Is This Easily Treatable Condition Hindering Your Sex Life?

Our sexual health writer reveals how to remedy it pronto!

By
Published April 24, 2025
illustration of woman holding a blanket of dry land and cacti
Kiersten Essenpreis

Vaginal Dryness. Up to 70 percent of older women have it. At best, 20 to 30 percent of health care professionals bring up the topic. It is more likely that a woman will talk about painful sex with her manicurist than her family doctor. Sometimes it’s because of embarrassment. But studies have shown that most women don’t bother to mention it because they assume it’s just an inevitable part of aging with no safe and effective solutions.

But as a menopause professional who has treated thousands of women, I can promise you that vaginal dryness and sexual pain are two of the most easily treatable medical conditions that exist.

The medical term for vaginal and vulvar dryness due to low or no estrogen is genitourinary syndrome of menopause, also known as GSM. Basically, your vagina dries up, your labia shrink and your vaginal walls lose their elasticity, causing pain with sexual activity. There are also non-sexual symptoms such as vulvar itching, burning and irritation.

But that’s not all. Changes in the urinary tract from GSM can be responsible for bladder symptoms such as urinary urgency (that constant “gotta go” feeling) and recurrent urinary tract infections. And unlike hot flashes, which almost always eventually go away, if untreated, vaginal dryness will get worse … much worse … over time.

Many women assume this is a DIY project and head to their kitchen or bathroom to see what they have on hand to make things slippery. Vaseline and baby oil seem like a good idea, but not the best strategy. Anything with oil can break down condoms, an obvious disaster if STI protection is a concern. There may also be an increased risk of vaginal infections. Ditto coconut oil, almond oil or vegetable oil. So, it's okay in a pinch, but not for regular use. As a general rule, if you use it for making lunch, don’t use it for making love.

If you have persistent vulvar burning, irritation, dryness and sandpaper sex it’s time to brave the drugstore or Amazon aisles for a lubricant or moisturizer. But you need to know before you go that vaginal moisturizers and lubricants are not the same thing.

Over-the-counter long-lasting vaginal moisturizers are intended to be used on a regular basis in anticipation of sexual activity. Moisturizers hydrate and thicken vaginal tissue with the goal of restoring natural lubrication. Regular use of a vaginal moisturizers may also help with non-sexual symptoms like burning, irritation and dryness.

Lubricants, on the other hand, are short acting, and are intended to be used at the time of penetrative sex. Lubricants do not change tissue, and they will not help non-sexual symptoms. The job of a lubricant, and the only job of a lubricant, is to make things more slippery.

All lubricants are not the same and some are way more vagina friendly than others. Popular water-based lubes often have additives and preservatives which cause irritation, tissue breakdown and dehydration. The wrong lubricant can dry out your tissues more! Your best bet is to use a silicone lubricant that is non-irritating, long lasting and super slippery.

And a good lubricant will often work. But, for a lot of women, even a bucket of super slippery, silicone based, expensive lubricant is not going to be enough to get rid of dryness and pain. The tissue is just too thin, too dry and too fragile. So, if your lubricant isn’t doing it, it’s time to take it to the next level and get an FDA-approved prescription product.

This is also the case if you are dealing with burning and irritation that have nothing to do with sex. The prescription products described below are the only things that will help if you are having urinary symptoms.

Local Vaginal Estrogen

A local vaginal estrogen can be safely used by everyone. Despite what the label says, you will not increase your risk of breast cancer, blood clots, dementia or any of the other terrifying things listed on the label. (There is a movement from physicians to get that false labeling removed.) Local vaginal estrogen comes in the form of a cream, ring, vaginal tablet or insert. Unlike systemic estrogens, these products only work locally. They will not do anything for your hot flashes, brain fog or bones. The choice depends on personal preference, what works best for you, and yes, your insurance.

DHEA  

The genitals are loaded with estrogen receptors. Less appreciated is that testosterone receptors are also found in vaginal and vulvar tissues and are major contributors to lubrication and elasticity. Ideally, to have maximum lubrication, the vagina needs both estrogen and testosterone. There are no FDA-approved forms of vaginal testosterone but the work around is to use vaginal DHEA suppositories. DHEA is a building block for both estrogen and testosterone that enables the vagina to produce its own estrogen and testosterone.

So, that’s a quick overview of your options. There are lots more details and nuances that will reverse the changes in vagina, vulva and bladder brought on by a lack of estrogen in my podcast and digital guide: "Come Again — Dr. Streicher's Proven Plan for Menopause Sexuality and Orgasm."

Remember, your vagina has no expiration date and any of these products can be started anytime, even if your vagina has not been used in decades. You can have enjoyable sex again after a long hiatus! But, whatever product you use, it needs to be used until you die, or your vagina will quickly return to your pre-treatment condition.

One last note. For many women the biggest roadblock is insurance. Medicare, inexplicably, does not cover many of these products. Check out discount drug sites online where you can often find very low prices.

Are you enjoying sex later in life? Why or why not? Let us know in the comments below.

Lauren Streicher, MD, is a Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, The Feinberg School of Medicine and is the medical director of the Northwestern Medicine Center for Sexual Medicine and the Northwestern Medicine Center for Menopause in Chicago. She is the host of the hit podcast, THE Menopause Podcast, and the author of Dr. Streicher’s Inside Information Series, which includes: Slip Sliding Away: Turning Back the Clock On Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain, and Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat. She is also the author of Sex Rx: Hormones, Health and Your Best Sex Ever, and The Essential Guide to Hysterectomy. Dr. Streicher is a Fellow in the American College of Obstetricians and Gynecologists, a member of the Sexual Medicine Society of North America, Inc. and is a Certified Menopause Practitioner of The North American Menopause Society. She was the 2019 recipient of the North American Menopause Society Media Award.