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When Taking the Pill Takes Away Your Sex Life

For the last 50 years, birth control pills have given women the power to enjoy sexual activity without worrying about getting pregnant. But for some women, the very pill that allows this freedom can impact libido and vaginal lubrication such that many lose the desire to have sex in the first place.

If you take birth control pills and can’t figure out why your vagina is like the Sahara Desert in spite of being 25 years old and totally in lust with your partner, you are not imagining it. It’s real and it’s likely that your birth control pill may be the problem.

For Most Women, the Pill Is a Good Thing
For the lucky majority of women, hormonal contraception enhances sexual health, and most pill users have more frequent sexual thoughts and fantasies, better orgasms and more interest in having sex. Removing fear of pregnancy, cramps, PMS and heavy bleeding also goes a long way to a better sex life.

For Some Women, the Pill Is a Problem
Thanks to the groundbreaking work of Dr. Andrew Goldstein, who sees hundreds of women a year at his Center for Vulvo-Vaginal Disorders, it is now appreciated that a small but significant percentage of women on hormonal contraception not only have reduced libido but also experience painful intercourse. Dr. Goldstein observed that many young women taking low-dose birth control pills experienced symptoms normally seen only in menopausal women with low levels of estrogen, one of the hormones that increases sex drive and contributes to normal vaginal lubrication. Given that birth control pills contain estrogen, one would think that the pill would be a major sexual booster, but Dr. Goldstein discovered that the explanation was in the other part of the hormone cocktail that’s responsible for sexual health: testosterone.

Less Testosterone, Less Libido
Birth control pills lower the amount of testosterone produced by the ovaries and increase a protein secreted by the liver known as sex-hormone-binding globulin (SHBG). SHBG binds to testosterone and makes the molecule inactive. The higher the SHBG level, the lower the functional testosterone level. Lastly, the synthetic progesterone component in some birth control pills actually blocks testosterone receptors if given in high doses. Since both estrogen and testosterone receptors in the vagina contribute to lubrication, it is understandable that low testosterone not only makes things drier, but also more painful, a condition known as hormonally mediated vestibulodynia. (The vestibule is the area at the opening of the vagina, and dynia is the Latin root for pain).

If that wasn’t bad enough, low testosterone can also lead to fatigue, lethargy and moodiness, all symptoms that make you more likely to want to take a nap than make love.

Anatomical Changes
If you needed any more convincing that the changes that occur on the pill are not just “in your head,” a study published in the Journal of Sexual Medicine in 2012 measured the thickness of the labia minora, the size of the clitoris and the size of the entrance of the vagina in women on the pill. It found that after only three months of use, some pill users had thinner labia, smaller clitorises and a decreased entrance of the vagina that correlated with increased pain during intercourse. In addition, these same researchers showed decreased orgasm in the women on the pill.

The Terrible Testosterone Trifecta
While most women do not have this problem, Dr. Goldstein discovered that about 3- 5% of women have a genetic variant that results in a defective or inefficient testosterone receptor. These women require much more testosterone to keep the vulvar and vaginal tissue healthy and for their glands to function normally. The effects are not obvious until testosterone levels become lower than normal, but that happens to every woman who takes the pill.

So, in women with this genetic variant, the problem is threefold:

1. The pill causes the ovaries to produce less total testosterone and less is in a usable form.

2. The synthetic progesterone found in newer birth control pills poisons the testosterone receptor at high doses.

3. The testosterone receptor doesn’t work well, making it extra dependent on high amounts of testosterone being present.

The Solution
So, if you are on the pill and find you would rather play Sudoku than play with your partner, what options do you have? Ideally, women who have this condition should not take the pill and instead use an alternative method of contraception, such as an IUD. A local vaginal estrogen and testosterone cream (by prescription from a compounding pharmacy) can also facilitate healing. Be patient, it usually takes months.

If another method of contraception is not an option, know that some pills may be better than others. Very-low-estrogen pills that contain drospirenone, desogestrol or norgestimate seem to have the greatest negative impact on libido and vaginal dryness, so if you’re taking one of these, talk to your doctor about whether it’s contributing to any symptoms you might have. Use a silicone lubricant, and ask your doctor for a prescription for hormonal creams to apply to the opening of the vagina. Pelvic floor physical therapy will help tight muscles (that are anticipating pain) to relax.

And know that you are not crazy.

Recently, some friends and I found ourselves discussing the TMI topic of vaginal lubrication. (No overshare is off limits for me, whether you’re a friend or a stranger who reads Well+Good.) I had become concerned about some changes in that department—AKA it was suddenly as dry as the Sahara (or California) down there at, shall we say, inopportune times—and needed to know if I was the only one. I wasn’t. My friends assured me that what I was experiencing was happening to them, too, which had to mean it was “normal.”

But after a visit to my OB/GYN resulted in the opposite verdict—a “Hmm, that’s weird for your age” shrug and a recommendation for what I considered to be an extreme treatment—I decided to investigate. When should dryness raise a red flag? And what, besides stocking up on lube, can you do about it?

Keep reading to find out when and why vaginal moisture matters.

Photo: Getty Images/ Xuanyu Han

Good news: Regular fluctuations in moisture are normal

First and foremost, the idea that healthy women can “get wet” at the drop of a hat (or trousers) is a ridiculous one, says women’s health and hormone expert Alisa Vitti. “Pornography would have us believe that we should be wet constantly, and that is not biologically accurate or possible and doesn’t factor in the myriad hormonal transitions a woman goes through,” she tells me.

Sexologist Jess O’Reilly (who goes by Dr. Jess) likewise assures me that “normal” wetness has a range. “You’ll likely find that your lubrication not only varies according to mood and arousal, but also your menstrual cycle, diet, sleep, and hydration,” she says. With respect to the cycle piece of the puzzle, Vitti explains that the ovulatory and luteal phases are wetter while the menstrual and follicular phases are drier. So, any fluctuations in moisture that occur within these parameters are normal.

“Pornography would have us believe that we should be wet constantly, and that is not biologically accurate or possible.” —Alisa Vitti, hormone expert

Dr. Jess adds that some people believe your hydration levels affect your lubrication—meaning, you can stave off dryness if you drink enough H20. So, while this is anecdotal rather than science-backed evidence, if you’re finding yourself uncharacteristically dry in this hot season, you may want to up your water intake.

And here’s something you may find surprising regarding the connection between randiness and wetness: “Lubrication isn’t a sure-fire sign of arousal,” says Dr. Jess. “Sometimes we’re intensely turned on and we’re as dry as the desert, and other times we’re just riding the bus and find ourselves soaking wet.” Worrying about your moisture situation, however, can kill arousal (and potentially exacerbate the situation), so Dr. Jess suggests you and your partner focus on pleasure—whether or not whatever you’re doing feels good—rather than fluid levels. “You can always use your favorite lube,” she says. (To this end, Sara Twogood, MD, an OB/GYN at USC Keck School of Medicine, recommends store-bought lubricants such as KY Jelly or Astroglide instead of oils you find in your kitchen. “Some vegetable oils, like olive oil and coconut oil, shouldn’t be used with latex condoms,” she says.)

Chronic dryness is also considered “normal”…in certain phases of life

What if you experience chronic dryness, whether sudden in onset or as a more gradual change? According to Dr. Twogood, this condition, known as “atrophic vaginitis,” is considered normal when it occurs during the transition into menopause (perimenopause) or during menopause itself. (This doesn’t mean it’s a universal change, however. “In one study, about one in five perimenopausal women complained of vaginal dryness and about one in three menopausal women,” says Dr. Twogood.) The average age for menopause is 51, and perimenopause can occur months or years (even fifteen years) prior.

Changes in lubrication are also common during other times hormones are disrupted, Dr. Twogood says, including postpartum (especially during breastfeeding) and when both ovaries are removed in a process known as surgical menopause.

Photo: Getty Images/monkeybusinessimages

If it’s happening outside of these circumstances, this might be why

If chronic vaginal dryness occurs outside of these circumstances, Dr. Twogood recommends a visit to the doc for further investigation. “Your gynecologist will review medical problems, surgical history, and medications that may contribute to your vaginal dryness complaints, including autoimmune disorders, a history of ovarian or vaginal surgery, or the use of certain types of contraception, like birth control pills or Depo-Provera,” she says.

Yep, she said that birth control could be a factor. “Contraception methods that suppress ovulation can affect the changes in vaginal discharge that are usually associated with ovulation,” Dr. Twogood explains. “For some women, these changes are described as altering lubrication or feeling dry—especially with the progesterone-only forms of birth control.”

Vitti also notes that synthetic hormones such as birth control can cause changes in sex-hormone-binding hemoglobin—even after you’ve ceased taking the pill—which can also decrease moisture.

Other possible culprits for dryness you should talk to your gyno about include:

Endometrosis: Some treatments for endometriosis, like Lupron Depot, push women into a temporary artificial menopause state, which results in dryness, says Dr. Twogood.

Autoimmune disorders: Primary ovarian insufficiency (which some experts put in the autoimmune disorder bucket) is a cause of early menopause and, therefore, dryness, Dr. Twogood says. Also, severe lupus and rheumatoid arthritis are sometimes treated with medications that can have vaginal dryness as a side effect, such as high dose steroids or methotrexate.

Surgeries: It’s not just removal of your ovaries that can cause lubrication issues. Dr. Twogood tells me that if you’ve had your Bartholin glands—the glands located near the vagina that secrete moisturizing mucus—removed due to cysts or recurrent abscesses, you may experience less severe dryness as well.

Photo: Getty Images/ asiseeit

Lube is great! But it’s not the only answer

Balancing your hormones

If you’re suffering from estrogen-related dryness, Vitti offers a potential solution: Balance your hormones. “If you’re dry during the ovulatory phase, for example, you may not have actually ovulated, even though you may still menstruate,” she says. “Supporting insulin, cortisol, and estrogen hormones will help you regain ovulation and lubrication.” Diet and exercise are critical components of any hormone-balancing regimen, so you may want to start there. Or, you could try something called seed cycling.

Supplements

Vitti also tells me you can biohack your vaginal moisture through dietary changes and supplements. She recommends adding phytoestrogenic foods such as flaxseed meal, oil, soy, and miso to improve dryness. Maca, which raises estradiol levels, can help, too, as can vitamin E, which Vitti says increases blood supply to vaginal tissue.

A company called Femininity also makes a supplement specifically geared towards vaginal dryness. It’s made with sea buckthorn, which founder Bruce McMullin explains is a uniquely-rich source of Omega-7. He tells me that studies have shown the nutrient to be beneficial for those who suffer dryness of mucous membranes, including those of the urogential tract.

Over-the-counter treatments

Over-the-counter topical ointments referred to as “vaginal moisturizers”—like Replens or Vagisil—are another treatment option for women dealing with dryness, says Dr. Twogood. And you know that super-hydrating ingredient, found in moisturizers, called hyaluronic acid? Apparently, there’s an OTC vaginal version, which Dr. Twogood says may be helpful for some women as well (research backs her up).

Estrogen and DHEA

For perimenopausal and menopausal women, estrogen is considered the best treatment for vaginal dryness, according to Dr. Twogood; however, she notes that women should consult with their doctors before taking any sort of estrogen treatment because it may not be advised if they have a history of breast cancer, blood clots, or abnormal/unexplained vaginal bleeding, among other reasons. Estrogen treatments come in many forms, but Dr. Twogood tells me that if atrophic vaginitis is the main complaint, most experts will recommend vaginal-based estrogen, which comes in cream, suppository, and ring form.

When I went in complaining of dryness, my doc prescribed a sexy estrogen suppository. I was surprised, and hesitant to take it.

When I went in complaining of dryness, my doc prescribed a sexy estrogen suppository. I was surprised, and hesitant to take it because I’d heard about a connection between estrogen therapies and certain kinds of cancers. When he waved away my concerns, I did my own research. Apparently, applying estrogen directly to the vagina in this way—as opposed to taking pills or using patches, which is what’s often been done in traditional menopausal hormone therapy—allows for lower dosages, which reduces the cancer risk; however, there have been no clinical studies of low-dose vaginal estrogen treatments that look at the effects more than a year later. (One observational study does suggest its extended use is safe.) If you’re wondering: I ultimately opted against the suppository for now in favor of holistic therapies (and lots o’ lube) because I’m nowhere near menopausal and didn’t see how this treatment could sustain if I wasn’t assured of its safety over time.

According to Vitti, there may be an alternative for those who can’t take or who are hesitant to take estrogen. Studies are showing that treatment via another type of hormone called dehydroepiandrosterone (DHEA), which was recently approved by the FDA for the treatment of painful sex in postmenopausal women, is proving to be effective as well.

Vaginal rejuvenation lasers

Another new treatment—vaginal rejuvenation lasers—has found itself at the center of controversy. Recently, the FDA issued a statement saying such lasers were not approved for the conditions they were treating, e.g. vaginal dryness and pain during intercourse; however, Dr. Twogood tells me doctors are fighting back.

“There’s an outcry against the FDA warning—gynecologists are complaining that the warning against lasers is too generalized,” she says. “There is consensus that ‘vaginal rejuvenation’ should not be marketed towards women, but that lasers can be an effective treatment option for the right candidate after counseling.” Patients who have seen success, Dr. Twogood continues, are mostly postmenopausal or haven’t had luck with—or aren’t able to pursue—other treatment options, including estrogen. In other words, while vaginal rejuvenation as an idea is problematic—um, our aging vaginas are just fine y’all—the use of lasers to treat the painful effects of atrophic vaginitis might not be.

Want more TMI topics? Here’s what the color of your period blood is telling you. And yeah, your poo has something to say, too.

Dry vagina

Vaginal dryness is a common but treatable problem that many women experience at some point in their lives.

It can be a problem at any age, but is a particular issue for women who are going through or have experienced the menopause .

Don’t ignore a dry vagina or feel embarrassed to seek help if it’s a problem for you. There are a number of treatments that can help.

This page covers:

Symptoms

Causes

What to do

Treatments

Symptoms of a dry vagina

Some women only have symptoms of vaginal dryness at certain times, such as during sex, while others have them all the time.

Problems associated with having a dry vagina include:

  • vaginal irritation, discomfort, itchiness or a burning sensation
  • discomfort during sex
  • a reduced sex drive
  • difficulty getting aroused and reaching orgasm
  • the surface of the vagina looks pale and thin
  • narrowing or shortening of the vagina
  • needing to pee more often than usual
  • repeated urinary tract infections (UTIs)

Causes of vaginal dryness

Causes of a dry vagina include:

  • the menopause – decreased levels of the hormone oestrogen during the menopause can cause persistent vaginal dryness (also known as vaginal atrophy or atrophic vaginitis )
  • breastfeeding or childbirth – oestrogen levels can temporarily decrease after giving birth and make your vagina feel drier than usual
  • not being aroused before sex – if you don’t feel aroused before having sex, your vagina may not produce natural lubricant and sex may be uncomfortable
  • some types of contraception – the combined contraceptive pill and contraceptive injection can occasionally cause vaginal dryness, although this is uncommon
  • cancer treatment – radiotherapy to the pelvic area, hormonal cancer treatments, and sometimes chemotherapy can cause vaginal dryness

Vaginal dryness is also sometimes caused by an underlying condition such as diabetes or Sjögren’s syndrome , where the immune attacks the glands in the body that produce fluid.

What to do if you have a dry vagina

If you’re having problems with vaginal dryness, it’s worth trying self-help options first. It can help to:

  • try using a lubricant or vaginal moisturiser – these can be bought without a prescription
  • give yourself enough time to become aroused before having sex – read more about female arousal and get good sex tips

It’s a good idea to see your doctor for advice if:

  • self-help measures aren’t effective
  • your symptoms are particularly severe and are interfering with your normal activities
  • you have other troublesome symptoms, such as hot flushes and night sweats

Don’t feel embarrassed about seeking help. Vaginal dryness is a common problem that doctors see frequently.

Dry vagina treatments

The main treatments that can help if you have a dry vagina are:

Lubricants

Vaginal moisturisers

Vaginal oestrogen

Hormone replacement therapy (HRT)

Lubricants

Lubricants are liquids or gels that you apply to your vulva, vagina or your partner’s penis just before having sex to keep your vagina moist. They offer immediate but short-term relief from vaginal dryness.

Several different brands of lubricant are available to buy from shops and pharmacies without a prescription. You may need to experiment with a few different types to find one that works best for you.

Vaginal moisturisers

Vaginal moisturisers are creams that you apply inside your vagina to keep it moist.

They may be better than lubricants if the dryness isn’t just causing problems during sex, as they tend to have a longer-lasting effect. They usually need to be applied every few days.

As with lubricants, several different brands are available to buy. You may need to experiment with a few different types to find one that works best for you.

Water-based moisturisers are generally best, as oil or petroleum-based products can damage latex condoms and sometimes irritate the vagina.

Vaginal oestrogen

Your doctor may prescribe vaginal oestrogen if your dryness is caused by the menopause. This works by increasing the level of oestrogen that declines during and after the menopause.

Vaginal oestrogen is available as pills you place in your vagina (pessaries), vaginal creams and vaginal rings. These all work equally well, but you may find one type more convenient to use.

Oestrogen treatment can be more effective than lubricants and moisturisers for menopausal women, and it generally causes few side effects.

However, it can take a few weeks to start working, so you may want to use a lubricant or moisturiser as well to begin with. Treatment usually needs to be continued indefinitely, as the dryness tends to return if treatment stops.

Hormone replacement therapy (HRT)

HRT is a treatment that involves taking medication to replace the hormones that start to decline during the menopause.

It’s available on prescription from your doctor either as tablets, a skin patch, an implant under the skin, or a gel that’s applied to the skin.

HRT has a wider effect on the body than vaginal oestrogen, so may be best if you have other menopause symptoms, such as hot flushes. However, it also has more side effects.

Read more about HRT and the side effects of HRT .

Download Clue to track your sex drive and sexual activity.

Top things to know about vaginal dryness:

  • Vaginal dryness can have physical or psychological causes

  • Vaginal lubrication is often closely tied to levels of the hormone estrogen, which changes at various life stages

  • Medications (including hormonal birth control) may cause vaginal dryness

  • You can have a happy and healthy sex life even if you don’t produce much natural vaginal lubrication

Vaginal dryness is common but treatable, and can happen at any age. Symptoms may include a burning sensation, vaginal discomfort or itching, abnormal vaginal discharge, or pain during sex or masturbation.

There can be a number of reasons for vaginal dryness, both psychological and physiological. Whether you’re drier than you would like to be during sexual activity, or are experiencing more general discomfort due to vaginal dryness, here are some of the possible causes—and solutions:

Why is my vagina dry? Common causes of vaginal dryness

Vaginal dryness and estrogen levels

The hormone estrogen helps to keep the vagina moist and to maintain the thickness of the vaginal lining. Atrophic vaginitis (vulvovaginal atrophy) is a common condition that can occur when the ovaries produce a decreased amount of estrogen, which includes the prominent symptom of vaginal dryness (1).

Your body produces less estrogen:

  • At the time of menopause—then it is classified as genitourinary syndrome of menopause

  • After having a baby, particularly if breastfeeding

  • Medications which interfere with reproductive hormone regulation, such as those with treat breast cancer or certain gonadotrophin releasing hormone agonists.

  • Removal of the ovaries, chemotherapy, or radiation therapy of the pelvis (1-5)

Vaginal lubrication and sex

If you’re noticing dryness during vaginal sex, this could be for a number of reasons. Maybe what your partner is doing just doesn’t turn you on. If you feel turned on but are still dry, your body might simply need time to catch up with your brain. If you’re noticing vaginal dryness along with a lack of sexual desire, you may be experiencing low libido, which can be caused by a number of factors including medication and health conditions. Or you just might not be all that into your partner or the acts you are performing together.

Your sexual desire is influenced by some of the same hormones that fluctuate with your cycle, like estrogen and progesterone.

You may find your desire tends to increase in the days leading up to ovulation and decrease after ovulation is over (6,7). Sex drive may be lower when more progesterone is produced during the luteal phase (the days after ovulation and leading up to menstruation) (7). Exactly how reproductive hormones influence desire and preference isn’t the same for everyone; some people report a higher sex drive as part of their premenstrual experience, while other present with decreased libido (8). Tracking desire throughout your cycle can help you discover what’s true for you.

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Vaginal dryness treatments

If you’re experiencing dryness since being on medication or a form of hormonal birth control: talk to your healthcare provider about trying another one that’s a better fit for your body.

If you suspect your dryness could be caused by low estrogen levels, there are several treatment options: vaginal moisturizers or lubricants, local vaginal estrogen cream or tablet, systemic estrogen (and progesterone) therapy, or sometimes selective estrogen receptor modulators (SERMs) (3). See your healthcare provider to find out what’s the best option for you.

If what your sexual partner is doing doesn’t work for you: you could try discussing your sexual likes and dislikes—you may even find that just talking about it increases your arousal. If you lack desire for your partner, it’s up to you what you do from there, whether you want to re-evaluate your relationship or investigate any health issues that might be messing with your libido.

If you feel turned on but you’re not wet: spending more time on foreplay can be one way to increase your natural lubrication. Another option is to use personal lubricant (lube) during sexual activity or masturbation.

Use a personal lubricant for “simply better sex”

In a 2013 study, lubricant use was associated with higher ratings of sexual pleasure and satisfaction in both solo masturbation and partnered sexual activities. More than 9 out of 10 women in the study agreed or strongly agreed that lube made sex feel “more comfortable,” “more pleasurable,” and simply “better” (9).

Lubricants made with water or silicone can be used with latex condoms and diaphragms. Oil-based products, such as petroleum jelly, baby oil, mineral oil, or vegetable oils are not healthy to use internally, and are likely to damage latex condoms and/or diaphragms and make them less effective at preventing pregnancy or STIs.

A study published in the journal Obstetrics and Gynecology found that women who had used petroleum jelly as lube in the past month were more than twice as likely as non-users to have bacterial vaginosis (10). Hand or body lotions are not recommended either, as they can be irritating to vaginal tissues.

If you prefer to use something natural, avoid using food products like olive oil or coconut oil as this can lead to yeast infections or bacterial vaginosis. Instead, try an organic lubricant or a water-based lube without additives.

Other possible causes of vaginal dryness

Aside from sexual arousal and estrogen levels, there are additional factors that can affect vaginal lubrication:

Vaginal dryness can be a side effect of some medications and contraceptives. Talk to your healthcare provider to find out if the source of your vaginal dryness could actually be your medication or contraception (11).

Cigarette smokers have been shown to have an increased risk of an earlier menopause transition as compared to non-smokers. This means that atrophic vaginitis symptoms may appear at a younger age in this population (2).

Sjögren’s syndrome could be another cause of possible vaginal (and other symptoms of dryness). This is an autoimmune disease where the body’s glands aren’t able to produce enough moisture (12)

If you’ve checked out everything else and still don’t find the culprit, you might have an allergy to chemicals in soap, detergent, lubricant or hygiene products—these can also cause vaginal dryness or irritation. Try switching to natural products and wash with unperfumed soap or just water, and see if your symptoms improve.

Your vagina is self-cleaning, so there is no need to use any internal washes (douches) or vaginal deodorants—in fact, they can be harmful. Research has linked the practice of douching with increased risk of bacterial and yeast infections, pelvic inflammatory disease, cervical cancer, increased transmission of STIs, upper genital tract infections, endometritis (inflammation of the lining of the uterus), and other adverse health outcomes (13,14).

Use Clue to track vaginal fluid throughout your cycle.

Article was originally published on Oct. 13, 2017.

SIMONE BECCHETTI

We tend to take vaginal lubrication for granted. It’s usually there when you need it and sometimes shows up even when you don’t. But it’s often only when you have trouble getting wet that you even think about it.

As it turns out, lack of vaginal lubrication doesn’t necessarily mean you’re not turned on (just as trouble getting an erection doesn’t). Experts say there can be a number of reasons vaginal dryness takes place, and it can be due to things you wouldn’t even think of.

Here are some reasons, both psychological and physiological, why you might be having trouble getting wet.

1. You have a yeast infection.Yeast infections can interfere with your ability to get wet by disrupting the balance of flora in the vagina, says Raquel Dardik, M.D., clinical associate professor of obstetrics and gynecology at NYU Langone Medical Center. “For some women, having intercourse during the time they have a yeast infection increases the amount of irritation they feel vaginally,” she says. “It varies from woman to woman but can make the symptoms worse. It will not harm the person or make the infection more severe, but the woman may find it uncomfortable to be sexually active while having a yeast infection.”

2. Your medication is messing you up.Certain medications that seemingly have nothing to do with your vagina can cause below-the-belt dryness, says Dardik. The antihistamines you might take for allergies around this time of year, for example, often have this pesky side effect.

3. Life is kinda stressful at the moment.One common reason a woman might have trouble getting wet is that she’s not able to be fully present, says sexologist Barbara Winter, Ph.D. “A woman needs to ‘shift gears’—that is, allow her sexual space to open. It’s easy to shut it down, particularly when the craziness of life comes into the bedroom.” Psychologist Ramani Durvasula, Ph.D., agrees: “A woman distracted or overburdened by other things in life—work, housework, money issues, etc.—will likely be distracted not feel amorous.” So, instead of trying to transition immediately into sex from whatever you were doing before, take time to set the mood and relax.

4. You’re not feeling body-confident.Your vagina can sense when you don’t feel totally comfortable about getting naked. “A woman feeling less than confident about her body or not wanting to be seen by her partner with her clothes off can also impact sexual response,” says Durvasula. If you suspect this is happening to you, try slipping into your sexiest, feel-good lingerie before hopping into bed. Also keep this in mind: Your partner is psyched to see you naked.

If you have trouble getting wet on occasion, it’s probably a good idea to keep some lube handy to get you through it. But if you find that you’re struggling with it regularly, it’s time to talk to your doctor.

Sex should be fun, but it can also be complicated. Welcome to Sexual Resolution, a biweekly column by sex therapist Vanessa Marin that answers all your most confidential questions to help you achieve the healthy, safe, and joyful sex life that you deserve. In this column, she answers a question from a reader who has difficulty with natural lubrication.

DEAR VANESSA: I have major problems with wetness. I’m super attracted to my boyfriend and enjoy having sex with him, but I never, ever get wet. I feel the desire for sex, but nothing happens. He thinks it’s because he’s doing something wrong, but everything feels good and I want it. We’ve also experimented a lot in the bedroom, but nothing seems to help get me more wet. I’m always dry. What’s wrong with me? What do we need to be doing? – Dry as a Desert, 22

DEAR DASD: Here’s the most important thing for you to know: Your wetness is not a foolproof indicator of your arousal level. Wetness actually says very little about how turned on you are in the moment. As you’ve experienced many times, female-bodied folks can be completely turned on but still remain totally dry. They can also find themselves feeling wet without feeling mentally interested in sex.

For the record, it’s the same with male-bodied folks. Your boyfriend’s erection is not a foolproof indicator of his arousal level, either. Male-bodied people can struggle to get erections even when they want to have sex, and they can also get erections at the worst possible times, when sex is the last thing on their minds.

The idea of your genitals and your mind operating separately from each other is a concept called genital non-concordance. (If you’re interested in learning more about non-concordance, I highly recommend checking out Emily Nagoski’s amazing book, Come as You Are.)

As an extreme example of genital non-concordance, we can look at the reactions of sexual assault survivors. While being abused, women can get wet, men can get erections, and many people even orgasm. The fact that their body responded does not mean that the survivor wanted to be abused, nor does it mean that they enjoyed the abuse. It only means that their bodies had a non-concordant reaction to their desires and boundaries. I talk about this reaction a lot with the survivors I work with because they often feel deeply confused about why their bodies reacted — most people don’t know that non-concordance is a thing.

What’s most important to pay attention to is what your mind wants. It sounds like you desire and enjoy sex with your boyfriend, so I would encourage you to continue desiring and enjoying sex with him.

There’s an easy solution to your wetness concern: lube.

It sounds like your boyfriend also needs to be educated about genital non-concordance. Help him understand that your lack of wetness is not an indicator of a lack of arousal. Reiterate that you enjoy having sex with him, and that neither of you are doing anything wrong. Ask him to trust you to be the authority on your own desires and experiences.

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Have you ever started a new birth control, and then noticed that things started feeling a little…off? Turns out, you aren’t the only one! More women are noticing vaginal dryness as a result of their birth control regimen. Don’t worry, though – there are plenty of things you can do to start feeling better.

How is vaginal dryness linked to birth control?

Although vaginal dryness is most commonly associated with menopausal women (two-thirds of women over 60 list dryness as one of their top sexual health problems!), it can actually happen to women of all ages. Typical symptoms of dryness include: discomfort, itching or burning, and pain during sex. Some women experience day-to-day discomfort, while others only notice when they aren’t able to get wet before or during sex.

For some time, it seemed nobody was talking about the correlation between birth control and vaginal dryness – we were too busy talking about other symptoms, like weight gain and acne. But now, more and more physicians are recognizing the link between the two. As Lauren Streicher, M.D., shared in this article , “between three and five percent of women on low-dose birth control pills experience vaginal dryness.”

Why? In short: hormones. Specifically, estrogen. Estrogen helps keep the tissues of your vagina lubricated , and birth control pills may cause changes in estrogen levels that can lead feminine dryness. According to SELF magazine , “lowering the amount of estrogen circulating in your body will reduce blood flow to the tissue, resulting in dryness of either the vagina or vulva.” Yikes!

Does all birth control cause dryness?

Fortunately, no. But several different methods can. Although the pill seems to be the biggest offender – specifically, combination pills like YAZ – other forms of hormonal birth control can lead to dryness as well.

Non-hormonal birth control methods, like the copper IUD or the mini pill, should not lead to vaginal dryness that the pill can sometimes cause.

I’m suffering from dryness. What should I do?

If these symptoms sound familiar, you aren’t alone. The first step you should take when experiencing vaginal dryness is to consult your doctor. Your physician or healthcare provider can help determine the root cause. If it is a result of your birth control, they can help you find a non-hormonal birth control to replace your current method.

There are things you can do at home, too. Some women report success is treating vaginal dryness with natural remedies and dietary changes .

If you aren’t experiencing daily discomfort, but are having trouble getting wet in the bedroom, try slowing sex down and spending more time on foreplay.

And last but not least, try using a lubricant like our Bio Match™ Restore™ moisturizing vaginal gel. Because as we say here at Good Clean Love: wetter is better!

When Alice*, 31, first went on the birth control pill YAZ, she noticed an immediate change in her body. “There was noticeably a lot of vaginal dryness once I started the birth control ,” she says. Alice only took the pill for another two months before stopping. “Once I realized the birth control pill was causing this issue, I immediately went off of it,” she says. “The dryness completely went away. It made me never use again!”

Alice isn’t an outlier — this side effect is actually pretty common, but isn’t often talked about. According to research, the biggest culprit is the combination pill (like YAZ, which Alice was taking). In one study of 260 women, 12.7 percent of users reported dryness after three cycles of a combination pill containing 20 micrograms of ethinylestradiol and 100 micrograms of levonorgestrel, and 30.4 percent had dryness with a combination pill containing 15 micrograms of ethinylestradiol and 60 micrograms of gestodene. But in NuvaRing users, only 2.1 percent reported dryness after three cycles.

Why the pill and not the ring you ask? The ring has a lower level of synthetic estrogen — the hormone that prevents ovulation — than the pill. When you have a high ratio of estrogen to progesterone in the body, you get what’s called “estrogen dominance,” which can cause PMS-like symptoms including water retention, heavy periods, and yep, dryness, thanks to your body not producing enough lubrication.

It gets even more complicated when you remember that not every pill is created equal. YAZ, for example, contains 20 micrograms of synthetic estrogen, ethinylestradiol, while Ortho-Tri Cyclen contains 35 micrograms. And the level of estrogen in your birth control isn’t the only factor. Everyone has different sensitivities to hormones and a different balance of hormones to begin with — that’s why you might be on the same birth control pill as your bestie but have totally different side effects (or lack thereof).

Translation? If you’re not happy with your current hormonal birth control pill (whether it’s because of vaginal dryness or another side effect), talk to your doctor so you can work together to figure out the right one for you. They may recommend a different pill (or patch or ring), or suggest a non-hormonal or progesterone-releasing IUD. Just don’t be afraid to speak up — left unaddressed, vaginal dryness can mean painful sex and can lead to light bleeding and more-frequent UTIs.

*Name was changed for privacy

Diana Vilibert

Diana Vilibert is a freelance writer and copywriter living in Brooklyn, NY. She loves flea markets, martinis, to-do lists, traveling, and wearing leggings as pants. You can see more of her writing at www.dianavilibert.com and follow her on Twitter at @dianavilibert.

6 Surprising Side Effects You May Experience When on the Pill

Weight gain, nausea, breast tenderness, and menstrual cycle changes are all well-known side effects of oral contraceptives, but others aren’t as universally familiar. Similarly, some side effects are just bothersome and go away over time, while a few can be signs of serious or life-threatening health conditions.

To help you separate the simply annoying from the more severe, we spoke to a handful of women’s health experts who told us what signs to look for and how to respond to six unexpected side effects of the pill.

1. Irritating, Itchy Yeast Infections

Lower estrogen levels while on the pill can increase the frequency of yeast infections for women who have other risk factors. And women on the pill who have poorly controlled diabetes, a diet high in sugar or alcohol, or a weakened immune system may also experience more yeast infections, says Alyssa Dweck, MD, an obstetrician-gynecologist in Mount Kisco, New York. Treatment with an over-the-counter vaginal antifungal cream or a prescription medication typically cures a yeast infection. But if the problem is chronic, says Dr. Dweck, it may help to switch birth control methods.

2. Vision Problems Caused by Dry Eye

Hormone changes from taking the pill can cause dry-eye symptoms that affect vision, says Beth Kneib, OD, the director of the clinical resources group at the American Optometric Association. See your eye doctor right away if you have dry eyes accompanied by discharge or a change in vision, which can be more serious, she says. “Some eye infections mimic dry-eye symptoms and can lead to a larger problem,” she explains. If you have no other symptoms, try over-the-counter saline eye drops for relief. While the risk is small, chronic pill use may also be associated with an increased risk of open angle glaucoma, according to research presented at the American Academy of Ophthalmology in 2013.

3. Blood Clots: Uncommon but Serious

Blood clots are a rare but potentially serious side effect of oral contraceptives. Each year, a small number of women who take oral contraceptives (3 to 10 out of every 10,000) develop blood clots, notes the American Congress of Obstetricians and Gynecologists (ACOG). Women who smoke, are overweight, are over 35, or have recently given birth are considered at higher risk.

Blood clot signs to watch for:

  • Breathing problems or chest pain could signal a clot in the heart or lungs.
  • Pain, warmth, and swelling in the leg could indicate clotting in the lower leg, called deep vein thrombosis.

If you experience symptoms of a possible blood clot, seek immediate medical attention, says Kyoko Peña-Robles, MD, MPH, who specializes in obstetrics and gynecology with One Medical Group in San Francisco.

4. Migraine Headaches Caused by Hormones

Some women who already experience migraines may notice that their headaches get worse when they’re on the pill, Dr. Peña-Robles says. A study published in June 2014 in Current Opinion in Neurology found that a drop in estrogen levels can trigger migraines. Peña-Robles says this can happen just before your period and later in your menstrual cycle. Consider talking with your doctor about switching to a pill with fewer placebo days or a change in the method of contraception to ease the hormonal fluctuations that can contribute to migraines, she suggests.

5. Depression, Especially if You Have a Family History

Women with a personal or family history of mood disorders may be more likely to experience depression while taking the pill, says Peña-Robles. This may be because the pill’s synthetic hormones can affect the balance of certain neurotransmitters, according to a study published in November 2016 in JAMA Psychiatry. But depression can develop because of many factors, so it’s important to try to determine the cause. If you experience depression related to the pill, your doctor may recommend a nonhormonal birth control option, or one that delivers a lower level of hormones.

RELATED: Best and Worst Birth Control Options

6. Painful Intercourse, Sometimes Caused by Dryness

Low-dose birth control pills may be linked to chronic pelvic pain and uncomfortable intercourse, according to Peña-Robles. “This may be due to the dip in estrogen, which can lead to sexual side effects such as low libido, decreased lubrication, and painful intimacy,” she says. Report pelvic pain to your doctor right away in order to rule out conditions like endometriosis and fibroids. If you experience painful intercourse, talk with your doctor about other birth control options.

One of the most amazing things about the vagina is that it self-lubricates, and in case you hadn’t heard by now, lubrication can make ALLL the difference in the world when it comes to having good sex. Unfortunately though, you can’t just will yourself to get wet, and it can be super frustrating when you are turned on, but your body isn’t giving you all the help you need. According to experts Jennifer Landa, MD, chief medical officer for BodyLogicMD, clinical sexologist Kristie Overstreet, PhD, and Laurence Orbuch, director of the GYN Laprascopic Associates and co-director of Gynecologic Robotic Surgery at the Beth Israel Mount Sinai Hospital in New York City, here are some of the most common reasons you’re not as a wet as you’d like to be.

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1. Your antidepressants might be causing the dryness.

Not only do SSRIs interfere with libido, they can also impact vaginal lubrication, explains Dr. Landa. Talk to your psychiatrist about switching to a different medication until you find one that works best for your mental health and your sexual health.

2. You’re breastfeeding.

Dr. Landa says that breastfeeding is also a common time when women have trouble with vaginal dryness due to hormones.

3. You’re a smoker.

Aging, smoking, and other factors that can cause blockage of the arteries could block small arteries in the vaginal area and reduce moisture there, Dr. Landa explains. “The main reason we get wet to begin with is that when the blood vessels in the vaginal area get engorged (like an erection in a man), the higher blood pressure in the blood vessels causes serum to leak across the blood vessels and the mucous membranes of the vagina leading to more moisture.” Dr Landa says.

4. Your hormones are wacky.

One of the most common reasons for a dry vag is a decrease in estrogen levels during menopause, perimenopause, after childbirth, or during breastfeeding, but cancer treatments like chemotherapy and pelvic radiation can also lead to low estrogen and a decrease in vaginal lubrication. If you’ve never experienced any of those things though, it’s probably not that.

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5. You’re not connected with your body during sex.

Overstreet says if you simply go through the motions of sex and don’t enjoy the moment, this could be also factor. “If you are disconnected from your body and the present moment, you aren’t allowing your body to fully be aroused. This arousal is what gets the fluids pumping.” To tap into your body more fully, Overstreet recommends practicing mindfulness and breathing exercises to connect with your body and stay in the moment. The more in tune you are with your body, the more you can relax and allow yourself to be turned on.

6. The medications you’re taking have side effects that are drying you out.

Allergy and cold medications with antihistamines and even some asthma medications can cause vaginal dryness, so I guess the solution is simple: Never leave your house again and stop having asthma. Easy, right?! But you could try switching to more natural remedies or talk to your doctor about other options.

7. You might be feeling guilty or shameful about sex.

Overstreet says if you struggle with feeling guilty or dirty about having sex, this can also keep your body from getting wet. “Whether you have felt this way since you were a child or as an adult, it’s important that you work through these. If your mind is telling you that what you’re doing is wrong, your body will listen to it.” Overstreet says it’s important to explore any negative or guilty feelings you have about sex, and work to change your irrational thoughts into rational ones. Try seeing a therapist who specializes in cognitive behavioral therapy. “When your thoughts and beliefs about sex are healthy and accepting, your body will respond favorably.”

8. Your partner isn’t that great in bed. I know it seems obvious, but it’s not you, it’s him.

Sometimes vaginal dryness is just caused by having a low sex drive or having issues with your sexual partner. If he’s not doing what he should be doing or he is and it’s just not working for you, you’re not going to be as wet as you would be if you were really attracted to someone who was spinning your clit in circles like a plate on a stick.

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9. The soap you’re using is messing with you.

Some women are allergic to chemicals in soaps, detergents, hygiene products, dyes, and perfumes, which could be on your underwear or towels, and that could cause dryness or irritation, which often go hand in hand. Even some lubes if they’re not right for you can cause dryness, so try switching to natural detergents or a different, more natural lube.

10. You’re way too stressed out.

It’s really hard for women to get turned on when they’re stressed out and not focusing on the sexy thing at hand. And if you’re too distracted to get turned on, your vagina’s not going to get turned on and lubed either. So basically take a nap, have some pizza, and watch Magic Mike. Ideally, you’ll be fine.

Of course, if it is severe and persistent, check in with your gynecologist to make sure it’s nothing serious. And then if it’s not, that Magic Mike thing though. For real.

This post was originally published in 2015 and has been updated.

Carina Hsieh Sex & Relationships Editor Carina Hsieh lives in NYC with her French Bulldog Bao Bao — follow her on Instagram and Twitter • Candace Bushnell once called her the Samantha Jones of Tinder • She enjoys hanging out in the candle aisle of TJ Maxx and getting lost in Amazon spirals. Lane Moore Sex & Relationships Editor I’m Lane Moore, sex & relationships editor at Cosmopolitan.com.

If You’re Not Getting Or Staying Wet During Sex, These Reasons Might Be Why

You deserve to be having the best sex you want to be, and knowing how to make your body feel good can be a total game changer. If you’re starting to find that you’re not getting or staying wet during sex, there are plenty of ways to make getting frisky more comfortable for you. Feeling stressed about not getting wet or experiencing any pain from vaginal friction can make it harder to relax and really enjoy getting it on. If you’re not getting super wet, it’s helpful to understand what that means for your body.

“When sexually aroused, blood flow increases to the genitals,” Alicia Sinclair, founder and CEO of COTR, Inc. and certified sex educator, tells Elite Daily. “For someone with a vulva, this means the clitoris and vulva swell, and the vagina reacts by lubricating itself with the famous Bartholin’s Glands (at the opening of the vagina). Dryness creates friction, so this is the body’s way of making any sort of vaginal penetration or vulva stimulation more comfortable.”

While natural lubrication is defined by the physical, Dr. Misty Smith, PhD, LPC-S and certified sex therapist attests the psychological aspect of getting wet. “‘Getting wet’ is a physiological response by your body in preparation for sex,” Dr. Smith says. “It requires sexual arousal, which begins with the ‘excitement phase’ of the female sexual response cycle”. Although you may totally know what turns you on, Dr. Smith shares the importance of reading up on your body’s sexual response cycle. “If you don’t understand the female sexual response cycle, I would encourage you to do a small Google search to get familiar! For us very complicated women, this ‘excitement phase’ typically requires both physiological and psychological stimulation.”

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Of course, you can be totally aroused and still struggle to get wet. “If you feel aroused, you’re aroused; you don’t have to be physically wet to show you’re enjoying sex!” Sinclair says. “Getting wet can happen differently for everyone. It’s your body’s response, so sometimes we can’t help if getting wet is slower or sparse.” Like everything sex-related, what’s right for your body may not be the same as what’s right for someone else. According to McKenna Maness, sex educator and former education and prevention coordinator at The Santa Cruz AIDS Project (SCAP), there are a number of reasons you may not be getting or staying wet.

“Antidepressants, dehydration, marijuana use, not being turned on enough, age, sometimes it’s just that persons body, general friction — too much friction during penetration can reduce dryness.” Maness says. From not drinking enough water before sex to having a little too much friction, there are many factors that go towards dryness. And while it’s completely natural to deal with the occasional vaginal dryness, having sex without being properly lubricated can be uncomfortable or even painful. “Common causes of sex vaginal soreness is having too much sex, running out of vaginal lubrication, vaginal dryness, vaginal infection or a condom latex reaction,” Dr. Sherry A. Ross, women’s health expert, and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., says. “These are often overlooked reasons to have vaginal dryness with sexual intercourse.”

Still, the arousal process is paramount when creating natural lubrication. If you’re jumping into sex before giving your body a little warmup, or if you’re not in the right headspace when you’re getting it on, it may be hard for your body to get wet. “If your body is not getting aroused as it should, this will affect its ability to lubricate appropriately,” Dr. Smith says. “No arousal equals no vascular engorgement equals no blood flow and pressure to cause the increase in fluid production.”

When it comes to having penetrative sex, experts attest the importance of starting with a sexy warmup to get both your body and head ready. “Foreplay stimulates lubrication, and lubrication is really the equivalent of getting an erection for the male,” Dr. Mary Jane Minkin, OB/GYN at at Yale-New Haven Hospital and clinical professor at Yale University School of Medicine says. Yet, if you’re having plenty of pre-sex fun and you’re still unable to get or stay wet, you may find sex to be uncomfortable or even painful. “The natural lubrications of the vagina can dry up with prolong sexual contact and penetration causing friction and pain,” Dr. Ross says. “The vagina will be dry, making sex painful when the penis or fingers enter the vagina.”

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If you’re experiencing vaginal dryness, it may help to use some personal lubricants or toys before engaging in penetrative sex. “Lube mimics what your vulva would produce, and allows you to think less about how wet you are and more about the sexual encounter you’re having,” Sinclair says. “After all, that is the goal.” According to Sinclair, using lube doesn’t mean anything is wrong or not working with you or your sex. Sinclair also suggests using toys that can increase blood flow or otherwise putting direct pressure on the vulva, without penetration — dry humping, for example.

You deserve to be having the best sex for your body. If you’re finding that it’s hard to get or stay wet, there are plenty of ways to try to make your sex more comfortable for your body. Discovering what helps you get or stay wet can make fooling around totally hot.

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