Although vaginal dryness is often associated with menopause, plenty of young people have a hard time getting wet, too. Temporary dryness can stem from a lot of different issues, like stress, anxiety, depression, and hormonal fluctuations (whether they happen naturally or because of medication); or from a lack of foreplay or arousal during sex. Some health conditions and procedures can cause more chronic dryness, too.
Vaginal dryness often comes bundled with itching and burning sensations, both of which can feel a lot more intense during sex—some people describe sexual friction without adequate lubrication as “sandpapery.” Dry sex can also make it easier for people to develop UTIs, or get cuts or abrasions that, in turn, increase their risk of contracting STIs.
Despite its ubiquity, vaginal dryness is under-discussed among medical experts and patients. When it does come up, health care providers usually recommend using plenty of lube during sex, but caution that people should be wary of anything with scents or flavoring that can irritate sensitive skin. (That warning also extends to lotions, soaps, and douching products.) Doctors may also suggest more foreplay to hopefully maximize wetness before penetration. In persistent or severe cases, they sometimes recommend using vaginal moisturizers, or undergoing estrogen therapies (although the latter treatment can have painful side effects and may not be safe for everyone).
But sometimes, none of these treatments totally resolve a person’s vaginal dryness issues. Beth, a woman in her 30s, has Sjögren’s disease, an autoimmune disorder that affects up to 4 million people in the U.S. Sjögren’s leads a person’s immune system to attack glands and tissues that produce moisture. Symptoms of the condition vary, but typically include chronically dry eyes and mouths, as well as fatigue, headaches and concentration issues, and general joint pain. Beth and most other people with vaginas who develop Sjögren’s also experience chronic, severe vaginal dryness, which many say seriously disrupts their sex lives.
Over the last decade, Sjögren’s experts have done some solid research on, and gotten better at talking about, how to mitigate its effects on vaginal lubrication. But even with treatment, dryness is a persistent problem for many people with Sjögren’s—which can also be the case for those who experience dryness for other reasons. VICE spoke to Beth and her husband, Greg, about how they’ve adjusted to sex with intense, enduring vaginal dryness.
VICE has withheld Beth and Greg’s last names for privacy reasons. This interview has been edited for length and clarity.
Beth: As a teenager, I had a lot of joint pain and constantly felt sick and tired. In 2013, when I was in my mid-20s, my father passed away, and stress and anxiety led those symptoms to get much worse. After many tests, my doctors determined that I had an autoimmune disorder of some kind. In 2015, I went to an arthritis specialist who asked if I had issues with dry eyes and mouth. I said yes, and he diagnosed me with Sjögren’s.
Greg: Beth and I got married just before her diagnosis. We’d been together for a few years. I went to all these appointments with her, and I remember that doctor telling us, “I’ve got good news and bad news. The bad news is that you have a disease that’s going to negatively affect you. The good news is that it’s not going to kill you. But you are going to have to use eye drops and drink a lot of water, and you may need sexual aids like lubrication.”
Beth: When I was younger, I didn’t have any issues with natural lubrication. [Laughs] I could stay wet all day! I started to feel significant vaginal dryness right around the time I got diagnosed. It was awkward and confusing, because even though the doctor had told us dryness was a common issue with Sjögren’s, I wasn’t sure whether the condition was actually the cause—or whether the dryness came from my stress and depression around figuring out what was going on, or something else. For a while, I questioned whether I was still sexually attracted to Greg. Over time, it became increasingly clear that my level of dryness corresponds to my other Sjögren’s symptoms.
This change had a big effect on my self-esteem. I kept thinking, I’m in my mid-20s, and already I’m this dried-up old lady.
Greg: Yeah, she said that out loud a lot.
Beth: Getting mentally aroused, then seeing your body fail to respond to that, was frustrating. It made me not want to have sex at all. I felt like this condition had taken something away from me. I haven’t tried to put it into words before, because no one else has ever really asked how I feel about it. But I was embarrassed that I couldn’t get lubricated enough on my own—that I needed help with this thing that used to be so easy for me.
But I’ve always been a sexual person—I like the feeling of closeness that comes with it. Eventually, I decided that I didn’t want these issues to stop me from having sex.
Greg: Neither of us had experience with lube. When we realized that we would need to use it during sex from then on, we didn’t know what kind to use. Beth’s doctor told us we should try water-based lube, as that’d probably be best for her.
Beth: He didn’t give us any more details. He just told us to try a few brands.
Greg: Beth is pretty sensitive, in general.
Beth: I’ve always had to be careful about things like the soap and shampoo I use, because a lot of the things they add to products, like scents, irritate my skin.
Greg: We had to go through five or six brands of lube before we found one that worked for us.
Beth: It wasn’t just about sensitivity. A lot of water-based lubes only last for a little while before you feel dry again. You have to stop and reapply, which isn’t something we want to do all the time. We needed to find one that would make me feel ultra-lubricated for a long time.
Greg: We settled on a brand made by a regional sex store. We make several one-and-a-half-hour trips into a nearby city every year to stock up. There are times when we run out and want to have sex before we can get more. And we just can’t, because we know the discomfort involved would be too much. Sometimes, we deal with our frustration by going to a local 24-hour store to buy lube that works well enough for the moment. On our next day off of work together, we make a trip to buy our favorite brand, and a toy or two.
Beth: Some days, I can get a little wet on my own, although not as much as I used to. (Sometimes, nothing helps at all.) I still want to have sex using as much of my natural lubrication as I can, as a personal preference. So we do more stimulation before penetration than we used to. (Kissing used to be enough to get me fully ready to have sex.) We’d never used vibrators together before, but now we use them during foreplay to help me get wet. I even try to lie in specific positions in order to be as comfortable, and get as turned on, as possible.
Greg: Yeah, it’s a process.
Beth: We also have sex less often than we used to, because I find that the less frequently I have sex, the easier it is for me to get wet naturally. And when I'm having a bad Sjögren’s flareup, my entire body is in a lot of pain, so it's too uncomfortable to have sex. I have frequent anxiety that affects how often we have sex, too.
In the early days of our relationship, we used to have sex three times a day. Now we have sex sometimes as rarely as once or twice a month. That’s depressing, and I’m insecure about it.
Oral sex doesn’t really work for us because I can’t easily produce saliva due to Sjögren’s. My vagina is so sensitive now that I don’t really like receiving oral sex, either. But I don't like either form of oral anyway. I masturbate occasionally—but maybe less than once every few months.
Greg: I don’t mind the decrease in the amount of sex we have. Whenever there’s an issue where I feel like sex but Beth doesn't, or we try to have sex but it doesn't work out, maybe one time out of five I'll either go take a cold shower or masturbate. Most of the time, I just continue on with my day. So having sex a little less often isn’t a huge issue for me.
Beth: We still grab each other around the house, and do playful, sexual things like that. But our “love language” used to be sex, and now it's become more about emotional communication. We’re more emotionally intimate than we've ever been before, and I think that’s the most important thing. So, ultimately, I’m OK with these changes.
With time, I’ve gotten over most of the shame and insecurity I felt about using lube. It’s become part of our sexual routine, so I don’t feel frustrated by having to remember to use it, and I’m not in my head anymore about what’s changed in my life when I do. And I’ve learned that sex just always feels better when you use lube.
Greg: We always keep lube on the bedside table. It’s just part of life now.
Beth: When we do have sex, I’d love go for a long time. We used to have sex for 30 minutes, an hour, or more. But even with a lot of lube, I have to stop after about 15 minutes because it starts to hurt. Especially right after I climax, I almost instantly get really dry, so I need more lube right away and can’t keep going for long.
Greg: Because we know each other really well at this point, we can make each other come in just a few minutes if we need to.
Beth: When I feel sore, I tell Greg he has to finish soon, or I ask him if he’s close. He knows what I mean by that. We usually start having sex in missionary.
Greg: Beth finishes pretty fast in that position.
Beth: But when I feel sore, we switch to a from-behind position, because… [Laughs]
Greg: It’s quicker for me that way.
Beth: I can’t do a lot of aggressive in-and-out thrusting like we used to do.
Greg: The actual motion we do isn’t something you see in porn often.
Beth: Greg has to fully enter me, stay inside, and thrust and grind like that. Or else, thanks to the friction, it’s painful, even with lube. It does kind of suck that we can’t have aggressive sex like we used to—we have to be more careful.
Sometimes, when I feel pain, I don’t tell Greg about it because I just want to have sex like I used to for a moment. Afterwards, I usually end up crying because of the pain. I know that Greg feels so bad about that, but I always tell him that’s not his fault.
Greg: If the shoe were on the other foot and I had a condition that affected my ability to have sex, Beth would be considerate and give me the support I needed to work through and feel better about it. I want to provide her with that. For us, that means me being nonchalant about everything that’s changed in our sex life, and trying to be as non-pressuring as I can. I know things are still hard for Beth. But we still like to express ourselves sexually with each other. Having to change how we have sex, or how often, isn’t going to stop that.