What helps vaginal dryness, and when should I see a doctor?

Dryness may feel like irritation, burning, itching or soreness. Sex may feel uncomfortable, but symptoms can also bother you at other times. You do not need to be sexually active to ask for help.

Mention urinary changes too, such as needing to wee more often or discomfort when you wee. These symptoms can overlap with vaginal changes, but they can also have other causes.

Lower oestrogen around menopause can affect the vulva, vagina and urethra, the tube urine passes through. The tissues may become thinner, drier and less flexible, and changes in moisture, acidity and the local mix of bacteria can reduce their usual protection. Menopause-related vaginal, vulval and urinary symptoms are sometimes grouped under the name genitourinary syndrome of menopause (GSM). RANZCOG explains this symptom group and its assessment.

GSM can involve dryness, burning, irritation, pain during sex, urinary urgency or discomfort and recurrent urinary tract infections. The symptoms overlap, but they do not all have the same cause: vaginal irritation can sting when urine touches the skin, while an infection can occur at the same time and needs its own assessment.

Dryness can also occur during breastfeeding or with some medicines or hormonal contraception. Products, infections and skin conditions may cause similar discomfort. New symptoms should not simply be assumed to be menopause.

You can start with the symptom that bothers you most. The GP may ask about:

Avoid vaginal douching and perfumed soaps, wipes, sprays or washes around irritated vulval skin. Wash gently, pat rather than rub, and stop a product if it stings or makes symptoms worse. Persistent itching, a skin change or discharge needs assessment rather than repeated self-treatment for presumed dryness or thrush.

A lubricant reduces friction during sexual activity, while a vaginal moisturiser is used regularly for ongoing dryness. Check that a lubricant is compatible with condoms or sex toys you use; oil-based products can damage latex condoms. There is no need to continue penetration through pain. More time for arousal, a different activity or position, and stopping when something hurts can protect comfort and choice.

If pain continues after dryness is addressed, another contributor such as a skin condition or pelvic-floor muscle problem may need assessment.

Treatment should match the likely cause. Non-hormonal lubricants and moisturisers can support comfort. When symptoms are related to genitourinary syndrome of menopause, a clinician may discuss local vaginal hormone treatment. This targets vaginal and urinary symptoms differently from systemic menopausal hormone therapy, which is used for symptoms elsewhere in the body as well. Neither approach should be chosen from dryness alone without considering the history.

Vaginal and urinary symptoms can persist even when systemic MHT is helping hot flushes or other symptoms elsewhere in the body. A clinician may discuss adding or changing a local treatment after considering the likely cause, previous response and your health history. Systemic MHT should not be started or increased solely to prevent recurrent UTIs. NICE distinguishes local vaginal treatment from systemic MHT for recurrent-UTI prevention.

If you have had breast cancer, another hormone-sensitive cancer or treatment that affects hormones, tell the clinician before using a hormonal treatment. After breast cancer, non-hormonal options are generally considered first. If symptoms persist, local vaginal oestrogen may be considered after an individual discussion: a small amount is absorbed into the bloodstream and its effect on breast-cancer recurrence remains uncertain. If you take an aromatase inhibitor, involve your breast-cancer specialist in the decision.

CO2 vaginal laser is not recommended for menopause-related genitourinary symptoms; evidence for other laser approaches remains uncertain.

Agree on what improvement you are looking for and when to review it. Return sooner if a product worsens burning or irritation, symptoms persist, sex remains painful, urinary symptoms recur, or bleeding or discharge develops.

Dryness around menopause can occur alongside urinary urgency, needing to wee more often, burning or recurrent urinary tract infections. Vaginal or urethral irritation can cause symptoms that feel like a UTI, and irritation and infection can coexist. Symptoms alone cannot show which is present. NSW menopause guidance explains why vaginal, urinary and sexual symptoms are assessed together.

Fever, back or side pain, vomiting, blood in urine or feeling significantly unwell needs prompt assessment for infection or another urinary problem. A local vaginal treatment used for menopause-related symptoms does not treat an active UTI.

If infections have been confirmed and keep returning around perimenopause or menopause, a clinician may discuss local vaginal oestrogen as one prevention option. This is different from systemic MHT and needs an individual discussion. Record whether symptoms occur only during urination, after sex or throughout the day, and have previous urine results and treatments handy.

A conversation helps establish the history, but it cannot replace an examination of irritated skin or vaginal tissue. The GP may suggest an examination or tests when symptoms persist, the cause is unclear, or there is pain, discharge, bleeding or a urinary concern.

If a product has not helped or has made symptoms worse, mention that rather than repeatedly treating the symptom without checking its cause.

An external or internal examination should be explained and requires your consent. You can ask what information it may add, request a support person or chaperone, ask about alternatives, and pause or stop the examination. A referral can be arranged when a suitable examination or specialist assessment is not available in the current setting.

Call 000 for severe bleeding with faintness or collapse, severe pelvic pain with serious illness, severe breathing difficulty or another emergency. Seek prompt local care for fever with pelvic pain, possible pregnancy with pain or bleeding, or urinary symptoms with fever or back or side pain. Arrange medical assessment for bleeding after sex, between periods or after 12 months without a natural period, unusual or offensive discharge, or persistent or worsening symptoms. A scheduled withdrawal bleed may be expected with some prescribed hormonal plans; ask what pattern is expected for yours.

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