What it feels like:

Persistent dryness, burning, irritation, tightness, or discomfort during everyday activities or intimacy.

What it can be caused by:

Decreased lubrication and tissue thinning can cause irritation, dryness, pain on sitting or during activities as well as painful intercourse (dyspareunia). 

Practical Steps:

Avoid irritants, such as:

• Fragrance or perfumed soaps, washes or douches in or around your vagina
• Constant wearing of panty liners or pads (sometimes a problem with bladder leakage)
• Products containing glycerin, propylene glycol or petroleum-based products like petroleum jelly, which disrupt the vaginal environment and are not ideal for internal use.
• Spermicides such as nonoxynol-9, which can increase irritation
• Baby or adult wipes
• Very hot water
• Moisturisers that are not specifically for vaginal use
• Very tight clothing and use 100% cotton underwear if possible

Over-the-Counter Options:

• Vaginal moisturisers – designed for ongoing dryness, not just sex-related lubrication.  Used regularly, often a few times per week, they help hydrate the vaginal tissues, provide a protective barrier, improve elasticity and help reduce discomfort. It is important to read the label carefully and choose products that are pH balanced, fragrance free and ideally contain hyaluronic acid. Water based options are generally more soothing and safer for internal use. They can also be used with condoms and toys. Oil and silicone-based moisturisers may last longer but may be more irritating and are unsafe with condoms.
• Vaginal lubricants – used before or during intercourse to help reduce friction and/or pain. Water-based lubricants are generally recommended as they are low irritant and can be used safely with condoms and toys. They can soak quickly into dry tissues during sex however, whereas oil and silicone lubricants stay slick and “glidier” for longer. Silicone lubes should be avoided with silicone-coated toys, and oil-based lubricants should be avoided with condoms. Once again, choose products that are fragrance and flavour free, pH balanced and avoid the same ingredients as moisturisers.
• Barrier creams – for those times when your vulval area might be exposed to chemicals or soaps (like swimming or baths), or friction from bike/ horse riding or chafing clothes, a barrier layer will help to coat and protect the delicate tissues. Ask your pharmacist about bland baby-safe zinc or barrier creams (external use only), or even an oil-based lubricant (we love Olive and Bee for this job), as well as intimate lubrication.

Localised Hormonal Treatments:

In milder cases of vaginal dryness, it may be sufficient to use vaginal moisturisers and lubricants to treat the symptoms, however this does not treat the underlying cause of low hormones. In Australia, vaginal hormone preparations are prescription-only and should be discussed with a doctor or nurse practitioner.

• Vaginal estrogen cream: Applied inside and around the entrance of the vagina to improve tissue thickness and moisture.
• Vaginal estrogen pessary/tablet: A small pessary placed into the vagina, containing a form of low-dose oestrogen.
• Vaginal DHEA (dehydroepiandrosterone) pessary: A pessary containing DHEA that once inserted in the vagina, the vaginal cells will convert the DHEA into estrogen and androgens, such as testosterone. 
• Systemic hormone therapy: May be considered if vaginal dryness occurs alongside hot flushes or other menopausal symptoms. This may be given as tablets, patches, or gels.

Please note: Vaginal estrogens are a very safe and effective treatment for menopausal vaginal dryness and GSM; they may even be used after breast cancer (after discussion with the cancer specialists). They are localised topical treatments only and are not absorbed measurably into the bloodstream so they do not treat systemic symptoms like hot flushes.

What it feels like: 

A stinging, burning sensation inside or around the vagina, often worse with sex, peeing, or touching the area. May come with itching, rawness, or sensitivity that makes daily activities uncomfortable.

What it can be caused by: 

Burning & irritation may be caused by infections, underlying conditions such as lichen sclerosis or reactions to irritants in addition to low hormones.

Practical Steps: 

• Wear cotton underwear and loose clothing to let the area breathe
• Avoid irritants such as scented soaps, bubble baths, douches, perfumed wipes, or dyed toilet paper
• Wash with plain water
• Wipe front to back to avoid spreading bacteria from the bowel
• Take cool sitz (salt water) baths for 10 mins at a time, or apply a cold pack wrapped in a cloth
• Pat dry gently & don’t rub
• Avoid sex or tampons until symptoms settle

Over-the-Counter Options:

• Vaginal moisturisers are designed for ongoing dryness, not just sex-related lubrication. Used regularly, often a few times per week, they help hydrate the vaginal tissues, provide a protective barrier, improve elasticity and help reduce discomfort. It is important to read the label carefully and choose products that are pH balanced, fragrance free and ideally contain hyaluronic acid. Water based options are generally more soothing and safer for internal use. They can also be used with condoms and toys. Oil and silicone based moisturisers may last longer but may be more irritating and oil-based lubes should not be used with condoms.

Please discuss the following options with your pharmacist:

• Antihistamine cream for external itching: Thin layer 1-2x/day max
• Hydrocortisone 1% cream: For vulval irritation only, short-term (3-5 days max)
• Antifungal cream (e.g. Canesten/clotrimazole): If yeast infection suspected
• Oral antifungal tablets: for likely cases of thrush, and less irritant than creams [NOTE: if you think you have recurrent “thrush” but it persists or returns despite treatment, it may be something else. See your doctor for proper examination and diagnosis!]
• Probiotic vaginal pessaries may help support healthy vaginal bacteria

Medications & Hormonal Options: Prescription Only

• Burning & irritation may be caused by infections or reactions to irritants in addition to low hormones.

For infections:

Antibiotics for bacterial vaginosis

Stronger antifungals for recurrent or resistant thrush

Treatment for STIs if relevant

Antibiotics for urinary tract infection

Localised Hormonal Treatments:

Vaginal estrogen cream: Applied inside the vagina to improve tissue thickness and moisture

Vaginal estrogen pessary/tablet: A small pessary placed into the vagina, containing a form of low-dose oestrogen

Vaginal DHEA (dehydroepiandrosterone) pessary: A pessary containing DHEA that once inserted in the vagina, the vaginal cells will convert the DHEA into estrogen and androgens, such as testosterone

Systemic hormone therapy: May be considered if vaginal dryness occurs alongside hot flushes or other menopausal symptoms. This may be given as tablets, patches, or gels

Specialist review if symptoms persist, as some chronic or pre-cancerous conditions may cause similar symptoms

See your doctor promptly if symptoms persist or worsen, you have discharge/ odour/ fever, or suspect you have a urinary tract infection, a sexually transmitted disease, recurrent thrush or bacterial vaginosis.

What it feels like: 

Persistent urge to scratch inside or around the vagina or vulva, and perhaps even the anus. It can range from mild tickling to intense irritation that disrupts sleep or daily life and is often worse at night or after sweating.

What it can be caused by:

Low estrogen (menopause), yeast infections (thrush), bacterial vaginosis, allergies to soaps/pads/perfumes, skin conditions (lichen sclerosus, eczema), hormonal changes (PCOS), or sexually transmitted infections.

Practical Steps: 

• Wear breathable cotton underwear (avoid synthetics, tight clothing)
• Wash once daily max with plain water or sorbolene cream-overwashing strips protective oils
• Avoid irritants such as scented soaps, bubble baths, douches, perfumed pads/wipes, or fabric softener
• Wipe front to back after toilet use
• Keep the area cool and dry use cotton pads in underwear if sweaty
• Cold compress (10 mins, 2-3 times daily) to calm inflamed skin
• Avoid scratching (trim nails, wear cotton gloves at night if needed

Over-the-Counter Options:

• Please discuss the following options with your pharmacist
• Oral antihistamines, particularly to help reduce nighttime itching
• Antihistamine cream for external itching: Thin layer 1-2x/day max
• Hydrocortisone 1% cream: For vulval itching only, short-term (3-5 days max)
• Antifungal cream (e.g. Canesten/clotrimazole): If yeast infection (thrush) suspected
• Oral antifungal tablets: for likely cases of thrush, and less irritant than creams [NOTE: if you think you have recurrent “thrush” but it persists or returns despite treatment, it may be something else. See your doctor for proper examination and diagnosis!]
• Probiotic vaginal pessaries may help support healthy vaginal bacteria
• Barrier cream (zinc/specified barrier cream or ointment): protects irritated skin from moisture/urine

Localised Hormonal Treatments:

• Vaginal estrogen cream: Applied inside the vagina to improve tissue thickness and moisture
• Vaginal estrogen pessary/tablet: A small pessary placed into the vagina, containing a form of low-dose estrogen
• Vaginal DHEA (dehydroepiandrosterone) pessary: A pessary containing DHEA that once inserted in the vagina, the vaginal cells will convert the DHEA into estrogen and androgens, such as testosterone
• Systemic hormone therapy: May be considered if vaginal dryness occurs alongside hot flushes or other menopausal symptoms. This may be given as tablets, patches, or gels.

What it feels like:

Sharp or burning pain at the entrance, deep ache with thrusting, or soreness that lasts for some time after sex. It can make you tense up or avoid intimacy.

What it can be caused by:

Low estrogen (menopause, breastfeeding), vaginal dryness and tissue thinning, infections (thrush, BV), pelvic floor tension, endometriosis, vaginismus (involuntary vaginal muscle tightening), allergies to products or condoms, or insufficient arousal/foreplay. Sexual pain is a complex issue, and some causes can be more serious; check out our full article here for more information. 

Practical Steps: 

• Extended foreplay (20+ mins) to allow natural lubrication
• Use lubricants generously before and during sex
• Try positions where you control depth and pace (e.g. woman on top), or use spacer devices like Ohnut
• Pelvic floor relaxation exercises (deep breathing, reverse Kegels)
• Communicate with your partner about what feels good/painful
• Empty bladder before sex to reduce pressure
• Avoid sex if very dry, irritated or recovering from an infection; wait until symptoms settle

Over-the-Counter Options:

• Vaginal lubricants before or during intercourse
• Vaginal moisturisers (2-3 times per week to improve baseline comfort)
• Paracetamol or ibuprofen: 30 mins before sex if muscle tension contributes
• Lidocaine 2-5% gel/ointment: Numbing gel for entry pain (short-term use only)

Medications & Hormonal Options:

• Prescription-only (discuss with your doctor or nurse prescriber)
• For infections/inflammation:
• Antifungals (fluconazole) or antibiotics (metronidazole) if infection present
• Low-dose steroid cream for vulval irritation
• Your practitioner should also take a sexual history and ask questions to rule out possible sexually transmitted infection (STI), which is easy to treat with antibiotics in most cases. A vaginal swab or urine sample may be required for diagnosis

Hormonal Treatments:

• Vaginal estrogen cream: Applied inside the vagina to improve tissue thickness and moisture.
• Vaginal estrogen pessary/tablet: A small pessary placed into the vagina, containing a form of low-dose oestrogen.
• Vaginal DHEA (dehydroepiandrosterone) pessary: A pessary containing DHEA that once inserted in the vagina, the vaginal cells will convert the DHEA into estrogen and androgens, such as testosterone. 
• Systemic hormone therapy: May be considered if vaginal dryness occurs alongside hot flushes or other menopausal symptoms. This may be given as tablets, patches, or gels.

For Muscle Tension:

• Pelvic floor physiotherapy
• Muscle relaxants or Botox injections (specialist referral)
• Psychological therapy from a qualified sexual counsellor can help in cases of trauma, aversion or relationship issues causing sexual pain or avoidance.

See your doctor if: Pain persists despite lubrication, new bleeding/discharge, you have deep pelvic pain, a history of sexual trauma or violence, suspect an STI or are unable to have penetrative sex.

What it feels like: 

Not everyone has all these symptoms, but they can include intense vaginal itching (especially at night), thick white “cottage cheese” discharge, redness/swelling of vulva, soreness or burning with sex or peeing. Episodes return frequently despite treatment.

What it can be caused by: 

Recurrent thrush is four or more episodes per year of vaginal fungal overgrowth (Candida albicans most common). Risk factors include low estrogen, antibiotics, high blood sugar or diabetes, tight clothing, pregnancy, hypersensitive immune response, or atypical yeast strains.

Practical Steps: 

• Wear cotton underwear, avoid tight synthetics or damp clothing
• Dry thoroughly after bathing/swimming, use hairdryer on cool setting if needed
• Wash with plain water only, skip soaps, bubble baths, douches
• Wipe front to back, change pads/tampons frequently
• Avoid spermicides, perfumed products, glycerin-based lubricants
• Manage blood sugar if diabetic & check HbA1c regularly
• Eat low-sugar diet, consider probiotic-rich foods (yoghurt, kefir)
• Sleep naked or in cotton to keep area cool/dry

Over-the-Counter Options:

• For acute episodes (use 7-14 days):
• Clotrimazole pessary/cream (Canesten 1-day/3-day/6-day)
• Miconazole (Gyno-Daktarin)
• Oral antifungal tablets: generally a single oral dose, and less messy and irritant than creams
• Probiotic pessaries (e.g. Fem Dophilus) to support good bacteria
• Gentle hydrocortisone 1% cream twice daily for external itching

Short-term Prevention (trial for 1-2 months):

• Weekly clotrimazole 500mg pessary after periods
• Note: If episodes recur despite OTC treatment, see your doctor for testing

Medications & Hormonal Options:

• Prescription-only (discuss with your doctor/nurse)
• Induction treatment (for active infection):
• Fluconazole 150mg oral daily x 3-7 days OR clotrimazole 10-14 days
• For non-albicans yeast: Boric acid pessaries 600mg nightly x 14 days

Maintenance/suppression (6+ months, most effective):

• Fluconazole 150mg oral weekly
• Clotrimazole 500mg pessary weekly or topical cream 2-3x/week

Hormonal Treatments:

• Vaginal estrogen cream: Applied inside the vagina to improve tissue thickness and moisture
• Vaginal estrogen pessary/tablet: A small pessary placed into the vagina, containing a form of low-dose oestrogen
• Vaginal DHEA (dehydroepiandrosterone) pessary: A pessary containing DHEA that once inserted in the vagina, the vaginal cells will convert the DHEA into estrogen and androgens, such as testosterone

See your doctor if: you have many episodes per year, symptoms persist despite treatment, unusual discharge or odour, pain, diabetes symptoms, or pregnancy. They may test for resistant yeast or underlying causes.

What it feels like: 

Small leaks when coughing, sneezing, laughing or exercising (stress leakage), sudden uncontrollable gush before reaching the toilet (urge leakage), or constant dribbling (overflow). Can feel embarrassing and limit activities.

What it can be caused by: 

Weak pelvic floor muscles (childbirth, menopause), low estrogen thinning urethral tissue, overactive bladder, obesity, chronic cough, constipation, prolapse, or neurological conditions.

How common is it: 

This is an incredibly common symptom, with leakage and other continence issues affecting more than half of postmenopausal women. It can be debilitating and keep women restricted in even leaving the house or going about their daily activities.

Practical Steps: 

• Pelvic floor exercises (Kegels): Check out Continence Australia’s guide to the pelvic floor, and see a pelvic floor physiotherapist to ensure you are doing the exercises correctly
• Maintain healthy weight: Extra abdominal weight weakens pelvic floor
• Avoid constipation: High-fibre diet, adequate water, regular toilet habit
• Bladder training: Gradually increase time between bathroom visits; again, see a pelvic floor physiotherapist for a thorough review and guidance in these techniques
• Double voiding: Pee, wait 30 seconds, then try again to fully empty
• Cut bladder irritants: Less caffeine, alcohol, fizzy drinks
• Good lifting technique: Tighten pelvic floor before lifting
• Timed toileting: Go every 3-4 hours even without urge

Over-the-Counter Options:

• Incontinence pads and panties: Absorbent protection while building control
• Pelvic floor trainers: App-guided exercise devices
• Cranberry tablets: May help prevent UTIs that worsen leakage
• Ural sachets: For bladder irritation/discomfort
• Paracetamol: For pelvic discomfort during exercises

Medications & Hormonal Options:

• Prescription-only (discuss with your doctor/nurse):
• For stress incontinence:
• Duloxetine (sometimes used off-label)
• Vaginal estrogen (Ovestin/Vagifem): Strengthens urethral tissue

For urge incontinence:

• Anticholinergics (oxybutynin, tolterodine)
  Mirabegron (eg. Betmiga , fewer side effects)

Specialist Options:

• Pelvic floor physiotherapy (biofeedback, electrical stimulation)
• Pessary (vaginal support device for prolapse); often recommended and fitted by pelvic floor physios
• Urethral bulking injections
• Sling surgery (mid-urethral sling, very effective)
• Botox bladder injections

See your doctor if: leakage affects quality of life, sudden worsening, blood in urine, pelvic pain or prolapse symptoms. Pelvic floor assessment recommended.

What it feels like: 

Sudden strong urge to pee that’s hard to ignore, needing to go more often than usual (8+ times/day), waking multiple times at night (nocturia), or leaking a little before you reach the toilet.

What it can be caused by: 

Low estrogen (such as GSM, causing bladder and urethral tissue thinning and bladder irritability), overactive bladder, urinary tract infections (UTIs), pelvic floor weakness, diabetes/high blood sugar, caffeine or alcohol excess, overhydration, constipation, certain medications or anxiety/stress.

Practical Steps: 

• Bladder training: Delay peeing by 5-10 mins when you feel the urge, gradually increase time between voids (pelvic floor/ continence physiotherapists can help train you in this)
• Cut irritants: Reduce caffeine (coffee, tea, cola), alcohol, fizzy drinks, artificial sweeteners
• Sip, don’t gulp: Spread fluid intake evenly through the day, aim for 1.5-2L water
• Timed voiding: Pee every 3-4 hours even without urge to retrain bladder
• Pelvic floor exercises: Kegels (squeeze/release 10x, 3x/day) or see pelvic physio
• Good bowel habit: Prevent constipation with fibre, water, movement
• Weight management: Extra weight increases bladder pressure
• No “just in case” peeing, train bladder to hold longer

Over-the-Counter Options:

• Cranberry products (tablets, juice): May help prevent UTIs (evidence mixed)
• Paracetamol: For discomfort if bladder is irritated
• Probiotics: Oral or vaginal to support urinary/vaginal health
• Bladder support supplements (e.g. Ural sachets): Alkalinise urine for mild irritation
• Pelvic floor training e.g.: Guided Kegel trainers
• Some OTC medications can help prevent UTI’s such as methenamine hippurate and D-Mannose.
• Some OTC medications can relieve the symptoms of urinary discomfort, like urinary alkalinisers, eg. Ural, Citravescent

Medications & Hormonal Options:

• Prescription-only (discuss with your doctor/nurse):
• For overactive bladder:
• Anticholinergics (oxybutynin, tolterodine)
• Beta-3 agonists (mirabegron)
• Desmopressin for severe nocturia
• Mirabegron (eg. Betmiga)

Hormonal Treatments:

• Vaginal estrogen cream: Applied inside the vagina to improve tissue tone and moisture.
• Vaginal estrogen pessary/tablet: A small pessary placed into the vagina, containing a form of low-dose oestrogen.
• Vaginal DHEA (dehydroepiandrosterone) pessary: A pessary containing DHEA that once inserted in the vagina, the vaginal cells will convert the DHEA into oestrogen and androgens, such as testosterone. 
• Systemic hormone therapy: May be considered if vaginal dryness occurs alongside hot flushes or other menopausal symptoms. This may be given as tablets, patches, or gels.

For infections:

• Antibiotics for confirmed UTIs; can be used for treatment and prevention (eg. nitrofurantoin, trimethoprim)

Specialist options:

• Pelvic floor physiotherapy
• Sleep study (lack of deep sleep increases night-time diuresis)
• Botox bladder injections
• Nerve stimulation (sacral neuromodulation)

See your doctor if: Leaking with urgency, blood in urine, fevers, chills, symptoms lasting over 2 weeks, or diabetes symptoms. Urine tests may be needed.