Ask the Sexpert: Oct. 20, 2011

Dear Sexpert,

My boyfriend and I have been happily together for six months. Our relations are exciting and generally healthy, save for one rather inconvenient problem: I suffer from perpetual vaginal dryness. I consider myself an otherwise healthy young adult; however, I have difficulty getting “wet” before intercourse. I cannot seem to have pleasurable, satisfying sex with my partner, and I become seriously depressed after having sex because I feel like I haven’t “performed” properly. I dislike using manufactured, artificial lubricants. I’m at a loss for alternatives to lubrication or where I might go to talk to someone about this personal insecurity. What causes vaginal dryness, and how might I ameliorate this problem?

—Kalahari Desert

Dear Kalahari Desert,

Many women who are sexually active experience either slight or extreme cases of vaginal dryness. Normally the vaginal walls remain lubricated with a very thin coating of transparent fluid. The hormone estrogen maintains the secretion of vaginal fluid, preserving the thickness and elasticity of the vaginal walls and, by extension, overall vaginal health. Dips or fluctuations in estrogen levels may contribute to slight or lengthy spells of vaginal dryness.

Vaginal dryness can be caused by many factors. The primary, and perhaps most obvious, basis for vaginal dryness is not being aroused enough before or during intercourse. Stress or alterations in one’s dietary regime may increase or inhibit the secretion of vaginal fluid. Medications like isotretinoin (generic name: accutane), antihistamines or nasal decongestants — “drying medications” — may effect the level of lubrication down there. Other factors include the following: 1) having a bacterial or yeast infection; 2) using marijuana (or other drugs) before or during sex; 3) growing older and entering menopause; 4) douching; 5) bubble baths; 6) using scented soaps or lotions around the vaginal area. Finally, experiencing changes or abnormalities in hormone levels may disrupt the normal secretions of fluid within the vaginal area, for example, which happens when taking birth control, using the morning-after pill “Plan B,” receiving depo-provera (the birth control shot), in childbirth or while breastfeeding.

Inadequate lubrication within the vagina can make intercourse uncomfortable and, in some cases, excruciatingly painful. Vaginal dryness may be the physical manifestation of vaginal atrophy, or atrophic vaginisis. Atrophic vaginisis is the condition whereby the vaginal walls thin and inflame, usually due to a decrease in estrogen levels in the body. Itching or a perpetual stinging sensation within the vagina may accompany vaginal atrophy. If you think you are experiencing vaginal atrophy, visit your local healthcare provider or physician for an accurate diagnosis.

Vaginal dryness is why some women enjoy having sex while on their period, as the menstrual blood acts as a form of natural lubrication. Saliva and water-based lubricants are effective alternatives to oil-based lubricants. Vaginal moisturizers such as Replens and Lubrin are two over-the-counter medications that may cure vagina dryness — they are readily available at most local pharmacies and drug stores.

Vaginal dryness may be medically treated by way of topical estrogen therapy. Topical estrogen therapy can relieve vaginal dryness, but a more effective measure against dryness is taking oral supplements of estrogen. The insertion of a vaginal estrogen ring (estring), taking vaginal estrogen tablets (vagifem) or applying topical vaginal estrogen creams (estrace or premarin) may relieve bouts of vaginal dryness.

Both individual and couples counseling are available at McCosh sans charge if you feel the need to talk to a professional about this as a personal insecurity.

— The Sexpert

The Sexpert is written by a team of peer sexual health educators and fact-checked by University health professionals. You can submit questions to sexpert@dailyprincetonian.com. Don’t be shy!