is cbd oil for vulvovaginal atrophy and painful sex effective

Natural Remedies for Vaginal Atrophy

When you get a diagnosis of a chronic condition like vaginal atrophy (or VA, also known as genitourinary syndrome of menopause), you might be wondering if your only treatment option is estrogen therapy, in all its various forms like rings, creams, or tablets. And while up to 90% of women with moderate to severe VA show improvement with this treatment type, there are “natural” options that can help lessen (or even stop!) VA symptoms if estrogen therapy isn’t working for you—or you just want to explore other treatments. Read what our experts have to say on natural remedies for VA.

When you think “natural” solutions for VA, you might not be thinking of sex—but that’s exactly where your mind should go. “The old adage, ‘Use it or lose it,’ really applies here,” says Sheryl Kingsberg, Ph.D., chief of the division of behavioral medicine in the department of OB/GYN at MacDonald Women’s Hospital in Cleveland. “Exercising the vaginal tissues is important to treat and/or prevent VA/GSM.” VA not only includes thinning and drying of the vagina, but narrowing and shortening of the vaginal canal, which is stretched when you have sex. To make sure it’s comfortable, read on.

Using lubrication when having sex is vital to maintaining comfort, Kingsberg says, because VA hinders our ability to lubricate. Making sure those lubes are all-natural isn’t as tricky as it might have once been—you just need to get savvy at reading labels. Steer clear of anything petroleum-based. Look for all-natural, water-based products without glycerin or parabens. It’s best to find a product that has a similar pH to vaginal secretions (usually 3.8-4.5). Warming agents can also cause irritation and should be skipped.

If you want the optimal natural lubrication, try extra-virgin coconut oil, says Sheryl A. Ross, M.D., an obstetrician and gynecologist (OB-GYN) in Santa Monica, CA. “It’s a cleaner, hydrator, and moisturizer all in one,” she says. Just know that if you need to prevent sexually transmitted infections (STIs), oils can damage condoms, and shouldn’t be used as lube. Some people might be allergic to certain oils in their vagina, so watch out for any irritation. Other natural oils to try include olive and sea buckthorn oil (a study of this oil found promising results for VA).

While lubricants play an important role during sex, moisturizers can help reduce vaginal dryness not only when you’re getting it on but throughout the day too, Kingsberg says. Just like lubricants, it’s important to read the ingredient label for moisturizers, avoiding any products with parabens, glycerin, or propylene glycol. Look for products that are certified organic (like the YES VM vaginal moisturizer or the Good Clean Love product line). Most women’s go-to pick? Hyaluronic acid. You can get it in different forms over the counter or with a prescription, including applicators and inserts. Aloe vera is another natural choice.

If you’re experiencing pain, CBD oil may offer some relief, Dr. Ross says. “It’s a great anti-inflammatory medicine when you’re thinking about natural options,” she says. If you’ve ever browsed in a CBD dispensary, you might be overwhelmed by the number and variety of products. In this case, look for a lubricant that contains the ingredient, she suggests.

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If you’re not able to use estrogen therapy (like if you’ve had breast cancer or have coronary artery disease), or have experienced troublesome side effects from it (which can include hot flashes, vaginal discharge, or blood clots), using vitamin E suppositories might be a possibility, a 2016 study found. It looked at surveyed results of 52 postmenopausal women divided into two groups, receiving either 100 IU of vitamin E suppositories or 0.5 g of conjugated estrogen cream. Researchers found that vitamin E suppositories relieved VA symptoms—but always talk about any new treatment option with your doctor before trying!

Like so many things in life, a plant-based diet and regular exercise routine is important for overall vaginal health, Kingsberg says. Diet can provide invaluable nutrients and vitamins. Exercise can improve blood flow. A probiotic might help VA, too, according to one study. Beginning healthy habits early in life is also extra helpful, Dr. Ross says. “Starting at an earlier age gives your tissue a fighting chance,” she says. “We’re always trying to fix things at the last minute, but a good offense is the best defense.”

A lesser-known symptom of VA is pelvic floor dysfunction, Kingsberg explains. Sometimes, pain in the vaginal area actually stems from this condition. Talk to your OB-GYN about getting a referral to a physical therapist who specializes in the pelvic floor for a natural way of addressing this, she suggests. “Everybody tends to know about Kegel exercises, but sometimes they can be unhelpful depending on the problem,” Kingsberg says. If you’re experiencing shortening of muscles because of tension, for example, you wouldn’t want to tense those muscles more with Kegels. A physical therapist can give you appropriate, personalized exercises.

Ever heard of a vaginal dilator? These cone-shaped devices are easy to find online. There are also types you can wear while sitting or standing, so explore which option is best for you, suggests Dr. Ross. Unless you’re engaging in penetrative sexual activity daily, adding a dilator to your sexy-time routine can be helpful, Kingsberg says. A couple of minutes of insertion a few times a week should keep things stretched. Then, she says, when you do have intercourse, it shouldn’t be painful.

Keep in mind that not all natural products are created equal. “Vaginal pH is very sensitive,” Dr. Ross says. “So different types of gels and other products that are plain as far as no additives, fragrances, and parabens will be more accommodating.” Sometimes those additives, which also include sodium sulfates and other chemicals designed to make products smell pretty, can trigger a rash or yeast imbalance. Be on the lookout for “for anything that would cause irritation, like douching,” Kingsberg adds. As with trying anything new, even “natural,” be sure to discuss use with your doctor first.

  • Effectiveness of Estrogen Therapy: ObG Project. (n.d.). “Genitourinary Syndrome of Menopause: New Name, Old Problem.”
  • Getting pH Right:Climacteric. (2016). “Treating Vulvovaginal Atrophy/Genitourinary Syndrome of Menopause: How Important is Vaginal Lubricant and Moisturizer Composition?”
  • Sea Buckthorn Study:Maturitas. (2014). “Effects of Sea Buckthorn Oil Intake on Vaginal Atrophy in Postmenopausal Momen: A Randomized, Double-blind, Placebo-controlled Study.”
  • Vitamin E Suppositories:Iranian Journal of Nursing and Midwifery Research. (2016). “A Survey of the Therapeutic Effects of Vitamin E Suppositories on Vaginal Atrophy in Postmenopausal Women.”
  • Estrogen Therapy Side Effects: Cleveland Clinic. (2020). “Vaginal Atrophy: Management and Treatment.”
  • Probiotics and VA:Menopause. (2014). “Association Between the Vaginal Microbiota, Menopause Status and Signs of Vulvovaginal Atrophy.”
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Sheila Mulrooney Eldred is a graduate of Columbia’s School of Journalism and a former newspaper reporter. As a freelance health journalist, she writes about everything from life-threatening diseases to elite athletes. Her stories have appeared in The New York Times, Nature, FiveThirtyEight, Pacific Standard, STAT News, and other publications. In her spare time, she and her family love running, cross-country skiing, and mountain biking in Minneapolis.

Doctors Weigh In: Favorite Lubes and Moisturizers for Vaginal Atrophy

If you’re living with vaginal atrophy (VA)—a.k.a. genitourinary syndrome of menopause—you’re likely no stranger to discomfort, whether it’s vaginal dryness or pain with sex. But there’s good news: There are many different products out there (many you can find right on the drugstore shelves) that can manage these symptoms and help you feel your best. Keep reading to learn what to look for in a vaginal moisturizer or lubricant, with recommendations straight from gyno experts.

First up are vaginal moisturizers, which help target many symptoms of VA, according to the Cleveland Clinic. These hormone-free products add moisture to the vaginal tissue—and can be used for increased comfort throughout the day, not just when you’re having sex. “Moisturizers are very helpful for the discomfort that comes with dryness,” says Evelyn Mitchell, M.D., an obstetrician and gynecologist (OB-GYN) with Keck Medicine of the University of Southern California in Los Angeles. “Moisturizer will last throughout the day and night.” There are a variety of options on the market, so let’s break them down even further.

For Dr. Mitchell, her go-to recommendation for patients with vaginal dryness is Replens, a brand of vaginal moisturizer. “It’s wonderful—some of my patients buy it in bulk because it’s so good,” she says. “It’s completely safe, and you can use every day if you want to.” Replens comes as cooling gel or cream that you can apply to the inside of the vagina as well as the vulva (the outer genital area) to bring back some moisture to these sensitive tissues, she says.

There are plenty of other moisturizers available over-the-counter you can try, including Regelle, Sylk, Yes, and more. When trying new products, check the labels first—the vaginal area is super sensitive, so you don’t want to add any ingredients that could be extra irritating on top of your other VA symptoms. For example, parabens and propylene glycol are additives that may irritate your skin, says the Cleveland Clinic—so you may want to pass on these.

Personal lubricants are another widely available option to help manage the symptoms of VA. “While it dries out pretty quickly compared with moisturizer, I still recommend lubricants before intercourse,” says Dr. Mitchell. Compared with moisturizers, lubricants are usually reserved specifically for sexual activity to relieve dryness and pain, with popular brands including Astroglide, K-Y, Uber Lube, and many others. But how do you know which one to buy?

When it comes to lube, the three main types you’ll find on the market are water-based, silicone-based, and oil-based. If you’re using condoms (the best way to prevent sexually transmitted infections, or STIs) you’ll want to steer clear of oil-based lubes, which can break down the condoms and put you at risk, per the American College of OB-GYNs. “In terms of lubricants for VA, I would recommend a silicone-based lubricant, because water-based tends to dry out faster,” says Dr. Mitchell.

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Your doctor may also recommend plant-based lubricants for VA, says Susan D. Reed, M.D., an OB-GYN and program director of the Women’s Reproductive Research Program at University of Washington Medicine in Seattle. That’s largely because they are less likely to contain irritating ingredients, like perfumes. “Coconut oil is one of the basic go-to options,” she suggests. “Anything that is hypoallergenic, is a good idea, including natural plant-based lubricants.” But again, as Dr. Reed reminds us, you want to avoid these types of lubricants if you’re using condoms to protect yourself from STIs.

In general, when you’re considering which moisturizer or lube to try for VA, you want to consider the product’s pH, which tells you how acidic or basic it is, says Dr. Reed. “Look for a pH that is acidic, so in the range of around 4 or less,” she recommends. “This is important because as the pH becomes more basic, it changes the vaginal environment, and you can get overgrowth of certain bacteria that may not be good.” In general, a healthy vagina typically has a more acidic pH—around 4.5—according to the World Health Organization.

Another thing to consider when choosing a moisturizer or lube is osmolality, a fancy-sounding word that basically tells you whether the product will dehydrate or hydrate the vagina, says Dr. Reed. As strange as it sounds, some over-the-counter products might be dehydrating, Dr. Reed says—not exactly what you want when you have dry VA. Look for products with osmolality of 380 mOsm/kg or less—higher osmolality has been linked to increased irritation, according to a review in the journal Climacteric. The packaging may offer this information—along with pH—or you can look it up online.

Remember—the vagina is a super sensitive environment. That means it’s important to avoid products or practices that mess with the vagina’s delicate balance of bacteria, says Dr. Mitchell. “That includes any sort of fragrance, soaps, powders, or lotions down below, as those can make dryness worse and disrupt the environment,” she says. And as sexy as it may sound to try a product that touts tingling or heat as a result, maybe save that kind of spice for the kitchen. “These spicy lubricants that are supposed to increase stimulation aren’t good for your very thin tissues” with VA, says Dr. Reed.

You don’t have to suffer the symptoms of VA. Moisturizers and lubricants are great options to try to relieve you from painful sex and uncomfortable dryness throughout the day, so long as you follow the basic tips outlined by the experts. And if you’re still feeling discomfort after trying these products, know that there are even more treatment options, including hormonal treatments, you can try for VA, says Dr. Mitchell—so don’t hesitate to talk to your doctor.