Vaginal dryness and painful sex on endocrine therapy

Oestrogen keeps the tissues of the vagina moist, stretchy and comfortable. Hormone therapy for breast cancer, particularly aromatase inhibitors, lowers oestrogen sharply, so many women develop dryness, itching, burning, soreness and pain during sex. These symptoms are very common and often get worse over time without treatment. The good news is that regular non-hormonal moisturisers, lubricants during sex, pelvic floor care and, for some women, other treatments discussed with the team can make a real difference.

Why it tends to be worse on aromatase inhibitors

Aromatase inhibitors lower oestrogen throughout the body to very low levels. Other hormone tablets block oestrogen in some tissues but can have a milder effect on the vagina, so symptoms are often more noticeable after a switch to an aromatase inhibitor.

What helps most

Using a vaginal moisturiser regularly, several times a week, rather than only before sex; using a good lubricant during sex; and being patient with arousal and positions that feel comfortable.

When to be checked

Bleeding, unusual discharge, sores that do not heal or pain that persists despite treatment should be checked, as infection or other conditions need to be ruled out.

Low oestrogen affects the bladder and urethra as well as the vagina, so some women notice urinary changes at the same time.

Needing to pass urine more often

Urgency or frequency can increase. Pelvic floor exercises and bladder training often help.

More urinary infections

Thinner tissues can make infections more likely. Drinking enough water and reporting burning or fever promptly helps.

Getting help

Tell your team about urinary symptoms, as they can be treated and may improve alongside vaginal care.

Pharmacy shelves and online shops offer many products, and it can be hard to know which will help rather than irritate already sensitive tissue. A few simple principles make the choice easier.

Keep it plain

Choose products without perfume, colour, flavours, warming or tingling agents, and without glycerine where possible, because these can sting or encourage thrush in thin, dry tissue.

Moisturiser and lubricant do different jobs

A moisturiser is used regularly, whether or not you are having sex, to keep the tissue hydrated over time. A lubricant is used during sex to reduce friction in the moment. Many women need both.

Water-based or silicone-based

Water-based lubricants wash off easily and are safe with condoms but may need reapplying. Silicone-based lubricants last longer and feel smoother, and are also condom-safe. Oil-based products can damage latex condoms and irritate some women.

Test gently

Try a small amount first. If a product causes burning or itching, stop using it and try another.