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Let’s just say it. It’s dry down there, and it hurts.
Maybe it started a few weeks into chemo. Maybe it started with tamoxifen, or an aromatase inhibitor, or the shots that switch your ovaries off. Maybe sex went from fine to “can we not.” Maybe it isn’t even about sex: it’s the itch in the middle of a meeting, or the sting when you pee.
And maybe nobody asked. A 2025 review of vaginal health after breast cancer says women “might withhold details due to embarrassment or seeing GSM as a natural aging consequence,” and that asking about it is the clinician’s job. So here we are, asking. This is what the research says, in plain English.
The short answer on vaginal dryness after a breast cancer diagnosis
It’s common, and it has a name: genitourinary syndrome of menopause, or GSM. The 2025 review found that women who’ve had breast cancer have GSM symptoms more often than other women, 74% compared with 50%, and that “these symptoms are often more severe.” The review lays out a range of options, starting with ones that don’t involve hormones.
What the research says, in brief
- It’s about estrogen. The review links these symptoms to low estrogen from hormone therapy, from chemotherapy that stops periods, from ovaries that stop working early, or from menopause.
- It’s more than dryness. GSM “affects the vulva, vagina, urethra, bladder, and pelvic floor,” according to the review.
- It matters for your treatment, too. The authors write that proper treatment can “enhance endocrine therapy adherence.”
- You may be able to get ahead of it. A trial at Memorial Sloan Kettering is testing counseling and a vaginal moisturizer at the start of ovarian suppression, before symptoms begin.
Why does breast cancer treatment cause vaginal dryness?
It comes down to estrogen. The review, published in Therapeutic Advances in Medical Oncology in 2025, says women with breast cancer “of all ages” can have menopausal symptoms caused by low estrogen. That can come from hormone therapy such as tamoxifen or an aromatase inhibitor, from chemotherapy that stops your periods, from ovaries that stop working early, or from menopause itself.
The authors call the result genitourinary syndrome of menopause, or GSM. It “affects the vulva, vagina, urethra, bladder, and pelvic floor, manifesting as genital, sexual, and urinary symptoms.” Elsewhere the review names symptoms such as dryness, itching, painful sex (dyspareunia) and pain when peeing (dysuria).
How common is vaginal dryness after breast cancer?
Very. According to the review, women who’ve had breast cancer “exhibit GSM symptoms at a higher rate compared to the general population (74% vs 50%), and these symptoms are often more severe.”
Why doesn’t anyone bring it up?
Partly because women don’t, and partly because clinicians don’t. The review says women may hold back “due to embarrassment or seeing GSM as a natural aging consequence,” and that “proactive inquiry” by health care providers “is crucial, especially in BC survivors.” It also says many clinicians “overlook the impact of endocrine therapy on the genitourinary system and lack knowledge about safe and effective treatments, leading to undertreatment and aggravated symptoms.”
This isn’t only about comfort. The authors write that the low-estrogen side effects of treatment affect whether women stay on their hormone therapy, and that proper treatment can “enhance endocrine therapy adherence, directly influencing long-term outcomes.”
What does the research say can help with vaginal dryness?
Lubricants, for sex. The review describes water-, silicone- and oil-based lubricants as products that “form a short-term physical barrier that reduces friction between surfaces and diminishes discomfort.”
Moisturizers, for every day. Vaginal moisturizers “aim to replicate natural secretions,” the review says, and are “intended for regular use,” anywhere “from daily to twice weekly” depending on how severe the symptoms are. We cover how to choose them in What Helps Vaginal Dryness After Breast Cancer?
Pelvic floor therapy and dilators. The review explains that “vaginal pain often prompts women to involuntarily tighten their pelvic floor muscles during penetration, intensifying the discomfort in a continuous cycle.” For that, it says “guided PFPT by a skilled pelvic floor therapist is advised.” (PFPT is pelvic floor physical therapy.) It also describes dilators, which come in several sizes, as a way to keep tissue flexible, and says “consistent use, several times weekly, is crucial.”
Lasers. The review notes that recent randomized trials “found no significant benefit of intravaginal lasers over placebo” and that “comprehensive RCTs are essential before recommending lasers for BC survivors.”
Hormonal options. The review covers low-dose vaginal estrogen, vaginal DHEA and vaginal androgens, and says the decision depends on your type of breast cancer and your treatment. It says “vaginal estrogen therapy may be safer in women treated with tamoxifen than in those receiving AIs,” and that the FDA has approved vaginal DHEA (prasterone, sold as Intrarosa) for painful sex caused by vaginal atrophy. This is a conversation for your oncologist. We go deeper in Is Vaginal Estrogen Safe After Breast Cancer?
Can you get ahead of vaginal dryness before it starts?
That’s exactly what one study is testing. A clinical trial listed by the National Cancer Institute, led by Memorial Sloan Kettering Cancer Center, is looking at whether “sexual health counseling and vaginal moisturizer use at the start of ovarian suppression therapy” can reduce side effects such as vaginal dryness and sexual dysfunction. The NCI notes that “currently, the usual approach is to treat these symptoms at the time they develop.”
The trial is for women 18 and older with stage 0 to III hormone receptor-positive breast cancer who are premenopausal or perimenopausal, are on or starting ovarian suppression, and don’t yet have vaginal symptoms. It’s listed as active at Memorial Sloan Kettering locations in New York and New Jersey. You can find it as NCI-2023-04986 (ClinicalTrials.gov ID NCT05910294) and ask your oncologist whether it’s a fit.
Questions to ask your care team about vaginal dryness
- Could my treatment be causing this? Is it GSM?
- Can you refer me to a gynecologist or a pelvic floor physical therapist who works with breast cancer patients?
- Which lubricants and moisturizers are OK for me to use?
- Given my type of breast cancer and my medicines, are vaginal estrogen or DHEA options for me?
- Am I eligible for any clinical trials on sexual health?
Quick question
Has anyone on your care team asked you about vaginal dryness?
Anonymous. We count answers, never names or emails.
More from Babette on sex after breast cancer: What Helps Vaginal Dryness After Breast Cancer? · Why Does Sex Hurt After Breast Cancer? · Is Vaginal Estrogen Safe After Breast Cancer?
Sources: Ram-Weiner M, Paluch-Shimon S, Allweis TM and Lev-Sagie A, Vaginal health in breast cancer survivors: a practical clinical approach, Therapeutic Advances in Medical Oncology, July 2025; National Cancer Institute, A Study to Prevent and Improve Sexual Health Concerns for People With Breast Cancer (NCI-2023-04986, NCT05910294), listed as active. Quotations are from the sources listed. This article is general information and is not a substitute for advice from your care team.
