Menopause, Painful Sex and Vaginal Dryness: What You Can Do

Even if you can't—or don't want to—use systemic hormone therapy, you still have options.

Hot flashes tend to get most of the attention when people talk about menopause. But for many women, the symptoms that linger—or become more noticeable with time—are much more private: vaginal dryness, burning, irritation, pain with penetration, urinary discomfort or repeated urinary tract infections.

These symptoms are part of genitourinary syndrome of menopause (GSM). As estrogen and other sex-hormone levels decline, the tissues of the vulva, vagina and lower urinary tract can become thinner, drier and less elastic. Natural lubrication may decrease. The vaginal opening can feel tight or tender. Sex that was once comfortable may begin to hurt. Some women also notice urinary urgency, burning or recurrent UTIs.

The good news is that systemic menopausal hormone therapy—pills, patches, gels or sprays that circulate throughout the body...