Vaginal Dryness (GSM): Causes, Symptoms and Treatments That Work

Many women tell me, "I've put up with it for years. I thought this is just what happens when you get older." The truth is that vaginal dryness is a very common medical condition, and there are safe, effective ways to treat it. You do not have to put up with it.

What are vaginal dryness and GSM?

When oestrogen levels fall, the tissues of the vagina, the vulva and the lower urinary tract become thinner, less moist and less elastic, and receive less blood flow.

In 2014, ISSWSH and The Menopause Society proposed calling this group of symptoms genitourinary syndrome of menopause (GSM), instead of older terms such as "vaginal atrophy", because it covers both sexual and urinary symptoms and is less stigmatising.

Unlike hot flushes, GSM usually does not go away with time, and may slowly get worse if it is not treated.

Common symptoms

• Vaginal dryness, burning, itching or irritation
• Pain or stinging during sex, light bleeding after sex
• Passing urine often, burning when passing urine, or repeated urinary tract infections
• Changes in vaginal discharge
• Reduced sexual sensation or arousal

With repeated pain, many women start to feel afraid and avoid sex, and their desire drops as a result. Read more in painful sex and FSIAD.

Causes: not only menopause

For new mothers, read more in body image and confidence after childbirth.

Lower hormones

• Menopause
• After ovary surgery
• Postpartum and breastfeeding

Medicines and treatment

• Anti-hormone drugs, some contraceptives
• Antihistamines, some antidepressants
• Chemotherapy, pelvic radiotherapy

Not enough arousal

• Rushed, stressed, not relaxed

Irritants

• Soap, intimate washes
• Vaginal douching

Step-by-step care

Step 1: things you can do straight away

• Lubricant: use during sex. Choose water-based or silicone-based, without fragrance and without warming or cooling ingredients. If you use natural latex condoms, avoid oils. Read more in lubricant matters more than you think.
• Vaginal moisturiser: use regularly, 2–3 times a week, even when you are not having sex. It improves baseline moisture.
• Stop using soap or douches inside the vagina; rinsing the outside with clean water is enough.
• Allow more time for foreplay. Regular sexual activity also helps improve blood flow.

Step 2: local medicines, as assessed and prescribed by a doctor

• Low-dose vaginal oestrogen, such as a cream, vaginal tablet or vaginal ring, is the treatment with the strongest evidence. The 2025 AUA/SUFU/AUGS guideline recommends offering it and notes that very little is absorbed into the bloodstream; most women do not need a progestogen alongside it.
• Other options available in some countries include vaginal DHEA (prasterone) and ospemifene tablets.

Things worth knowing

• Oestrogen gel applied to the skin (sometimes advertised for vaginal dryness) is a whole-body hormone and is better suited to hot flushes. If your problem is only in the vagina, low-dose local treatment is usually more suitable and safer. And if you still have a womb, whole-body oestrogen must always be combined with a progestogen. Read menopausal hormone therapy.
• Vaginal laser: long-term evidence is still insufficient, and the US FDA has issued a warning about marketing these devices for "vaginal rejuvenation", so it is not a first choice.
• Herbal products or "tightening" vaginal inserts sold online may cause irritation and make things worse.

1. 1LubricantWater- or silicone-based, fragrance-free, used during sex
2. 2MoisturiserUse regularly 2-3 times/week, even without sex
3. 3Stop irritantsNo soap or douching; wash the outside with water
4. 4Local medicineLow-dose local oestrogen, as assessed and prescribed by your doctor

AUA/SUFU/AUGS (2025) guidance. Bleeding after menopause always needs checking.

When to see a doctor

• Any vaginal bleeding after menopause always needs to be checked
• A sore, lump or rash that does not heal
• Discharge with an odour or unusual colour, or severe itching, which may be an infection
• Burning when passing urine with a fever, or repeated urinary infections
• No improvement despite using lubricants and moisturisers

At Dr. Kris Clinic, we look after this privately: assessing the cause, explaining the options and following up together until you are comfortable again, at the clinic or online, with English-speaking consultations available. For a wider overview, read women's sexual health.