What Causes Vaginal Dryness?

Vaginal dryness is most often caused by a decline in estrogen — the hormone responsible for maintaining the thickness, elasticity and natural lubrication of vaginal tissue. During perimenopause and menopause the ovaries progressively reduce estrogen output, causing the vaginal walls to become thinner, drier and less resilient — a process called vaginal atrophy or, more comprehensively, Genitourinary Syndrome of Menopause (GSM).

However, menopause is not the only trigger. Other common causes include:

• Post-partum and breastfeeding: prolactin suppresses estrogen, causing temporary dryness.
• Cancer treatment: chemotherapy, radiotherapy to the pelvis and anti-estrogen medications (e.g. tamoxifen, aromatase inhibitors) all reduce estrogen levels and can cause severe atrophy.
• Surgical menopause: removal of both ovaries induces sudden, often more intense GSM symptoms.
• Certain medications: antihistamines, antidepressants (SSRIs) and some contraceptives can reduce natural lubrication.
• Sjögren's syndrome and other autoimmune conditions affecting mucous membranes.

Unlike the hot flushes of menopause which tend to fade over time, GSM is a progressive condition — it does not improve on its own and typically worsens without treatment.

Symptoms of Genitourinary Syndrome of Menopause (GSM)

GSM is an umbrella term recognising that low estrogen affects not only the vagina but also the vulva, urethra and bladder. Symptoms fall into two main groups:

Vaginal and vulvar symptoms

• Persistent dryness, tightness or a feeling of sandpaper-like texture
• Burning or itching that can be constant or triggered by clothing
• Painful sexual intercourse (dyspareunia) — often the symptom women find most distressing
• Post-coital spotting or light bleeding due to tissue fragility
• Reduced vaginal elasticity and narrowing of the vaginal opening

Urinary symptoms

• Increased urinary frequency and urgency
• Recurrent urinary tract infections (UTIs)
• Burning on urination (dysuria) without infection
• Stress urinary incontinence exacerbated by tissue thinning

If you recognise several of these symptoms, a consultation with our urogynecology team can confirm a diagnosis and identify the most appropriate treatment pathway for you.

Treatment Options at THE FIT CLINIC Bangkok

Our approach is individualised. We start with a detailed history, examination and, where appropriate, hormonal blood work before recommending any treatment. The following options are available:

MonaLisa Touch CO2 Fractional Laser

MonaLisa Touch is a non-hormonal treatment that uses fractional CO2 laser energy to stimulate collagen and glycogen production within vaginal tissue. The procedure is performed in-clinic. The number of sessions, how long each takes and the downtime are decided at an assessment. Because it carries no systemic hormonal effect, MonaLisa Touch is sometimes considered for women who cannot or prefer not to use hormone therapy. Whether it is appropriate for you is decided at an assessment.

Localised Hormone Therapy (Vaginal Estrogen)

Low-dose vaginal estrogen — available as a cream, pessary or ring — delivers estrogen directly to the vaginal tissue with minimal systemic absorption. It acts locally on vaginal tissue rather than throughout the body. How quickly symptoms change differs from person to person, and your doctor will talk through what to expect. For women with a history of hormone-sensitive cancers, we work closely with your oncologist to determine whether localised therapy is appropriate for you.

Hyaluronic Acid Gel / Vaginal Filler

Hyaluronic acid (HA) is a naturally occurring molecule that attracts and retains water within tissue. Vaginal HA gel applied topically provides immediate and sustained moisture relief, particularly for women who prefer a completely hormone-free and non-invasive approach. Injectable HA-based options are also used; whether they suit you is decided at assessment. This option is popular among younger women experiencing post-partum dryness and women undergoing cancer treatment.

Combination Approach

For moderate-to-severe GSM, a combination of MonaLisa Touch laser with localised estrogen therapy or hyaluronic acid may be considered, and the plan is decided at assessment. Our specialists design personalised treatment plans based on your symptom severity, medical history, lifestyle and personal preferences. Follow-up assessments ensure your response to treatment is monitored and the plan adjusted where needed.

Who Is Suitable for Each Treatment?

Every woman's situation is different. The following summary provides a general guide, but suitability is always confirmed at consultation:

• MonaLisa Touch: suitable for most post-menopausal, perimenopausal, post-partum and cancer-treatment women; no hormone contraindication; mild-to-moderate and severe GSM.
• Vaginal estrogen: most women with GSM; avoid with active hormone-sensitive cancer (discuss with oncologist); used for urinary as well as vaginal symptoms.
• Hyaluronic acid gel: all women; particularly appropriate as first-line for mild symptoms, post-partum dryness or where injections are not desired.
• Combination therapy: moderate-to-severe GSM or women seeking optimal, long-lasting results; tailored by specialist at consultation.

Frequently Asked Questions