This is the symptom women are least likely to mention and most likely to be helped by mentioning.
Surveys consistently find a large proportion of postmenopausal women experiencing genital dryness or discomfort, and a small minority ever raising it with a doctor. The gap between how common it is and how rarely it is discussed is larger here than anywhere else in this area.
There are two reasons that matters. First, it responds well to treatment. Second — unlike most menopause symptoms — it does not get better on its own.
Why this one is different
Hot flushes typically settle over years. Sleep usually improves. Mood often stabilises.
Genital and urinary tissue changes do not follow that pattern. The tissue becomes thinner, less elastic and less well lubricated, and without attention that tends to continue rather than resolve.
Which inverts the usual advice. For a lot of symptoms, waiting to see how things develop is reasonable. Here, earlier is better.
What women describe
- Dryness, or a raw and irritated feeling
- Itching or burning, sometimes mistaken for thrush
- Discomfort or pain during sex, from mild to severe
- Bleeding or spotting after sex
- Soreness from ordinary things — exercise, cycling, tight clothes
- Needing to pass urine more often or more urgently
- Recurrent urinary tract infections
- Reduced sensation, or difficulty reaching orgasm
Those last few surprise people. Genital, urinary and sexual symptoms are grouped together clinically because the same tissue changes underlie all of them — which is why treating the dryness often improves the urinary symptoms too.
The knock-on effects
Rarely confined to the physical.
Women describe avoiding sex, then avoiding the affectionate contact that might lead to it, then a distance in the relationship neither partner quite names. Partners often interpret it as rejection or loss of attraction. The actual cause — it hurts, and I have not told you — goes unspoken.
Lower-grade versions show up too: avoiding cycling, avoiding certain clothes, a background discomfort that becomes normal.
None of this is inevitable, and all of it is easier to address early.
Moisturisers and lubricants
Available over the counter, different products for different jobs, and routinely confused.
Vaginal moisturisers are used regularly — typically every two or three days — regardless of sexual activity. They work on tissue condition over weeks. Think of them as maintenance.
Lubricants are used at the time of sex to reduce friction. Immediate effect, no lasting change.
Most women who have tried "something from the chemist" have tried a lubricant only, used it once, and concluded it did not help. Using a moisturiser regularly is the part usually missing.
Practical notes:
- Water-based lubricants are safe with condoms and are the usual starting point
- Silicone-based last longer and suit water, but not with silicone toys
- Oil-based including coconut oil are not safe with condoms
- Avoid anything perfumed, warming or flavoured on already irritated tissue
- Look for products with pH and osmolality suited to vaginal use; some
mainstream lubricants are irritating with regular use
What to discuss with a doctor
There are effective treatments beyond what you can buy over the counter. What is suitable depends on your history and your circumstances, and that is a conversation for you and a doctor.
The harder part is raising it. Some things that help:
Say it first. Lead with it rather than saving it for the end. "I want to talk about vaginal dryness and sex" in the first minute means it gets proper time.
Use the plain words. Doctors are not embarrassed, and vagueness costs you accuracy.
Write it down if saying it is hard. Handing over a note is entirely acceptable and GPs are used to it.
Be specific about impact. Whether it hurts during sex, whether you have stopped, whether it affects daily life. This shapes what gets suggested.
Ask for a female GP if that makes it easier. Reasonable and common.
If a doctor brushes it off — and some do — that is a reason to see someone else rather than to drop it. This is a treatable problem.
Related
Urinary symptoms and recurrent UTIs covers the urinary side of the same tissue changes. Preparing for your appointment has more on raising difficult subjects.