Vaginal Lubrication

The natural moistness of the vagina prevents its sides from rubbing against each other as you move about during the day. The vaginal moisture is also slightly acidic, and this helps to keep infections such as thrush at bay. This acidity is caused by the friendly bacteria that live in the vagina and help to keep it healthy.

Vaginal moisture is mainly produced by the cervix (neck of the womb) at the top of the vagina and eventually oozes out of the vagina – some vaginal discharge is normal. This means that there is a very slow flow of moisture through the vagina, and this keeps it clean, as it moves dead cells and the remains of the menstrual period to the outside. On average, a woman discharges 2 grams of dead cells and 3 grams of mucus through the vagina each day.

During sex. When you are sexually excited, two special glands at the entrance of the vagina, called Bartholin’s glands, produce extra secretions. The moisture from these glands is more slimy than the moisture from the cervix, because its purpose is to provide good lubrication during intercourse. Its musky smell is the result of millions of years of evolution to increase female attractiveness to the male of the species, and signals that the woman is ready for sex.

Vaginal Dryness before the Menopause

Vaginal dryness before the menopause is mostly a problem during sex. It may mean that you are not sufficiently aroused which can occur for all sorts of reasons such as inadequate foreplay, feelings of guilt, fear or relationship problems. Also remember that men generally get aroused sooner than women, so your partner may be attempting penetration before you are ready, before good lubrication has occurred. Lack of lubrication is also common in breastfeeding women, because oestrogen levels are low (see Estrogen Deficiency: Effect on Tissue Quality in the Genital Region), and in women with diabetes.

Vaginal Dryness during or after the Menopause

Vaginal dryness can be a particular problem at and after the menopause, because of a lack of oestrogen (the female hormone). Oestrogen is responsible for the plumpness of the lining of the vagina, for the elasticity of the tissues round the vagina and for the production of the moisture from the cervix (see Estrogen Deficiency: Effect on Tissue Quality in the Genital Region).

Oestrogen levels fall at the menopause, so the vagina loses some of its elasticity, its lining becomes thinner and it feels dryer. Because there is less moisture, there are fewer of the ‘friendly’ bacteria that help to keep the vagina acidic. When the vagina becomes less acidic, infections such as thrush can take hold, which cause further irritation and discomfort.

All these changes can make intercourse uncomfortable, so it is not surprising that about 40% of women report painful intercourse after the menopause. Another factor is that after the menopause, the Bartholin’s glands are less efficient they take longer to produce the lubricating juices for sex, and produce less than in younger women.

What to Do about Vaginal Dryness before the Menopause

A dry vagina can be lubricated easily. For additional lubrication for intercourse, use a water-soluble lubricant (for example, KY jelly or Sylk), rather than a petroleum-based product like Vaseline, which may interfere with your natural secretions or degrade condoms causing them to fail.

Sylk, Yes and KY jelly are used just before intercourse. Smear the product liberally over the vulval area, particularly round the opening of the vagina. Most products are available from supermarkets and pharmacies, online, or by mail order from some stockists. Sylk is a lubricant derived from an extract of kiwi fruit; obviously you should not use it if you are allergic to kiwi fruit. It has a non-sticky texture very similar to natural vaginal lubrication. Some lubricants damage condoms, whereas Sylk, KY jelly, water-based formulation of YES, Replens and Senselle do not.

Replens, Yes VM and Senselle are moisturizers that you use two or three times a week just like you would a normal body lotion. They coat the inside of the vagina with a non-hormonal moisturizer, which lasts for a day or two, so they do not have to be used immediately before intercourse.

What to Do about Vaginal Dryness during and after the Menopause

Leisurely sex with lots of foreplay. Taking time during sex is particularly important for the older woman. This allows the Bartholin’s glands to produce the maximum amount of lubrication before penetration.

Simple lubricants, such as KY jelly, or moisturizers, such as Replens or Senselle, can be used if you need additional lubrication for intercourse.

Hormone replacement therapy (HRT) replenishes oestrogen levels which drop due to the menopause, and will increase vaginal lubrication and thicken the vaginal lining. If vaginal dryness is your only menopause-related problem (not suffering with flushes, mood, joint pains, memory problems, dry skin, hair loss etc.), then topical HRT (vaginal oestrogen) may be most appropriate.

Vaginal oestrogen creams or tablets can be prescribed by your doctor to be used every night for 2–3 weeks then twice a week after that. It may be a few weeks (or even months) before you notice any improvement. Some creams and most tablets come with a special syringe (applicator) to help you insert the cream into the vagina, or you can smear the cream inside your vagina with your fingers. If you are not used to touching the inside of your vagina you may find this peculiar at first, but you will very soon become quite relaxed about doing so.

An oestrogen-containing vaginal ring (Estring) is another option, which gradually releases oestrogen into the vagina. It has to be replaced every 3 months, and you must not use it for more than 2 years in total. It is not painful or uncomfortable, but you might feel a slight irritation at first. Some people find that it gets in the way during intercourse, in which case you can remove it beforehand and put it back afterwards. It is easy to take in and out – your doctor will show you how.

Black cohosh capsules are derived from the root of a plant and can be bought from health food stores. It is commonly used as a natural remedy for menopausal symptoms, with the theory that it may have an oestrogen-like effect on the lining of the vagina, which might translate into better vaginal lubrication.


First published on:
Reviewed and edited by: Dr Laura Gush
Last updated: May 2021

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