menstrual phase, which is about cycle day 21-28, or in the 24 hours prior to bleeding when your estrogen dips, you may feel the most dryness you experience all cycle long. Some women even get some minor itchiness and/or discharge during this phase due to the sudden change in hormones.
It's normal to feel somewhat dry in comparison to the pre-ovulatory phase. Some women experience these ups and downs in vaginal dryness and interpret them as that's physically wrong with them, when in fact they are simply normal fluctuations in the fluids the cervix produces in response to hormones.
As I mentioned above, estrogen is responsible for signaling the cervix to produce lubricating fluids in the days leading up to ovulation. Typically our estrogen levels are high enough to keep the vagina somewhat moist all cycle long, but with age, certain medications, or conditions, low estrogen may be to blame for an unusually dry vaginal environment.
It's common for menopause to signal huge changes in estrogen levels. These sudden shifts can cause not just vaginal dryness but also lack of ovulation/menstruation, hot flashes, skin dryness, mental fog, mood swings, and/or irritability.
Menopause typically occurs sometime in the late 40s to mid-50s. It's fairly rare, but sometimes women can undergo menopause at an early age.
Some women use Hormone Replacement Therapy to lessen the symptoms of hormonal imbalance caused by menopause, but it only postpones the side effects and it can't be used long-term. Often, I see women use HRT for a while, only to have to deal with these symptoms again a few years later when they have to discontinue the hormonal medications.
The thing is, menopause is a transition, the body is trying to change how it functions. Taking exogenous hormones only serves to trick the body into thinking it hasn't undergone the transition yet and delays dealing with it. Herbal medicine and acupuncture work well to help menopausal and peri-menopausal women during their transition, reducing annoying symptoms and speeding up the process so your endocrine spends less time regulating.
Other causes of hormonal imbalances
Symptoms that are related to menopause, such as vaginal dryness or hot flashes, can occur in women of all ages without indicating they are menopausal. It's caused by a lack of estrogen in the system, but doesn't necessarily indicate anything about ovarian function or fertility.
Women taking hormonal medications, such as birth control or fertility medications, may experience hormonal imbalance symptoms. Some hormonal medications, such as those used in IVF or for endometriosis, can down regulate the hormones in your body from your brain down to your ovaries, resulting in lower estrogen everywhere.
Ironically, even medications that add estrogen to the system, such as birth control pills, can cause estrogen deficiency symptoms for the simple reason that they body can metabolize exogenous hormones very quickly and clear them out of the body. This causes both hormonal highs and lows, thus signs of excess and deficiency. The same is true of pregnancy. Although hormone levels tend to rise throughout pregnancy, they can come on in waves and then cause dips as well. In fact, vaginal dryness is a common side effect of pregnancy.
Do not discontinue any hormonal medication without first consulting your doctor or healthcare physician. Some side effects are worth dealing with if taking the medication is truly necessary. But it's helpful for patients to have all the information they need to make informed decisions about their healthcare, which includes understanding if your vaginal dryness may be caused by something you're taking.
In Chinese medicine estrogen is considered to be very Yin in nature, especially because some of the main attributes of Yin is it's cool in nature and represents the fluids in the body. Estrogen levels are well known to have a direct correlation to the moisture levels of the body as well as temperature regulation. This is why lack of estrogen leaves most women feeling dry and hot.
If you already tend towards feeling warm, hot flashes/night sweats, high energy/metabolism, hyperthyroidism, insomnia, anxiety, heart palpitations, frequent urination, and/or dry skin, or if you routinely have a high intake of caffeine, alcohol, cigarettes, and/or spicy foods, then you may be prone to Yin deficiency already and thus are more prone to signs of Yin deficiency. It's also common to notice Yin deficiency symptoms increase with stress, poor diet, or age.
It's helpful for Yin deficient patients to focus on nourishing their Yin in as many different ways as they can. This can include eating a healthy diet (very little/no processed food, sugar, alcohol, caffeine, or spicy foods), getting plenty of sleep, incorporating calming practices like meditation or restorative yoga, and I've had great success treating Yin deficiency with acupuncture and herbal medicine.
Lack of Arousal
Whenever I ask my patients about vaginal dryness, I'm always sure to ask about their arousal levels, especially if sex/penetration is when the dryness is primarily noticed. If you aren't feeling very sexually aroused then it can be quite common for the vagina to feel dry, even sometimes with lube. Many women feel as if something must be wrong with them physically, when in reality it's more of a mental and emotional issue.
In some cases this could be caused by sexual trauma, depression or anxiety, emotional or relationship issues, or sometimes age and/or hormonal imbalances can result in lack of libido. It's normal for libido to decline with age, or to ebb and flow based on certain factors, but many women in their 30s and 40s complain of little to no desire for sex, and that's not normal if you previously had a healthy libido.
Acupuncture, herbs, and lifestyle changes (such as clean diet, exercise, and reducing exposure to toxins) may all help to improve libido, but none of these methods will necessarily change an underlying emotional or relationship issue.
If you feel your libido is abnormally low and you want to work on it, I usually recommend treating it physically, mentally, and emotionally, as they can all help to feed the libido energy. Supporting the Kidney system in Chinese medicine via herbs and acupuncture can improve the physical systems that effect libido, therapy (possibly couples therapy) can help understand feelings that may be underlying the lack of desire, and getting creative with your sexuality via masturbation and erotic mental stimulation can help to exercise your libido muscles and get in touch with what turns you on. Yes, hormones definitely play a role in vaginal dryness, but being in touch with your reproductive system, sexuality, and pleasure also factors in bigtime.
Anything Else Going On?
There are a few other medications besides the hormonal meds discussed above which may cause vaginal dryness as a side effect. These include, but are not limited to, sedatives such as Xanax or Ativan, some over the counter cold and allergy medications, calcium channel blockers, and beta blockers. Also, if you've recently given birth and/or you're breastfeeding, that may contribute to vaginal dryness but it should normalize on its own.
Dryness can sometimes be hard to figure out because there may be other symptoms obscuring it. For example, pain with sex could be from dryness, or it could be caused by a lot of other reasons. Some women experience pain during intercourse for multiple reasons.
Also, itching may happen as a result of dryness, in some cases long-standing dryness can change the pH of the vagina and lead to a yeast infection. Yeast infections usually cause discharge, sometime a foul smell, and may make the itching even worse. If you are dealing with simple itching from dryness then a bit of coconut oil my help to soothe, but if you're dealing with a yeast infection you may need further treatment.
If you notice any strange symptoms that seem like more than just vaginal dryness, then go see your doctor right away. These symptoms could include, but aren't limited to, vaginal discharge, foul smell, painful urination, intense pain, or fever.