Vaginal dryness is a problem that can affect both menopausal women and women of reproductive age. The causes of vaginal dryness are mostly hormonal, and the condition can seriously affect your sex life and self-esteem. Finding and treating the cause is the main goal to restore the normal rhythm of life and sexual desire. The vagina is a muscular-elastic tube 8-10 cm long that connects the external sex organs with the uterus. It is part of the birth canal and the fetus passes through it during birth. The vagina is lined by stratified squamous neuroprotective epithelium and contains glycogen-rich cells. Vaginal and cervical glands produce vaginal secretions. With vaginal dryness, there is a reduced production of vaginal secretions. As a result of vaginal dryness, patients complain of pain, burning and redness in the vaginal area, pain and bleeding during sexual intercourse and a reduced desire for sexual contact for this reason. Another common symptom is repeated (recurrent) infections of the genitourinary system, which are manifested by frequent and painful urination (dysuria). What are the most common causes of vaginal dryness? 1. Perimenopause and menopause – the most common cause of vaginal dryness. In the period of perimenopause, the secretion of estrogens gradually declines, during which the vaginal mucosa atrophies and the secretion of the glands of the vagina and cervix decreases. Lack of estrogens is the main cause leading to vaginal dryness in women; 2. Breastfeeding – during the period of breastfeeding, the increased secretion of prolactin suppresses the production of follicle-stimulating and luteinizing hormones, respectively of estrogens and progesterone. The so-called lactational amenorrhea, the result of which is also vaginal dryness; 3. Total hysterectomy – surgical intervention in which ovaries and fallopian tubes are removed together with the uterus (surgical castration). This leads to premature menopause with a lack of estrogen production and subsequent vaginal dryness; 4. Chemo- and radiotherapy – the so-called radiation castration. Antitumor therapy in the area of ​​the small pelvis or locally disrupts the normal functioning of the reproductive organs and leads to the development of atrophic vaginitis. Among the causes of vaginal dryness can be strong stress, depression, lack of sexual arousal before intercourse, the presence of some underlying diseases such as diabetes mellitus, Sjogren’s syndrome; the use of vaginal douches and products for intimate hygiene containing perfume substances, etc. A pelvic examination of a patient with vaginal dryness may reveal thinning of the vaginal mucosa, edema, and redness in the vaginal area. When examining sex hormones, estrogen deficiency and hormone values ​​characteristic of the menopause period are found – low levels of estrogens and high levels of follicle-stimulating hormone.To relieve vaginal dryness, it is recommended to initially try only using water-based lubricants and increasing the time to reach sexual arousal. In the absence of effect from these methods, hormone replacement therapy with local or systemic estrogens is applied. Topical estrogens are preferred over those with a systemic effect, as they act locally and do not pass as much into the bloodstream. Topical estrogens are administered in the form of vaginal globules, vaginal creams, and vaginal rings. Therapy with vaginal globules and creams is daily for two weeks, then applied several times a week as needed. Vaginal rings periodically release estrogens and are replaced at regular intervals. Systemic estrogens are not a preferred treatment option because they increase the risk of cardiovascular events, endometrial cancer, breast cancer, etc. It is recommended to limit the use of vaginal douches and intimate cosmetics containing perfume substances. More frequent sexual contact increases blood flow to the genitals and helps relieve vaginal dryness.