Coping with Vaginal Dryness During Cancer Treatment

When it comes to cancer side effects, losing your hair is likely the most well-known. But if you have a vagina, there’s another one that people don’t often talk about: vaginal dryness.

Vaginal dryness can also cause other symptoms, like burning, itching, vaginal tearing, and even urinary tract infections. It can also cause pain and irritation during sex.

The good news is there are some things you can do to help manage vaginal dryness. Here’s what you need to know.

Understanding the cause

There are several different types of cancer treatments that may cause vaginal dryness.

Chemotherapy. This type of treatment affects rapidly growing cancer cells. Unfortunately, it also kills healthy cells, too. That includes the ones in your ovaries. When that happens, your ovaries may stop making eggs and estrogen. Your estrogen levels will drop, and you may go into menopause. This change is sometimes short-term (temporary). But it might be lasting (permanent). Lower estrogen levels mean you may have menopause symptoms, including vaginal dryness.

Pelvic radiation. Radiation directly to your vagina can make its lining thin and fragile. This makes it more vulnerable to dryness. If your ovaries get a large dose of radiation, they can stop working, too.

Hormonal treatments. If you have breast cancer, your healthcare provider may recommend treatments that affect estrogen levels like tamoxifen or aromatase inhibitors. These medicines lower the amount of estrogen in your body. This is good, because breast cancer cells need estrogen to grow. But these treatments can also cause vaginal dryness.

Surgery. If your ovaries have been surgically removed as part of your cancer treatment, you’ll go into early or premature menopause. This can also cause vaginal dryness due to low estrogen levels.

Finding relief

If you have vaginal dryness during your cancer treatment, you don’t have to suffer in silence. Talk to your healthcare team about the best option for your situation. Here’s what may help:

Vaginal moisturizers. They add moisture around and inside your vagina. There are different kinds of vaginal moisturizers:

• Gels and creams. You place these into your vagina with a disposable application, like you would a tampon.

• Vaginal melt. This is a pill that you put into your vagina with your fingers. Once it’s inside, it “melts” and is absorbed by your body.

Use vaginal moisturizers several times weekly around bedtime. It takes about 3 months to see results. You can buy vaginal moisturizers online or at your local pharmacy. If you are very dry, look for a hydrating moisturizer.

Don’t use Vaseline as a moisturizer, even if you’re in a pinch. It may irritate your vagina even more. It also raises the chance of infection.

Vaginal lubricants. Use them during sex to prevent pain from dryness. Choose a product that’s water- or silicone-based. Don’t use ones that contain petroleum or oils, as they can cause infection. Don't use any colored or scented lubricants either. These can cause more irritation.

Put the lubricant in your vagina every time you have sex. It should also go on anything that enters your vagina, like your partner’s penis.

Vaginal estrogen. These are topical products that you insert into your vagina 2 to 3 times a week. You can only get them with a prescription. They work well, but they may not be safe if you have or had certain types of cancer that are hormone-related, like breast or ovarian cancers. Talk with your provider to see whether this product is a good option for you. Follow any instructions your provider gives you.

Vaginal estrogens come in the following forms:

• Suppositories. You put them into your vagina every night at bedtime for 2 weeks. After that, you’ll use them twice a week.

• Vaginal ring. You’ll insert it into your vagina and push it as far back as you can. You’ll replace it every 3 months.

• Cream. You put it inside your vagina and vaginal opening 2 to 3 times a week.

Other tips for sex

Lubricants, moisturizers, and vaginal estrogen can all go a long way to treat vaginal dryness. But it can still persist and make sex uncomfortable. These tips can help:

• Tell your cancer care team and gynecologist about your pain. They may have other suggestions for relief.

• Focus on foreplay. The more you are sexually aroused, the more fluid your vaginal walls produce. Show your partner ways to please you that don’t cause pain.

• Consider pelvic physical therapy. Once you’ve felt pain during sex, you may unconsciously tense up before and during sexual situations. When you tighten your inner vaginal muscles, sex may become more painful. A pelvic physical therapist can show you ways to relax these muscles during sex.

Vaginal dryness during cancer is very common. But there are many things that can help. Often, vaginal dryness improves on its own once you’ve finished your treatment. But it may last if cancer treatment causes permanent menopause.