Treatment Options for Vaginal Dryness

First-Line: Non-Hormonal Options

Regular use of vaginal moisturizers provides daily maintenance of vaginal tissue health and relieves dryness and discomfort 2
Water-based lubricants are recommended during sexual activity to reduce friction and discomfort 1, 2
Silicone-based lubricants may be more effective as they last longer than water-based products 1, 2
Topical vitamin D or E can provide additional symptom relief for vaginal dryness 1, 2

Pelvic floor physical therapy can significantly improve sexual pain, arousal, lubrication, and overall satisfaction 3, 1
Vaginal dilators benefit women experiencing pain during sexual activity and those with vaginal stenosis, particularly after pelvic radiation 3, 1
Topical anesthetics such as lidocaine can be applied to the vulvar vestibule before sexual activity to reduce pain 2
Regular sexual activity or use of vibrators/clitoral stimulatory devices may help maintain vaginal health 3

Vaginal estrogen therapy is the most effective treatment for vaginal dryness when non-hormonal options fail 3, 1
Low-dose formulations of vaginal estrogen minimize systemic absorption while effectively treating symptoms 1, 2
DHEA is FDA-approved for vaginal dryness and pain with sexual activity, improving sexual desire, arousal, and overall sexual function 3, 1
Ospemifene, an FDA-approved selective estrogen receptor modulator (SERM), effectively treats vaginal dryness and dyspareunia in postmenopausal women without a history of estrogen-dependent cancers 3, 1

For breast cancer survivors, non-hormonal options should be tried first before considering hormonal treatments 1, 2
Women on aromatase inhibitors should generally avoid vaginal estrogen as it may increase circulating estradiol and potentially reduce treatment efficacy 1
DHEA may be a better option for women on aromatase inhibitors, though it should be used with caution as it increases circulating androgens 3
Estriol-containing preparations may be preferable for women with hormone-sensitive cancers as estriol is a weaker estrogen that cannot be converted to estradiol 1
A large cohort study of almost 50,000 breast cancer patients followed for up to 20 years showed no evidence of increased breast cancer-specific mortality in those using vaginal estrogen 3