II. Definition

  1. Vaginal Dryness
    1. Inadequate vaginal lubrication which may lead to vaginal friction and microtrauma to the vulvar and vaginal epithelium
    2. May result in Dyspareunia

III. Causes

  1. Sexual arousal disorder
    1. See Female Sexual Dysfunction
    2. Inability to obtain or maintain adequate lubrication from sexual excitement
    3. Dissatisfaction with sexual relationship
    4. Negative body image
    5. Fear of Dyspareunia
    6. Sexual abuse history
    7. Restrictive sexual beliefs
  2. Chronic Vaginal Dryness
    1. See Atrophic Vaginitis
    2. Estrogen deficiency
      1. Menopause
      2. Premature Ovarian Failure
      3. Bilateral oophorectomy
      4. Postpartum State including Lactation
    3. Decreased perfusion
      1. Peripheral artery disease
      2. Anemia
      3. Diabetes Mellitus
    4. Neurologic Disorder
      1. Diabetic Neuropathy
      2. Spinal Cord Injury
      3. Pituitary tumor
    5. Iatrogenic causes
      1. Chemotherapy
      2. Pelvic radiation
    6. Medications
      1. Gonadotropin-Releasing Hormone Agonist (e.g. Nafarelin Acetate, Synarel)
      2. Selective Estrogen Receptor Modulator (e.g. Tamoxifen, Raloxifene)
      3. Aromatase Inhibitors
      4. Progestogens
      5. Danazol

IV. Management

  1. Treat underlying disorders
    1. See Female Sexual Dysfunction
    2. See Atrophic Vaginitis
  2. Vaginal Lubricants
    1. Vaginal Moisturizers (Replens) applied three times weekly
    2. Vaginal Lubricant (e.g. Astroglide) applied before intercourse
      1. Only water-based and silicone-based lubricants can be used with Condoms
      2. Avoid oil-based lubricants with Condoms

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