Over The Counter Treatments for Vaginal Dryness

By Sara Twogood, MD

If you’re familiar with the “feminine aisle”, I don’t need to tell you there are many options for over the counter (OTC) treatment of vaginal dryness.

The medical terminology for “vaginal dryness” is GSM, standing for “genitourinary symptoms of menopause”.

But there’s a problem with this term – people who are NOT in menopause can suffer from these symptoms and have this diagnosis.  That’s really confusing. GSM is most common in menopause because of the inherent low estrogen state. However, ANYTIME a female is in a low estrogen state these symptoms and diagnosis may show up. These low estrogen states include postpartum and breastfeeding, taking hormonal contraception, perimenopause (still having periods but also having menopausal symptoms), and taking medication for a history of breast cancer (like tamoxifen).

The symptoms are usually all clumped under the term “vaginal dryness” but could also include discomfort, pain with sex, burning, itching, inflammation. GSM can cause urinary symptoms too – urgency, frequency, stress incontinence. This is because the bladder is RIGHT next to the vagina, the urethra travels right above the vagina, and the pelvic floor muscles are affected by low estrogen.

Gold standard treatment for GSM

Vaginal estrogen is considered the gold standard treatment. When symptoms are caused by low estrogen, adding back estrogen works like a charm. It helps restore the cellular functioning.

Topical DHEAS (like the brand name IntraRosa; also a prescription medication) works great. DHEAS is converted into estrogens and androgens (like testosterone) when inserted into the vagina. Vaginal estrogen levels therefore increase. The number of cells in the tissues in and around the vagina increase, plumping up the tissue and helping relieve symptoms.

P.S. Do not confuse this with the oral supplement DHEAS! I know oral DHEAS is marketed on IG as a libido or sexual function fixer. It’s never been shown to work for these symptoms when taken orally. But vaginally … it works great!

But, all that being said ….

I know sometimes there is a long wait for an appointment to get a prescription …

or your insurance sucks and it doesn’t cover topical estrogen or DHEAS …

or you want to try something OTC first before you see your doctor. This is usually just fine! If / when you see your doctor, make sure you tell her what you tried, what it helped with, and what you did or didn’t like about it.

Or what if you had a bad experience with estrogen in the past, or just want to try something non-hormonal?

What then? What are your options?

Polycarbophil based vaginal moisturizer

(most common brand name: Replens)

This moisturizer works by producing a film over the vaginal tissue. That film remains attached to the superficial cells, hydrating them and lubricating the vaginal wall.

In small studies it helped optimize vaginal pH, and helped with subjective symptoms of dryness, pain with sex, and sexual function.

Details: it comes in pre-wrapped individual packaged syringes, like a lot of yeast infection creams. You place inside the vagina and release the moisturizer inside, then remove the syringe and toss it.

How to use it: company recommends using every 3 days or so – but it can be used more or less frequently based on symptoms.

Other tips: don’t use as sexual lubricant – it needs time to work! It may increase vaginal discharge -  both because of the cellular hydration (which is good!) but also the product can work its way out of the body and be noticeable then too.

Hyaluronic acid

(one common brand name: Revaree)

You may be familiar with hyaluronic acid because it is in many moisturizing products, especially for the face. It’s a lubricant with ionic properties that attracts water (if you’re into chemistry, this helps explain ionic bonds better: LINK https://www.thoughtco.com/ionic-compound-properties-608497). Attracting water into the cells increases tissue volume and the integrity of the superficial vaginal cells (called the vaginal epithelial cells) – this helps restore some of the cellular function that is lost with low estrogen. Studies show it helps optimize vaginal pH and improves symptoms of GSM and pain with sex.

Details: it usually comes in pre-formed capsules that are placed inside the vagina, where they are warmed up (due to internal body temperature) causing the hyaluronic acid to come out and coat the vaginal walls.

How to use it: similar to other vaginal moisturizers, it’s recommended to use every 2-3 days, depending on symptoms, but this can be adjusted more or less frequently depending on symptoms.

Other tips: Many generics are on the market with slightly different formulations. Try a few and if you’re not crazy about them, try a different brand!

CBD

(a popular brand: Foria)

CBD has been touted as a magical elixir – and I don’t want to burst your bubble … but there is no such thing. While CBD is being studied pretty extensively for skin disorders there were no studies I could find that showed it worked when used vaginally. Most of the data is anecdotal. However, when used topically, it’s been shown to decrease inflammatory markers that get in the way of cellular function. Theoretically it could also decrease the inflammatory markers that cause itching, pain, irritation when used vaginally too.

Bottom line – there are so many treatment options for vaginal dryness and similar symptoms. You don’t have to just put up with it!