Can vaginal dryness and painful sex be treated without a prescription?

Vaginal dryness and pain during sex are common for women going through perimenopause and menopause. These issues happen mainly because oestrogen levels drop, which can make the vaginal lining thinner, drier, more sensitive, and prone to irritation. Some women cannot, or prefer not to, use hormone therapy. Even though studies show that low-dose vaginal oestrogen is the most effective treatment, fortunately, there are non-hormonal options to help:

1. Lubricants & Moisturisers

• Lubricants are applied during sex to reduce friction, and moisturisers are used regularly to keep the vaginal lining hydrated, usually every few days. [1]
• There is low-quality, inconsistent evidence that moisturiser help with painful sex, although they show more moderate improvement in general dryness. [2]
  

2. Hyaluronic Acid (HA)

• HA gels or creams can help with dryness, discomfort, and painful sex.
• Studies show using HA every few days can improve symptoms almost as well as low-dose oestrogen [3]

3. What Do Guidelines Say?

• UK NICE and other guidance recommend offering lubricants or moisturisers when hormone therapy isn’t suitable or wanted. [4]

Bottom Line

Women experiencing vaginal dryness or painful sex during menopause have several non-hormonal options with varying levels of evidence. Lubricants, moisturisers, and hyaluronic acid can provide relief. For some, these treatments are enough; for others, they can be combined with local or systemic hormone therapy.

It's also worth noting that very little, if any oestrogen is absorbed into the blood system from vaginal oestrogen creams and tablets. [5]

Always talk to your healthcare provider to find the best approach for you.

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References

1. Portman DJ, Gass MLS. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? 2014.
2. Danan ER et al. Ann Intern Med. 2024 Oct;177(10):1400-1414
3. Chen J, Geng L, Song X, Li H. Hyaluronic acid in postmenopause vaginal atrophy: a systematic review. 2021.
4. NICE. Menopause: Identification and management (NG23).
5. Santen RJ et al. Menopause. 2019 Dec 2;27(3):361–370

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