Managing Vaginal Dryness Caused by SSRIs

Introduction to Treatment

The American College of Obstetricians and Gynecologists recommends starting with non-hormonal vaginal moisturizers applied 3-5 times per week combined with water-based or silicone-based lubricants during sexual activity to address SSRI-induced vaginal dryness without adding hormonal complications 1, 2, 3

Apply vaginal moisturizers 3-5 times per week to the vagina, vaginal opening, and external vulvar folds for optimal symptom control, as recommended by the North American Menopause Society 1, 3
Vaginal moisturizers provide daily maintenance of vaginal tissue health and can be as effective as low-dose estrogen for mild to moderate symptoms, according to the American College of Obstetricians and Gynecologists 3
Use water-based lubricants during sexual activity to reduce friction and immediate discomfort, as suggested by the Journal of Clinical Oncology 4, 1, 3
Silicone-based lubricants last longer than water-based products and may provide more effective relief during intercourse, as recommended by the American College of Obstetricians and Gynecologists 1, 2

Pelvic floor physical therapy significantly improves sexual pain, arousal, lubrication, orgasm, and overall satisfaction, and should be considered early in treatment, especially if dyspareunia is present, according to the American Urological Association 1, 2, 3
Vaginal dilators help with pain during sexual activity and increase vaginal accommodation, and are useful for identifying painful areas in a non-sexual setting, as recommended by the American College of Obstetricians and Gynecologists 1, 2, 3

Vaginal DHEA (prasterone) is FDA-approved for vaginal dryness and dyspareunia, improving sexual desire, arousal, pain, and overall sexual function in premenopausal women on SSRIs, according to the American College of Obstetricians and Gynecologists 1, 2, 3
Low-dose vaginal estrogen is the most effective treatment when non-hormonal options fail, with minimal systemic absorption, and is available as tablets, creams, or sustained-release rings, as recommended by the North American Menopause Society 1, 3
Ospemifene (oral SERM) 60 mg daily is FDA-approved for moderate to severe dyspareunia and vaginal dryness in postmenopausal women, according to the American College of Obstetricians and Gynecologists 1, 3

Non-hormonal options must be tried first before any hormonal therapy in patients with a breast cancer history, as recommended by the American Society of Clinical Oncology 1, 3
If hormonal therapy becomes necessary, estriol-containing preparations are preferable as estriol cannot be converted to estradiol, according to the American College of Obstetricians and Gynecologists 1, 2, 3