Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Symptoms of vaginal dryness include itching and stinging around the vaginal opening and in the lower third of the vagina. Vaginal dryness also makes intercourse uncomfortable.

A thin layer of moisture always coats your vaginal walls. Hormonal changes during your menstrual cycle and as you age affect the amount and consistency of this moisture.

Most vaginal lubrication consists of clear fluid that seeps through the walls of the blood vessels encircling the vagina. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But the hormonal changes of menopause, childbirth and breast-feeding may disrupt this process.

Symptoms

Signs and symptoms of vaginal dryness include:

• Dryness
• Itching
• Burning
• Pain or light bleeding with sex
• Urinary frequency or urgency

As many as four in 10 women who have reached menopause experience signs and symptoms related to vaginal dryness.

Causes

A variety of conditions can cause vaginal dryness. Determining the cause is key to helping you find an appropriate solution. Potential causes include:

Decreased estrogen levels:
Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining.

Estrogen levels can fall for a number of reasons

• Menopause or perimenopause
• Childbirth
• Breast-feeding
• Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
• Surgical removal of your ovaries
• Immune disorders
• Cigarette smoking

Medications

Allergy and cold medications, as well as some antidepressants, can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Sjogren's syndrome: In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.

Douching: The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.

Diagnosis

• Medical history.
• Pelvic examination.
• Pap smear.
• Urine examination.

Treatment

• Vaginal estrogen therapy: It is the most effective way of treating vaginal dryness.
• Vaginal estrogens are available in several forms:
• Vaginal estrogen cream: The cream is applied directly with an applicator.
• Vaginal estrogen ring: A soft, flexible ring is inserted into the upper part of the vagina. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.
• Vaginal estrogen tablets: In this the vaginal tablets are inserted using an applicator.
• Use a lubricant or moisturizer. If vaginal dryness makes sexual intercourse
• Avoid certain products. Avoid using the following products to treat vaginal dryness, because they may irritate your vagina:

                 - Vinegar, yogurt or other douches.
                 - Hand lotions.
                 - Soaps.
                 - Bubble baths.