Management of Vaginal Dryness and Dyspareunia

First-Line Treatment: Non-Hormonal Options

The American College of Obstetricians and Gynecologists recommends starting with regular use of vaginal moisturizers for daily maintenance of vaginal tissue health, applying them 3-5 times per week to the vagina, vaginal opening, and external vulvar folds 1, 2
Water-based lubricants are recommended specifically for sexual activity to reduce friction and discomfort, with silicone-based lubricants being more effective as they last longer and provide extended relief 3, 4
Topical vitamin D or E can be considered as additional options for symptom relief 5, 2

Vaginal dilators can be beneficial for managing dyspareunia, especially when there is vaginal stenosis or pain with penetration, with the National Comprehensive Cancer Network recommending their use 5, 1
Pelvic floor physical therapy should be considered to improve sexual pain, arousal, lubrication, and overall satisfaction, with the American Cancer Society suggesting its benefits 5, 2
Topical anesthetics such as lidocaine can be applied to the vulvar vestibule before sexual activity to reduce pain 5, 1

The American College of Clinical Oncology recommends low-dose vaginal estrogen therapy (creams, tablets, or rings) as the most effective treatment for vaginal dryness and dyspareunia if non-hormonal treatments are ineffective 1, 2
Vaginal DHEA (prasterone) is an alternative for women who cannot use estrogen, improving sexual desire, arousal, pain, and overall sexual function, with the National Comprehensive Cancer Network suggesting its use 5, 2
Ospemifene (a selective estrogen receptor modulator) may be offered to postmenopausal women without a history of breast cancer who experience dyspareunia, with the American Cancer Society recommending its consideration 1, 2

The American Society of Clinical Oncology recommends careful consideration before using hormonal treatments in women with a history of hormone-sensitive cancer, especially breast cancer 1, 2
Women on aromatase inhibitors should generally avoid vaginal estrogen, with DHEA being a better option, according to the National Comprehensive Cancer Network 1, 2

The American Cancer Society suggests that psychoeducational support, sexual counseling, or therapy may be beneficial, especially when psychological factors contribute to sexual dysfunction 3, 4
Cognitive behavioral therapy can improve sexual functioning and should be considered as part of a comprehensive approach, with the National Comprehensive Cancer Network recommending its use 5
Integrative therapies such as yoga and meditation may help improve sexual function, according to the National Comprehensive Cancer Network 5