Medically reviewed by Dr. Tamara Neuhaus MD

Vaginal Dryness and Painful Sex During Perimenopause

Apparently my fountain of youth has dried up. It’s like someone turned a hair drier on my vagina, set it on high and walked away. Sex hurts. Masturbation is a waste of time. Sometimes even just walking around hurts. - Hillary, 53

What is it?

Vaginal dryness is exactly what it sounds like—a dry feeling in the vaginal tissues that can cause discomfort or pain, especially during sex. Some women also experience an itchy or irritated feeling on a regular basis. Vaginal dryness is very common during menopause, affecting 50% of women aged 50, and over 70% of women aged 70. 

Why does it happen?

Like just about all symptoms of peri/menopause, dwindling estrogen is to blame. Estrogen helped keep your vaginal tissue thick, lubricated, and elastic. Now that your estrogen is on short supply, the tissues are becoming thinner, drier, and they can tear more easily. 

What can you do about it?

There are a lot of approaches you can take to get your “fountain of youth” flowing again. Or at least, keep it pleasantly dewey.

Vaginal Estrogen

The sure-fire way to eliminate this peri/menopause symptom is to treat the cause. Vaginal estrogen is available by prescription in the form of creams, rings, or tiny pills inserted directly into the vagina. Because it works locally, and not systemically, this form of hormone therapy (HRT) is safe for just about all women, regardless of breast cancer or stroke history.

Over-the-counter Lubricants

Lubricants can dial down discomfort during sex and increase pleasure. Over-the-counter lubricants can be water-, oil-, or silicone-based. Keep in mind: Oil-based lubricants (including coconut oil and CBD oil) can break down latex condoms, making them unreliable for birth control or STD prevention. And if you’re still in peri/menopause, you can still get pregnant.

Over-the-counter Vaginal Moisturizers

For general vaginal dryness that affects your daily life, over-the-counter vaginal moisturizers applied 2 or 3 times weekly can be quite effective. Moisturizers retain water and provide longer-term relief than the short term relief of lubricants.

Vitamin E Oil

Vitamin E oil applied around the outside and/or inside your vagina can be used in addition to vaginal moisturizers and lubricants to decrease discomfort. Topical oils can be soothing and penetrate thin tissue well. Just remember, any kind of oil will render latex condoms useless.


If you have tenderness around the opening of the vagina during penetration, but the rest of the vaginal feels ok, one option is an over-the-counter local anesthetic like Lidocaine. You’ll just want to place this at the opening of your vagina 10-15 minutes prior to sex. This can help with entry pain, but won’t affect overall sensation or pleasure.

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At The Cusp, we provide expert menopause care. We are a comprehensive, convenient virtual healthcare service dedicated to help you feel better.