While menopause is a major cause, vaginal dryness can result from breastfeeding, hysterectomy, removal of the ovaries (oophorectomy) diabetes, or autoimmune diseases targeting secretary glands, such as Sjögren’s syndrome. Sjogren’s syndrome typically develops in women in their 30s to 60s, (although it can occur at any age in either sex) and may also be a later development of rheumatoid arthritis, systemic lupus erythematosus (SLE) or scleroderma.^12,13,14

Medications which may cause vaginal dryness include contraceptive pills, antidepressants, antihistamines, and treatments for cancer. Tamoxifen is an anti-oestrogen and may significantly influence gynaecological symptoms, potentially increasing vaginal dryness rates by 20%. Aromatase inhibitors (eg letrozole, anastrozole or exemestane) may cause more vaginal dryness than tamoxifen.^12,13,15

Transmen using testosterone to suppress circulating oestrogen may find changes in the vaginal epithelium similar to vaginal changes in post-menopausal women. In response to testosterone, the vaginal epithelium in a transman will thin with a reduction in glycogen availability and reduced levels of lactobacilli. In addition, there will be increased levels of inflammation, oedema, collagen fibrosis, and granulation tissue.⁹

Other factors can include a lack of arousal during sex, and use of perfumed soaps, washes or douches in the vulvovaginal area.¹²