Can medication cause vaginal dryness? Medicines that dry the vulva and vagina

Vulval and vaginal dryness isn't always down to hormones changing on their own. Some medicines cause it too. A few dry the skin or the vaginal lining. Others lower oestrogen. Some affect arousal, so you make less natural lubrication during sex.

The result can be soreness, itching or a raw feeling. Even getting dressed can feel like hard work. For other causes of dryness, see Why is my vulva dry, itchy or sore?

Why can medicines affect the vulva and vagina?

The vulva is skin, but it's more sensitive than skin elsewhere. The vagina is lined with a moist membrane, a bit like the inside of your mouth. Both depend on oestrogen and good blood flow. So medicines that dry you out, lower oestrogen or reduce blood flow can leave you dry and sore.

For some medicines, the link is well known. For others, it's based on how the drug works or on what women report. We say which is which.

Which cancer treatments cause vaginal dryness?

Aromatase inhibitors. Anastrozole, letrozole and exemestane treat oestrogen-receptor-positive breast cancer. They stop the body making oestrogen. That's the point. But the vulva and vagina need oestrogen. Without it, the tissue becomes thin, dry and easily irritated. These are the same changes as genitourinary syndrome of menopause (GSM), once called vaginal atrophy.

NICE says to try vaginal moisturisers and lubricants first. If you need more, your GP should work with your breast cancer team to find what's safe for you. See Vaginal oestrogen (estrogen): creams, pessaries, Gina and safety after breast cancer.

Tamoxifen. Tamoxifen blocks oestrogen in breast tissue. Elsewhere in the body it acts differently. Some women notice no change. Others get dryness, itching or more discharge.

GnRH agonists. Goserelin (Zoladex) and leuprorelin (Prostap) are used for endometriosis, fibroids and some cancers. They switch off the ovaries for a while. This causes a temporary menopause, with dryness. Doctors often add "add-back" HRT to ease the symptoms. Dryness usually eases once treatment stops.

Chemotherapy and radiotherapy. Chemotherapy can stop the ovaries working, so oestrogen drops suddenly. For some women, periods come back months later. For others, menopause comes early. Radiotherapy to the pelvis can also damage the vaginal tissue directly. It can leave it dry, fragile and narrower. Your cancer team may suggest vaginal dilators to help.

Can antidepressants cause vaginal dryness?

Yes. The NHS lists antidepressants as a cause. SSRIs, such as sertraline, fluoxetine and citalopram, often have sexual side effects. They can lower desire and make it harder to get aroused. Less arousal means less natural lubrication. If this happens to you, talk to your GP. Don't just stop taking them.

Can contraception cause vaginal dryness?

It can. The NHS lists hormonal contraception as a cause too. Some methods stop ovulation, which keeps your own oestrogen low. We explain how each method works in Low oestrogen symptoms: why your vulva and vagina get dry.

What other medicines can cause dryness?

Opioid painkillers. Taken long term, morphine, codeine, tramadol and oxycodone can lower sex hormones. That can mean dryness, lower libido and irregular periods.

Antihistamines and decongestants. Antihistamines dry up a runny nose. Some women find they dry other places too. The older, drowsy ones, such as chlorphenamine (Piriton), are the most drying. Decongestants such as pseudoephedrine may have a similar effect. For both, the evidence is mostly what women report.

Isotretinoin. Isotretinoin (Roaccutane) for severe acne dries the skin and lips. Some women find it dries the vulva too. It usually settles after treatment ends.

Steroid tablets. Long courses of steroid tablets, such as prednisolone, can thin the skin and slow healing. That includes vulval skin. Steroid creams prescribed for the vulva are different. Used as directed, they treat conditions such as lichen sclerosus. Don't stop them because of this.

Water tablets and beta-blockers. Some women notice dryness on water tablets (diuretics), such as furosemide, or on beta-blockers, such as bisoprolol. Beta-blockers can also affect arousal. The evidence for a direct link with dryness is weak.

Anti-seizure medicines and St John's wort. Carbamazepine, phenytoin, topiramate (at 200 mg a day or more) and St John's wort speed up how the liver breaks down hormones. This makes hormonal contraception less reliable. It may affect HRT tablets too, so tell whoever prescribes them. Whether these cause dryness on their own isn't clear. If you take herbs, tell your GP and pharmacist. A medical herbalist can also check for interactions.

What should I look out for?

Watch for itching or soreness that won't go away. You might feel tight when you walk or sit. It may sting when you wee, or feel sore after wiping. Sex may hurt. If any of this starts soon after a new medicine, tell your GP or pharmacist. A different dose or medicine may help.

What helps?

Don't stop a prescribed medicine without talking to your doctor first. There may be another option. Or there may be ways to manage the dryness while you stay on it.

For the vulva, use a plain, unscented emollient instead of soap, and as a moisturiser. For the vagina, use a vaginal moisturiser regularly, with a lubricant for sex. See Vaginal dryness treatment: menopause, perimenopause and after giving birth.

If you'll be on the medicine long term, ask about vaginal oestrogen. It comes as a cream, pessary, tablet or ring. If you're being treated for breast cancer, your GP should talk to your cancer team first.

In short

Medicines keep us well. But some have side effects in unexpected places. If you know which ones can affect the vulva and vagina, you can spot the signs early and ask for help sooner.

References

NHS, "Vaginal dryness," (reviewed July 2025) https://www.nhs.uk/symptoms/vaginal-dryness/

NICE, "Menopause: identification and management (NG23), genitourinary symptoms visual summary" https://www.nice.org.uk/guidance/ng23/resources/visual-summary-genitourinary-gu-symptoms-associated-with-menopause-pdf-13553202493

de Vries F et al., "Opioids and their endocrine effects: a systematic review and meta-analysis," Journal of Clinical Endocrinology and Metabolism (2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054712/

NHS, "Side effects of isotretinoin capsules" https://www.nhs.uk/medicines/isotretinoin-capsules/side-effects-of-isotretinoin-capsules/

Specialist Pharmacy Service (NHS), "Using contraception with enzyme-inducing medicines" https://www.sps.nhs.uk/articles/using-contraception-with-enzyme-inducing-medicines/

Gloucestershire Hospitals NHS Foundation Trust, "Caring for your vulva and vagina after cancer and cancer treatment" (May 2024) https://www.gloshospitals.nhs.uk/media/documents/Caring_for_your_vulva_and_vagina_after_cancer_and_cancer_treatment_GHPI1841_05_24.pdf