Vaginal Dryness and Painful Intercourse

Author: Courtney Misher, MPH, BS R.T.(T)
Last Reviewed: September 16, 2022

Vaginal dryness is a common problem for women who are receiving or have finished cancer treatments. It can cause painful intercourse (also called dyspareunia). Dryness happens when there is a decrease in vaginal lubrication. This decrease is often caused by a decrease or lack of estrogen in the body or changes to the vaginal tissue. These changes can be caused by:

  • Pelvic surgery.
  • Radiation to the ovaries.
  • Chemotherapy.
  • Hormone therapy.

The drop in estrogen levels cause the vaginal tissue to thin and make less natural lubrication, which can lead to itching, burning, or pain/discomfort all the time, not just during sexual activity.

The following may be helpful in managing vaginal dryness:

Vaginal Lubricants

There are many vaginal lubricants on the market, including AstroGlide, Durex, Femglide, KY, and Wet, as well as less expensive store brands. These products are designed to be used just before or during sexual activity.

Be sure to read the labels and choose products that are water-based/water-soluble, or silicone-based. Petroleum-based products are available, but these can damage the latex in condoms or diaphragms, making them ineffective. Petroleum can also act as a harbor for bacteria in the vagina and lead to infection. Avoid Vaseline and baby oil as well.

Ask the store pharmacist for help if you have questions about ingredients. Lubricants are available in standard preparations, edible flavors, and warming liquids. Be mindful that some products are more gentle to the vaginal tissues than others and you may want to avoid a lubricant that contains any type of herbal extracts, scents, or colors. These products can be purchased online if privacy is a concern.

Vaginal Moisturizer

Replens is a long-lasting vaginal moisturizer. It is designed to help vaginal tissue regain elasticity and moisture. Replens should be used 3 times a week for a minimum of 3 months, as it can take this long to achieve the desired effects. Women can also choose to safely use Replens or a vaginal lubricant prior to intercourse for added effect. This product is not estrogen-based (so it is safe for breast cancer patients). Ask the store pharmacist for help if you have questions. These products can also be purchased online if privacy is a concern.

Vaginal Estrogen

Vaginal estrogen creams are inserted in the vagina, generally 2-3 times a week at bedtime. These products are rapidly absorbed by the vaginal tissue, resulting in elevated estrogen levels in the body for the first 3-4 months. After that time, absorption is less but still results in higher-than-normal post-menopausal estrogen levels. Given the risk of estrogen stimulating breast cancer growth, these products are used with caution in breast cancer survivors.

Estring is a silicone ring that is inserted and remains in the vagina for three months. Vagifem is a tablet, inserted in the vagina once a day for 2 weeks, then twice weekly. Both products slowly release a low dose of estrogen, resulting in relief of vaginal dryness. Although the levels of estrogen in the body are lower with these preparations, they are not zero. The risk to breast cancer survivors is thought to be low, but long-term studies have not been done. Most oncologists are comfortable prescribing these products for breast cancer patients, realizing the importance of quality of life and the low risk involved. These products should not be confused with Femring, which is a form of hormone replacement therapy, which releases higher doses of estrogen.

In women with a uterus, there is concern that the lack of progesterone in these preparations could lead to endometrial changes. Studies have not confirmed this, but some physicians will follow women who use these products with vaginal ultrasound to detect any changes early.

Soy Products

Soy products have shown various benefits, including

  • Lowering cholesterol.
  • Lowering blood pressure.
  • Providing some relief for mild hot flashes during menopause.

Although it would seem likely that natural estrogens, such as soy, would help relieve vaginal dryness, studies of these products have not shown a benefit for vaginal dryness or atrophy (thinning or wasting of the vaginal tissue).

Other Suggestions for Dealing with Painful Intercourse

Decreased vaginal lubrication may not always be the primary or only cause of painful intercourse. Sometimes surgery or radiation therapy may have left scars or limited flexibility, causing discomfort. Trying different positions may help discover a position that is comfortable. Changing the view that sexual activity must be intercourse is another way to enjoy intimacy with your partner without pain.

Anxiety and tension can result in an inability to relax and enjoy yourself. Try creating the right environment: candles, lighting, music, or a glass of wine can help create the "mood." Communication is important between partners. Without knowing what is painful, your partner cannot help in finding the solution.

Other Helpful Links

OncoLink: Sexuality & Fertility Menopause and Menopausal Symptoms

American Cancer Society (ACS): Managing Female Sexual Problems Related to Cancer

Managing female sexual problems related to cancer. American Cancer Society. (2020, February 5). Retrieved September 13, 2022, from

Vaginal dryness. (2022, February 22). Retrieved September 16, 2022, from

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