Let’s talk about the vaginal symptoms of menopause

Hot flushes are what gets the headlines when talking about menopause. But for millions of women, the most persistent, distressing, and silenced symptom is one they’re least likely to talk about: vaginal dryness.¹

It’s not just uncomfortable. It’s painful, often emotionally as much as physically. It can make sex difficult or even impossible.^1,2 It can leave women feeling less like themselves, isolated in their experience, and unsure where to turn. And yet, many women never mention it to a doctor, let alone their partner. This silence is the product of decades of cultural conditioning, medical hesitancy, and shame. But with up to 60% of postmenopausal women experiencing vaginal symptoms, it’s time to change the conversation.¹

The symptom everyone keeps quiet

Vaginal dryness is one of the most common symptoms of menopause. As oestrogen levels decline, vaginal tissues become thinner, less elastic, and more fragile. This can cause itching, burning, and pain during sex, sometimes known as vulvovaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM).¹

But despite how widespread these symptoms are, women rarely speak up. One large study found that over half of postmenopausal women experiencing vaginal discomfort had never discussed it with a healthcare professional.¹ Most didn’t know that safe and effective treatments were available. Many believed they had to “grin and bear it”, and that it was just part of ageing.¹

More than a physical problem

Vaginal dryness can impact every aspect of a woman’s life, from sexual wellbeing and body confidence to relationship intimacy and overall mental health.

One study found that vaginal symptoms negatively affected self-esteem, sexual relationships, and quality of life. Women reported avoiding intimacy out of fear of pain or embarrassment. Some felt their bodies had betrayed them. Others internalised the idea that they were no longer desirable with the symptom being a big problem to their sex life.³ 

So why don’t women talk about it?

Research about the stigma of vaginal symptoms revealed that silence around them is deeply rooted in taboo and embarrassment. Women said they felt uncomfortable discussing “intimate” symptoms, even with trusted clinicians.^1-3 There’s a strong sense of social conditioning in which women don’t talk about “those parts” or “those problems.”

Even within relationships, women were reluctant to bring it up. Some even worried that discussing discomfort might burden their partners. As a result, many women simply put up with pain, discomfort, or a loss of intimacy, assuming, wrongly, that nothing can be done.¹

This is a public health issue

Vaginal symptoms affect millions of women, and yet receive nowhere near the clinical attention they deserve. Part of the issue lies in healthcare settings themselves. Time pressures, lack of training, and hesitancy around initiating conversations all play a role.⁴

In one study, even women who did seek help reported feeling dismissed or inadequately informed. Others were unaware that vaginal oestrogen treatments existed or were safe, even in very low doses.²

Breaking the taboo

It starts with normalising the conversation. Vaginal symptoms are not shameful. They’re not rare. They’re not something to “tough out.” And they’re certainly not the end of a woman’s sexuality or identity. They’re a biological result of hormonal changes, and they’re treatable.

Effective treatments include:^1-4

• Vaginal oestrogen delivers a low dose of oestrogen directly to the vaginal tissue with minimal systemic absorption.

• Non-hormonal options such as water-based lubricants and vaginal moisturisers can be used instead of hormone-containing medicines.

• Prescription treatments which include medicines which act on the vaginal lining without affecting the womb.

• Counselling and psychosexual support for women whose symptoms have affected intimacy or body confidence.

The best approach depends on individual circumstances and should be discussed openly with a healthcare professional. 

The numan take

Vaginal dryness is one of the most common symptoms of menopause, and one of the most stigmatised. The silence surrounding it highlights shame about ageing, discomfort with female sexuality, and a long-standing gap in women’s health education. But by talking openly, educating clearly, and advocating for better care, we can break the taboo. 

References

1. ^{Parish SJ, Nappi RE, Krychman ML, Kellogg-Spadt S, Simon JA, Goldstein JA, et al. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. International journal of women’s health. 2013;5: 437–447.}

2. ^{Duffy O, Iversen L, Hannaford PC. The menopause ‘It’s somewhere between a taboo and a joke’. A focus group study. Climacteric: the journal of the International Menopause Society. 2011;14(4): 497–505.}

3. ^{Nappi RE, Mattsson LÅ, Lachowsky M, Maamari R, Giraldi A. The CLOSER survey: impact of postmenopausal vaginal discomfort on relationships between women and their partners in Northern and Southern Europe. Maturitas. 2013;75(4): 373–379.}

4. ^{Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause (New York, N.Y.). 2013;20(10): 1043–1048.}