Three days ago you had to stop halfway through sex because it hurt. Like, properly hurt, not just a bit uncomfortable. You actually said "stop" out loud (first time ever) and then you both just lay there not knowing what to say, and now you're too embarrassed to bring it up again. Yesterday morning putting on your knickers felt weird. Scratchy. Raw, almost? And this morning at 6:14am you checked the time and you Googled "vaginal dryness 41 is this normal or am I broken" because you've been awake since 4am in a complete panic about whether something's seriously wrong with you.
We see you. And honestly? You would not believe how common this is.
What Vaginal Dryness Actually Is—And Why It Happens to You
When oestrogen drops, the skin in your vagina becomes thinner and weaker. There's a reduction in healthy bacteria (lactobacilli), allowing other organisms like E. Coli to become more predominant, with a rise in vaginal pH above 5.
Basically? Oestrogen keeps the lining of your vagina healthy, thick, and elastic, maintaining vaginal blood flow and lubrication. Less oestrogen? Less moisture.
Want the numbers? Over half of post-menopausal women aged between 51 and 60 are affected by vaginal dryness. In a major study that followed over 2,400 women for 17 years, around 19% of women in their early 40s dealt with vaginal dryness, rising to 34% by their late 50s.
So yeah. You're in massive company here.
But you're only 41. You're still getting periods (well, most months). The effect of lack of oestrogen on urogenital tissue often takes three to five years to become apparent after menopause begins. This can't be menopause yet, can it? You're too young for this.
Maybe. Maybe not. And we know that uncertainty is somehow worse than just knowing.
Symptoms of Vaginal Dryness
Vaginal dryness shows up as soreness or itching in and around your vagina, pain during sex, needing to pee more than usual, or getting UTIs more often than you used to.
The most common vaginal dryness symptoms include:
During sex: Pain or discomfort. Sometimes bleeding when inserting a speculum (or during attempts at penetrative sex) due to the vaginal mucosa becoming thinner and more prone to trauma. And we know you're worried your partner thinks you don't fancy them anymore.
Day-to-day discomfort: That scratchy, raw feeling when you're putting on your underwear. Burning or itching. Vaginal discomfort and irritation. The constant awareness that something feels off down there.
Bathroom issues: Urinary symptoms include frequency, nocturia, urgency and dysuria, which can lead to misdiagnosis of urinary tract infection. Some women develop culture positive urinary tract infection.
But here's what catches most women off guard: it's the ordinary stuff. Sitting through the 3pm meeting. Your usual Thursday morning run. Pulling on jeans. Things that never bothered you before suddenly feel… wrong.
In many cases vaginal dryness not only causes pain during sex, it can make it uncomfortable to sit, stand, exercise, urinate or even work. The burning. The itching that you can't scratch because you're in Tesco. The feeling that something's just not right but you can't quite explain what.
And the absolute worst bit? Despite around 70% of women experiencing symptoms, only 25% volunteer this information to their healthcare professional. Feeling too embarrassed to tell anyone. Even your partner. Even your best mate. Definitely not your specialist, because how do you even start that conversation?
What Causes Vaginal Dryness
After and around the time of menopause, your body makes less oestrogen. Low levels of oestrogen can cause thinning, drying, and inflammation of vaginal walls. That's what causes vaginal dryness in most women over 40.
Other causes of vaginal dryness include:
Low oestrogen and vaginal dryness can happen at other times. Oestrogen levels can fall after childbirth, with breastfeeding, during cancer treatment, or with anti-oestrogen drugs. Certain medications like the Pill, hysterectomy (especially if they took your ovaries too). Basically anything that messes with your hormones can dry things out.
Even more annoying: cold and allergy medications and some antidepressants can dry out vaginal tissue. Sjögren syndrome, an autoimmune condition that can cause dry mouth and eyes, also can cause vaginal dryness.
Your antihistamines are sorting your runny nose but drying out your vagina. Brilliant.
And sometimes? Not being properly aroused during sex, often caused by insufficient foreplay or stress, can contribute to vaginal dryness. Other factors include using perfumed soaps, or having diabetes.
The not-knowing which one it is? That does your head in.
Over-the-Counter Solutions You Can Try Today
Right. Before you book in (and yeah, we'll get to when you absolutely should), there are natural remedies and over-the-counter options you can try that actually work.
Water-based lubricants for sex
Lubricants are similar to natural lubrication and should be applied to the vulva and vagina just before sexual intercourse. They're in the family planning aisle at Boots, usually near the condoms. Grab a few different ones and see what works. They provide immediate relief during intercourse but only last a few hours.
Vaginal moisturisers for everyday comfort
For the everyday discomfort—the getting-dressed irritation, the sitting-in-meetings rawness—vaginal moisturisers are used two to three times a week and last for up to three days, so they don't have to be applied directly before sexual intercourse. YES, Sylk and Regelle are often available on prescription and are less likely to cause irritation compared to some over-the-counter preparations.
Vaginal moisturisers are bio-adhesive and attach to cells on the vaginal wall, retaining water and balancing vaginal pH. Replens and YesVM are popular choices. Both are hormone-free and available without prescription.
Lubricants: good for a few hours. Moisturisers: good for days.
What to avoid (because they'll make things worse)
Critical bit: don't use regular body lotion or creams that aren't specifically for vaginas—they'll irritate things or cause infections. Your Nivea? Not designed for delicate vaginal tissue. Leave it for your hands.
That fancy Molton Brown shower gel you got for Christmas? It's making things worse.
The foreplay solution
This sounds too simple to work, but taking more time during sexual intercourse gives the Bartholin's glands time to produce the maximum amount of lubrication before penetration. Your body just needs more time than it used to. It's not about you being "broken" or your partner not being attractive enough. It's biology.
When to See Your Menopause Specialist
Despite the high number of women experiencing problems related to vaginal dryness, only a quarter of affected women seek treatment. In one UK survey, a third never sought professional help at all, and 40% waited more than a year.
See your menopause specialist if you've tried moisturisers and lubricants for a few weeks and nothing's working, if this is affecting your daily life, if you've got unusual discharge, or if you're bleeding after sex, between periods, or after menopause.
That last one especially. Any unexpected bleeding needs checking, even if it's probably just from tiny tears. Better to know.
They'll ask about your medical history and find out how long you've had symptoms and what seems to make them worse or better. Physical appearance does not usually correlate with severity of symptoms. It is important to note that there may be minimal signs of disease despite marked symptoms. Maybe take a swab to rule out infections.
Five minutes of awkwardness. Then you've got answers and a plan.
Prescription Treatments That Actually Work
If you're getting vaginal dryness because of changes in your hormone levels, you may be prescribed creams, gels, patches or medicines to increase oestrogen. This is called hormone replacement therapy (HRT).
The best cream for vaginal dryness: Your options
For vaginal dryness specifically, vaginal oestrogen can be used for as long as needed. NICE guidance published in November 2015 stated that there is no need for endometrial surveillance or the addition of a progestogen for endometrial protection with the current low dose vaginal oestrogen preparations in use. The best cream for vaginal dryness depends on your specific situation, but commonly prescribed options include:
Vaginal creams: Ovestin (estriol cream, 500mcg): Daily for two weeks then twice weekly. Can be used more frequently as dose is so low. Useful for vulval itching or soreness. You insert this with an applicator.
Vaginal tablets: Vagifem or Vagirux (estradiol, 10mcg): Daily for first two weeks then twice weekly. Vagirux is more environmentally friendly as the box contains one reusable applicator. Small tablets you insert vaginally using an applicator. Many women find these easier to use than creams.
Imvaggis (oestriol pessary, 30mcg): Daily for first three weeks then twice weekly. No applicator needed. Inserted into the vagina using fingers.
Vaginal ring: Estring: A soft flexible ring inserted into the vagina by the woman or healthcare professional. Releases a steady stream of oestrogen over 90 days. Doesn't require daily application and no discharge. Slightly stronger than Vagifem pessary. Can be removed for sex if preferred. Pop it in and forget about it for three months. Loads of women prefer this because you don't have to remember daily or weekly applications.
Vaginal gel: Blissel (oestriol gel, 50mcg): Daily for first three weeks and twice weekly thereafter. Lower dose option. Inserted with an applicator.
The key bit: vaginally delivered oestrogen enhances blood flow which restores cell maturation, healthy bacterial flora and a pH below 5. Vaginal secretions and peripheral nerve function are improved with optimal symptom relief and low systemic absorption. Very little gets into your bloodstream, which is why it's considered safe for most women.
What if you're already on HRT?
Around 10-25% of women who take systemic HRT will have urogenital symptoms that persist. These women can be given vaginal oestrogen in addition to taking HRT. Your GP can sort this.
Worth knowing: these treatments aren't suitable for everyone, so your doctor needs to check whether hormonal treatment works for your situation. It is important to inform women that although symptom control is usually seen within the first few weeks of treatment, a beneficial effect may take longer to become apparent, and treatment needs to be continued in order to achieve and maintain this.
Most women see improvement within weeks to a couple months using estrogen cream for vaginal dryness. Things get less dry. Sex stops hurting. The constant irritation goes away.
It works. Genuinely.
Other prescription options
Intrarosa (DHEA pessary, 6.5mg): Prasterone, administered locally in the vagina and converted intracellularly to androgens and oestrogens. One pessary daily. Easy to use. When DHEA is delivered vaginally, it is converted into oestrogens and androgens by enzymes within the epithelial cells of the vagina. 95% of the active hormones made in the vaginal mucosa are inactivated at the site of synthesis preventing any increase in systemic hormone levels or a stimulatory effect on the endometrium.
Ospemifene (60mg oral tablet): Administered orally once daily. Acts as an agonist in the vaginal mucosa, lowering vaginal pH and improving symptoms including vaginal dryness and dyspareunia. Appropriate for women who prefer oral treatment to any form of vaginal treatment.
How to Treat Vaginal Dryness: Your Step-by-Step Plan
We know you want a clear plan. Something you can actually do today. So here's exactly how to treat vaginal dryness, starting now:
Week 1-2: Start with over-the-counter options
- Buy a water-based lubricant for sex (YES lube is a good starting point)
- Buy a vaginal moisturiser (Replens or YES VM) and use it 2-3 times weekly
- Stop using any perfumed products near your vagina
- Switch to unperfumed soap or simple emollient like Cetraben
Week 3-4: Assess what's working
- Is the discomfort improving?
- Can you have sex without pain?
- Has the day-to-day irritation reduced?
If things are better: Keep going with what's working. You might not need anything else.
If things haven't improved: Book an appointment. Treatment should be started early, as the time to respond to therapy will depend on the degree of atrophy at the time of presentation. Don't wait another month hoping it'll sort itself.
At your GP appointment:
- Be honest about how long you've had symptoms
- Mention what you've already tried
- Ask specifically about vaginal oestrogen if you're comfortable with it
- Don't leave without a clear treatment plan
Starting prescription treatment:
- Use exactly as prescribed (consistency matters)
- Give it 4-6 weeks to work properly. It may take three to four months for an improvement to become apparent, and the most severely affected women may take longer to respond
- Contact your GP if side effects bother you
- Don't give up if the first option doesn't suit you—there are alternatives
The Stuff Nobody Says Out Loud
Vaginal dryness isn't just about your vagina. It's about feeling broken. Worrying your partner thinks you don't fancy them anymore. Panicking about whether this is permanent. Feeling older than you are.
Vaginal dryness can make women feel different. Changes to the body can be difficult to accept and pain and discomfort can lead to loss in self-confidence and sexual confidence. Research shows these symptoms affect enjoyment of sex in over half of participants, and significantly impact interpersonal relationships, quality of life, and daily activities.
The physical discomfort you can describe. The emotional fallout? Harder to explain.
We've noticed that talking helps. (Yeah, awkward. But it helps.) Tell your partner what's happening. Many women keep it to themselves and this can put a large strain on their relationship with their partner, especially if women feel unable to tell their partner why they're not interested in sexual activity. Book that GP appointment. Message your friend who's also in her 40s (she's probably dealing with this too).
And be patient with yourself while you figure out what works. This isn't something you can ignore away or push through.
¹- NHS. Vaginal dryness. https://www.nhs.uk/conditions/vaginal-dryness/
²- British Menopause Society. (2024). BMS Consensus Statement: Urogenital atrophy. https://thebms.org.uk/wp-content/uploads/2024/04/09-BMS-ConsensusStatement-Urogenital-atrophy-MARCH2024-A.pdf
³- British Society for Sexual Medicine. (2023). Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM). https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf
⁴- Women's Health Concern. (2023). Vaginal Dryness Fact Sheet. https://www.womens-health-concern.org/wp-content/uploads/2023/11/25-WHC-FACTSHEET-VaginalDryness-OCT2023-B.pdf
⁵- American College of Obstetricians and Gynecologists. Experiencing Vaginal Dryness? Here's What You Need to Know. https://www.acog.org/womens-health/experts-and-stories/the-latest/experiencing-vaginal-dryness-heres-what-you-need-to-know
⁶- Waetjen LE, Crawford SL, Chang PY, et al. (2018). Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC6136974/
⁷- Edwards D, Panay N. (2016). Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4819835/
