When Olivia, 26, who has asked not to be named, decided to go on the contraceptive injection, things were normal at first. But gradually, she began to notice a significant change, not just in her moods, but in her desire to have sexwith her then long-term boyfriend. Among other things, Olivia experienced painful sex resulting from vaginal dryness caused by a lack of arousal. This made intercourse less than pleasant and fed into a long list of reasons why she was no longer feeling like herself.

“My mental health had been declining really, really slowly after I had the injection,” she tells Mashable. “I only had two moods. I was either upset and in a negative headspace or completely apathetic. My lack of desire was just another thing that made me feel confused about why I didn’t feel like myself.”

The issue became the “elephant in the room” with her partner. “The annoying thing about sexual intimacy in a relationship, nobody wants to talk about it if it’s not going well. But even though it was never fully brought up, it definitely impacted the relationship in little ways over time, whether from him feeling rejected or me resenting him after having sex out of a feeling of obligation.”

Olivia isn’t alone. A quick search of the term ‘vaginal dryness’ on Reddit will throw up thousandsofpostsover hundreds of varying forums, including r/sex, r/sexover30, r/birthcontrol and r/beyondthebump. It’s no surprise. Around 17 percent of premenopausal womenaged 18 to 50 will deal with a dry vagina at some point in their lives – a number that increases to more than 50 percent for postmenopausal women – and all for a variety of reasons. 

What is vaginal dryness?

Although it’s common, talking about vaginal dryness is still somewhat taboo, but it can be painful, inconvenient, and lead to poor mental health. But what exactly are the symptoms?

According to Dr. Haitham Hamoda, consultant gynaecologist and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), the main symptoms of vaginal dryness include feeling sore or itchy in and around the vagina, pain or discomfort during sex, and needing to go to urinate more than usual.

And it shouldn’t be understated how much these symptoms can have a knock-on effect on mental wellbeing. “Regardless of the cause, vaginal dryness can have a huge impact on women and their mental health,” Dr. Katherine Hertlein, sex therapist and expert advisor at sex therapy app Bluehearttells Mashable. “It can prevent intimacy which can then have a major knock-on effect on their relationships. It can also trigger negative feelings around self-worth and attractiveness.”

What causes vaginal dryness?

While chronic vaginal dryness can have a number of both physiological and psychological causes, the most common is a drop in oestrogen levels, which explains why it is more common among postmenopausal women. Oestrogen is the sex hormone responsible for the development and maintenance of female characteristics and the female reproductive system. While all humans have some oestrogen, women have a lot more than men. 

Low oestrogen levels

“Lower oestrogen levels are associated with the menopause, breastfeeding and childbirth,” RCOG's Hamoda tells Mashable. She adds that other possible causes include certain contraceptive pills or antidepressants, and some cancer treatments, particularly, but not limited to, treatments for breast and prostate cancer.

Low oestrogen levels can be caused by breastfeeding without your period returning yet, perimenopause or the menopause or the loss of menstruation due to being underweight. 

According to gynaecologist Dr. Jen Gunter's The Vagina Bible, "progestin-only methods of hormonal contraception can lower glycogen in the vaginal mucosa, affecting lubricant and causing pain." If you suspect you have low oestrogen, speak to your GP to get that seen to before looking into other causes (or treatments for) vaginal dryness. They may prescribe a topical oestrogen cream for your vagina if lubricant isn't helping. 

Lack of arousal 

However, hormones aren’t the only answer. As Hamoda explains: “Vaginal dryness can also be caused by using perfumed soaps, washes or douches in and around your vagina which can disrupt the natural bacteria in the vagina.” It can also be a symptom of an underlying condition such as diabetes or Sjögren's syndrome, an autoimmune condition that affects areas of the body that produce fluids, such as tears and saliva, which can either be genetic or hormonal. 

Another common reason, which shouldn’t be overlooked, is a lack of arousal during sex. Dr. Hertlein explains that, while this might be caused by a genuine lack or loss of attraction, it can also be caused by psychological issues such as depression or PTSD, which can be addressed through various types of therapy, including CBT, psychodynamic therapy, talk therapy. 

Common causes of vaginal dryness

• Low oestrogen levels caused by menopause, breastfeeding, childbirth

• Irritation from scented hygiene products

• Diabetes

• Sjögren's syndrome

• Lack of arousal during sex

How can you treat vaginal dryness?

The treatment for vaginal dryness will obviously depend on the cause, but it’s encouraging to know that there are many options. 

Your first port of call if you experience a dry vagina, says Hamoda, is to replace any products, such as perfumed soaps or other feminine hygiene products that might be disrupting the pH level of your vagina, switching instead to a mild soap for the vulva and leaving the inside of your vagina, which cleans itself, alone. “Vaginal dryness can sometimes be easily treated using things that are available without a prescription, for example changing to an unperformed soap to wash around the vagina or using water-based lubricants or vaginal moisturisers. However if these options do not help, and vaginal dryness continues for a few weeks, it’s recommended you visit a GP.”

If the cause is low oestrogen, you may be offered Hormone Replacement Therapy (HRT), which is hormonal medication to increase the levels of oestrogen in your body. And for those who believe their vaginal dryness was caused by antidepressants, birth control or another medication, it might be worth speaking to your doctor to try another option. 

If the reason is psychological, treatment may be a little more complex. “If the issue can’t be diagnosed medically, a sex therapist can help you address your arousal issues and provide support to help overcome them,” says Dr. Hertlein. She says that a lack of arousal isn’t a black and white issue of attraction and may be sparked by “mental, physical or emotional issues”. This is when sex therapy is likely to help. Such treatment is likely to include increasing the amount of foreplay and applying sex therapy techniques tailored to tackle arousal issues. 

 When Olivia came off contraception, the problem subsided, taking around a year for her emotions to regulate fully. “Relief was definitely the biggest emotion I felt [when things went back to normal], especially because I realised that it wasn’t just me.” 

Perhaps if she’d known more about the causes of vaginal dryness or a loss of desire, she would have been able to reach that point much sooner. As Dr. Hertlein says: “The mental health impacts [of vaginal dryness] highlight why you must never suffer in silence; seek help from a doctor and start moving towards solutions.”

Vaginal dryness doesn’t need to spend the end to your sex life, and you don’t need to keep quiet and put up with it. Your vaginal health is important, and so are you.