Vaginal Dryness – When Sex Hurts

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. 20 January 2016

Vaginal Dryness – When Sex Hurts


During menopause or if a woman has her ovaries removed (hysterectomy/oophorectomy), estrogen (along with progesterone) will plummet.  This drop in estrogen is what causes vaginal dryness and vaginal atrophy, creating pain with sex.

What’s estrogen got to do with it?

Estrogen has everything to do with vaginal dryness.  Estrogen hydrates and strengthens the vaginal cell.  It keeps the lining of the vaginal canal thick and resilient.  A lack of estrogen can cause the cell to become small and fragile.  This drop in estrogen will cause the vaginal canal to become smaller, the lining to become thinner and dehydrated.  This not only causes sex to become painful but also the vaginal tissues are not as sensitive which, further decreases sex drive.

Vaginal dryness or vaginal atrophy can also make you more prone to vaginal infections such as bacterial vaginosis and yeast.  The dryness can also cause a woman to become uncomfortable with exercise or walking due to the chaffing.

Summary of common symptoms associated with vaginal dryness:

  • Painful intercouse (dyspareunia)
  • Lack of tissue sensitivity
  • Cause chaffing with exercise or walking
  • More prone to vaginal infections

Treatments for vaginal dryness and vaginal atrophy:

Conventional treatments for vaginal atrophy are limited with side effects. Many are gels and creams, some made from pregnant horse urine and others made from estradiol which is a strong form of estrogen (see blog posts about estriol and biest).  

Other conventional treatments are oral estradiol which can have systemic side effects and create a burden to the liver.  An oral non-estrogen tablet (ospemifene) has been introduced as a conventional treatment to vaginal dryness. While this doesn’t contain estrogen, ospemifene still stimulates estrogen receptors having an estrogen effect on the body with side effects.

A healthier approach to vaginal atrophy and dryness is to use estriol suppositories.  Estriol is a gentle, safe form of estrogen that is not systemic.  It is a bio-identical, which means that estriol is made to look molecularly exact to that which our bodies make.  Estriol suppositories are not commercially available but is compounded at a compounding pharmacy.  If you are interested in more information, or purchasing

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So for atrophy and the dryness that accompanies it, is it Estriol only? Or, is it Estriol and Progesterone? I keep reading differing opinions on this subject. Some say DHEA and Estriol and Progesterone together for atrophy. Another hormone for atrophy is Pregnenolone. Which is it?

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