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And What Can I Do About It?
Welcome to Ask Barbie, where I answer your burning questions about menopause.
Today’s burning question is all about your burning vagina. Or at least it feels like it’s burning. The question is, “Why is my menopausal vagina so dry? And what can I do about it?”
So, let’s address this systematically.
We’ll start with a little bit of anatomy.
All three of these characteristics serve to make your vagina a vagina.
All these qualities of your vagina that make it a vagina are due to one thing and one thing only: Estradiol. Estradiol, the form of estrogen produced by your ovaries, is the very reason your vagina functions as a vagina.
So estradiol is your vagina’s fountain of youth. It keeps your vagina young and fit.
Before you become menopausal, the estradiol produced by your ovaries keeps your vagina thick, wrinkled, and moist. But when you lose your estradiol at the time of menopause, BAM! All three of these qualities disappear. Your vagina starts aging.
When this happens at the time of menopause, you perceive these changes as a dry, uncomfortable, itchy, burning vagina. It might even feel like you have a vaginal infection. It’s all due to vaginal aging.
Vaginal Aging
What’s really happening with vaginal aging is that your vagina is shrinking. And if you don’t do anything to prevent the shrinkage, your vagina will become extremely narrow, short, and unusable. So the cold heart fact is that your vagina is disappearing … just like your estradiol did.
Now think about this. Under normal circumstances, when you have plenty of estradiol, you don’t even know you have a vagina. You never feel your vagina unless you’re using it for sexual activity. But when you lose all your estradiol at the time of menopause, you suddenly feel your vagina. You know it’s there … even when you’re not using it for anything.
Well, it turns out that your vagina talks to you. And your vagina’s vocabulary is very limited. It’s as simple as this: If you know you have a vagina, it means that your vagina does not have enough estradiol.
Of course, if estradiol is the only thing that makes your vagina a vagina, the only remedy for fixing your disappearing vagina is going to be estradiol.
There are two categories of estradiol:
Systemic estradiol is what you use to alleviate all your non-vaginal symptoms and to prevent the three diseases of estrogen deficiency, which are heart attack, osteoporosis, and Alzheimer’s.
So there are local vaginal estradiol products available specifically for your vagina. They will prevent menopausal vaginal aging from ever occurring, or reverse it to some degree if it has already occurred.
These local vaginal estradiol products made specifically for your vagina do not travel anywhere. They are made with huge estradiol molecules that are too big to get into your bloodstream and go anywhere. Therefore, they stay confined to your vagina only, and they prevent vaginal aging only. And, because they are confined to your vagina only, they have zero risk. None at all.
Unfortunately and inappropriately, despite the fact that they have zero risk, they all have package labeling that warns you of all the risks pertinent to systemic estradiol. This is for the legal protection of the pharmaceutical companies that make them. It is not necessary for you to worry about any of these risks.
This is something we call “class labeling.” Class labeling is when the pharmaceutical company labels all drugs in a certain category similarly … even if they do not have the same risks or any risks at all. And that’s the case here. These local vaginal estradiol products have none of the same risks as other estradiol products, but all the same false warnings.
So, what are your options with regard to these local vaginal estradiol products? Well, there are three categories of options.
They all have advantages and disadvantages. So, it’s always a matter of trade-offs. Here’s how they differ:
Estradiol vaginal creams come in a tube that you squeeze into an applicator. Then you just expel the contents of the applicator into your vagina. The advantages are that they are simple to use, and you can put them on the inside or the outside. The disadvantage is that they are somewhat messy.
Estradiol vaginal inserts are either little pills in an applicator, or little suppositories without an applicator. For both, you just insert them into your vagina. The advantage is that they are nice and neat. The disadvantage is that you can’t put them on the outside if you have external symptoms.
And the Estadiol Estring vaginal ring is a ring that you fold, insert into your vagina, and leave in place for three months. It releases local vaginal estradiol into your vagina for three months. After that, you reach into your vagina, pull out the ring, and put in another one. The advantage is that it acts over a three-month period of time. The disadvantage is that you have to put it in and out of your vagina yourself. (Some women don’t like doing that.)
And here’s a warning: There are two estradiol vaginal rings.
They are not interchangeable.
The Femring is systemic estradiol that consists of little, tiny molecules that get into your bloodstream and travel all over your body. So, the Femring can prevent all your other non-vaginal symptoms of estrogen deficiency, as well as the three diseases of estrogen deficiency … if the dosage is high enough for you. It has all the risks of systemic estradiol.
The Estring is local vaginal estradiol that consists of great big, huge molecules that cannot get in your bloodstream, and cannot travel anywhere. So, the Estring can only prevent your vaginal symptoms and save your aging vagina. It cannot prevent any of your other non-vaginal symptoms of estrogen deficiency or the three diseases of estrogen deficiency. But, it has zero risks.
All women need to save their vaginas! And without the life-saving estradiol that is essential for your vagina, you will lose your vagina.
Your vagina is an estrogen hog that does not like to share its estradiol with any other part of your body. That’s why these products are made specifically for your vagina. Even when the rest of your body is perfectly satisfied with your estradiol dosage, your vagina will probably want more, more, more. Regardless of whether or not you use systemic estradiol, you will probably still need local vaginal estradiol. These products exist specifically for saving your vagina.
Do not assume that estriol can do the job of estradiol.
There are many vaginal estriol products, both pharmaceutical and non-pharmaceutical. But estriol is the estrogen produced by the placenta for the benefit of a baby during pregnancy. It is not for the benefit of your vagina ever.
There are no other vagina-saving options that can do as much as these local vaginal estradiol products. There are other products for dryness, and there are other products for sex. But neither can do the job of estradiol. Only estradiol can do the job of estradiol.
In order to choose what’s right for you, first define your goals.
If you want to save your vagina, use one of these local vaginal estradiol products.
If all you want is to keep your vagina moist, you can use a vaginal moisturizer. It will moisturize your vaginal skin just like a lotion will moisturize the rest of your skin. This means that the moisturization will be temporary, and it will not save your vagina. A vaginal moisturizer is something that you use on a regular basis. If you stop moisturizing, your vagina starts drying.
If all you want is to have less friction during sex, you can use a lubricant. A lubricant is for the sole purpose of sexual activity. Its goal is to make sex more comfortable. So, if all you want is to be able to have sex without the pain that comes from a dry vagina, you can use a vaginal lubricant. And there are many lubricants from which you can choose. But again, no lubricant can do anything that estradiol can do. No lubricant can save your vagina. And you only use a lubricant in the heat of the moment, for purposes of sexual activity. You do not use it on a regular basis.
And be wary of the vaginal laser craze. It’s crazy.
There are all sorts of professionals … promoting all sorts of vaginal laser devices … promising all sorts of vaginal “rejuvenation.”
Well, I hate to tell you, but they’re all scams. Not a one of them can save your vagina.
Think about it: These lasers fry your dry vagina. There is no way that frying your dry vagina is going to make it younger or more physically fit. All vaginal lasering will do is make your vagina a great big money pit. That’s because these procedures are very expensive.
All vaginal lasers require three painful treatments, followed by annual touchups. But all the lasering in the world cannot “rejuvenate” your vagina.
Face it: Your vagina is old. And the only thing that’s gonna keep it young is what kept it young in the first place: Estradiol.
Knowing that loss of estradiol results in loss of your vagina is very powerful. And the earlier in your menopausal journey you start saving your vagina with vaginal estradiol, the better off you’ll be. You should never sacrifice your vagina, regardless of whether or not you want to use it for anything.
So, I hope that this Ask Barbie answer helps you save your vagina.
Ask Barbie: Why is My Menopausal Vagina so Dry? And What Can I Do About It??September 30, 2025 - 7:28 pmLosing your Estradiol means losing your vagina. Here’s how to save it.
Ask Barbie: How Will I Recognize the Symptoms of Peri-Menopause?September 2, 2025 - 11:43 amSymptoms of peri-menopause fall into two categories. Know and watch out for them.
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