Step 1: A good medical history during the physical exam

Before doctors prescribe any treatment to alleviate vaginal dryness, it is critical to get a solid history from the patient. Has she been treated for endometriosis, for cervical or uterine cancer, has she experienced bleeding after intercourse or during times not associated with her menstrual period, or is she going through menopause?

Is she suffering from painful intercourse, relationship uncertainty, unusual or abnormal stress, fatigue from over-exercise, or psychological or emotional trauma? Does she have a family history of high blood pressure, diabetes, cancer, depression or other chronic illness? Is she eating a proper diet, exercising in moderation and maintaining a reasonable weight?

All of these factors help describe the patient’s life situation. The dryness condition is often caused by a number of factors beyond hormonal changes, from over-exercise to excessive sweating, chemical irritants such as soap or scented feminine hygiene products to over-douching (10), and especially high emotional or psychological stress (11).

The physical exam is a very important aspect of evaluation. The vulvar area may show signs of irritation or redness. Scratching and irritation may make the vulva swollen and red which is often seen with yeast infections. Women with vaginal dryness are often less sexually active and as such are more sensitive in the vaginal area. For this reason, ask your doctor to use the narrowest speculum that allows for vision. It’s important to get vaginal cultures for both sexually transmitted infections and bacterial vaginosis and to have the discharge looked at under the microscope in the doctor’s office.

An odor, particularly one that is “fishy,” that is most typical of BV and is present in about half the cases. (Table x) The confusion occurs because the symptoms often overlap for the three most frequent diagnoses – BV, yeast (candidiasis) and Trichomonas. Atrophic vaginitis caused by low estrogen levels is another common cause. The use of pH paper, a whiff of the wet prep slide and a microscope make the office diagnosis an easy one to make. Any other diagnosis will be uncovered by the culture.

Other causes include sexual abuse (either currently or in a previous relationship), trauma or depression, high stress over a prolonged period, confusion over sexual preference or an existing romantic relationship or any number of extenuating circumstances.(12)