This is something that’s bad for women and for the men who want to be with them.

Some of the afflicted women say it feels like sandpaper is lining the most intimate area of their bodies…others say it gets so bad that cracks actually form in their vaginal walls.

I apologize for these unsexy, unsettling images!

But the sad fact is that well over half of women suffer from some degree of vaginal atrophy and dryness at some point in their lives, especially after menopause—and the condition can be a serious impediment to sex. In addition to pain or bleeding during intercourse, symptoms that can arise anytime include vaginal irritation, tenderness and itching, as well as painful urination and/or urinary incontinence.

Oral hormone replacement therapy improves vaginal lubrication…but it exacts a high price by increasing the risk for heart disease, stroke, blood clots and breast cancer.

So if you (or the lady you love) are experiencing problems with vaginal atrophy and dryness, you doubtless want help—without such risks.

That’s why I called Laurie Steelsmith, ND, LAc, coauthor of Great Sex, Naturally. She told me about several safe, effective, natural therapies that alleviate the problem. And you don’t even need to swallow any pills, since the remedies she recommends are applied topically.


Vaginal atrophy and dryness, or VAD (a term coined by Dr. Steelsmith and her coauthor/husband), is defined as “the decreased size, reduced elasticity, thinning or increased fragility of vaginal tissue, accompanied by a reduction of the vagina’s natural lubrication.” Most often it is caused by the drop in estrogen level that occurs at midlife, which reduces genital blood flow and lowers the collagen content of vaginal and vulvar tissues.

As the protective mucosal barrier of the vagina breaks down, VAD can lead to vaginitis (inflammation of the vagina)…cracks or sores in the vaginal walls…and an increased risk for vaginal yeast and bacterial infections. Obviously, this can make sex excruciating for a woman (and darned uncomfortable for her partner).

If your only symptom is slight vaginal dryness that makes intercourse a bit uncomfortable, you probably need nothing more than to use a personal lubricant right before sex. Dr. Steelsmith recommends the all-natural brand Aloe Cadabra. (For another Bottom Line article on personal lubricants, click here.)

However, for more severe VAD symptoms, you’re probably better off trying regular applications of a topical product that actually makes the vagina more like its former comfortable, healthy, lubricated, flexible and, yes, exciting self!


If you suspect that you have VAD, your first step is to see your gynecologist, primary-care doctor or naturopathic physician to confirm the diagnosis and to discuss the treatment options that would be safe and effective for you.

The natural VAD remedies that Dr. Steelsmith most often recommends for her own patients come in the form of vaginal suppositories. They work by helping restore the integrity of the protective mucosal barrier of the vagina. Don’t let the idea of suppositories bother you—they are small and sort of slippery, so they’re painless to insert. All you do is gently place the suppository in your vagina at bedtime and let it work overnight. (You might want to wear a panty liner.)

With your doctor’s OK, you can try either of the following natural treatments for VAD, Dr. Steelsmith suggested. If you do not experience relief within a month, try the other one for a month…or try both at once for a month. Typically improvement is seen within a few weeks. If the suppositories help you, your doctor may recommend that you continue using them for as long as desired. Typical dosage: One suppository placed in the vagina at bedtime each night, reducing to every second or third night after two weeks. Options…

Vitamin E suppositories. These work by stimulating the normal mucosa of the vagina and vulva, increasing protective moisture and decreasing the risk for infection. Vitamin E suppositories are safe. They are sold over-the-counter in many health-food stores and online.

Black cohosh/wild yam suppositories. This type of combination product contains no actual hormones. However, the herb black cohosh has active constituents that may have mild estrogen-like effects on your tissues…while wild yam may have progesterone-like and estrogen-like effects. Both ingredients help improve vaginal lubrication and support the health of vaginal tissues. These suppositories are available through licensed naturopathic physicians. Though you may find them being sold online without a prescription, it is best to use them under medical supervision because they may not be appropriate for people with a history of certain medical conditions, such as breast or uterine cancer, blood clots, liver disease, seizure disorders, stroke or protein S deficiency.

If your VAD continues despite the treatments above, ask your doctor about prescription-only topical hormonal therapies, Dr. Steelsmith suggested. One option is vaginal suppositories of DHEA, a hormone that relieves VAD while also boosting libido and energy and reducing stress. Another possibility is a natural estrogen vaginal cream or suppositories containing estriol, a type of estrogen that’s much weaker—and less likely to cause side effects—than the estradiol and other estrogens commonly used in hormone replacement therapy. Though women with a history of breast cancer or any other estrogen-related cancer probably should not use DHEA or estrogen, for many other women, these hormonal therapies offer safe and effective ways to overcome VAD.