Vaginal Dryness, Itching, and Pain After Breast Cancer Treatment: What's Actually Happening and the Treatment Most Women Are Never Offered
If you've been quietly putting up with vaginal dryness, itching, or pain since your cancer treatment and haven't yet said a word to your doctor, this post is for you. Not because I'm going to make it clinical and comfortable. But because I waited far too long to say something, and I don't want you to make the same mistake I did.
Let Me Start With My Own Story
For the first six to twelve months, I said nothing.
I put up with chronic dryness and itching that I can only describe as relentless. I switched all my underwear to 100% cotton. Changed my pyjamas. Swapped my laundry detergent. Tried every over-the-counter moisturiser and anti-itch cream I could find at the pharmacy. I did everything I could think of on my own, because the thought of bringing it up with my GP made me deeply uncomfortable.
Which, in hindsight, seems completely ridiculous. I had been through a breast cancer diagnosis, surgery, chemotherapy, and radiotherapy. I had talked about my body in ways I never imagined. And yet this — this particular conversation — felt like too much.
I truly wish I hadn't waited so long.
When I did finally raise it, I was checked for thrush. Checked for bacterial infections and told to do all the things I'd already done. It took a referral to a dermatologist who specialised in vulvar conditions to get a clear and accurate diagnosis of Lichen Sclerosus. By that point, the condition had escalated to be quite severe.
And then the moment that still makes me furious: a biopsy was taken from one area of my vulva because it looked like it could be cancerous.
I had gone through breast cancer treatment, and now I was sitting there wondering whether I had potentially been left to develop another cancer, because nobody had caught this sooner. Because the conversation hadn't happened when it should have.
I am glad to tell you that the biopsy came back clear. After multiple visits with my dermatologist, everything was brought under control. My condition is now well managed and requires only an annual check-up, along with a steroid cream two to three times each week to prevent any escalation. But the road to get there was longer and harder than it needed to be — because I was embarrassed, and because no one in my care team raised it first.
That is exactly why I'm writing this.
Why Vaginal Dryness and Itching Are So Common After Breast Cancer Treatment
Vaginal dryness after breast cancer treatment is not a coincidence. It is a direct and predictable consequence of what that treatment does to your hormones, and it happens far more often than most women are warned about.
The medical term is the Genitourinary Syndrome of Menopause, or GSM. It is the collective name for changes to the vagina, vulva, and urinary tract that happen when estrogen levels fall. And when cancer treatments like chemotherapy, surgery to remove the ovaries, aromatase inhibitors and tamoxifen cause estrogen to drop suddenly and significantly, these changes can begin quickly and intensify fast.
Symptoms include vaginal dryness, itching, burning, pain during sex, recurrent urinary tract infections, urinary urgency, and leakage. Not every woman experiences all of these. But most women experiencing vaginal dryness and itching after breast cancer treatment are experiencing GSM, whether or not anyone has used that word with them.
Unlike some menopausal symptoms that ease with time, vaginal dryness and GSM often don't. Without treatment, they can progressively worsen. The tissue affected by low estrogen does not self-correct. It needs support.
Between 50 and 80 percent of postmenopausal women experience GSM. The research suggests that around 5 percent are currently using vaginal estrogen to treat it.
Up to 80 percent affected. Five percent treated.
That gap is not a coincidence either. It is the result of a myth I need to address directly.
The Myth That Is Leaving Breast Cancer Survivors Undertreated
Here it is: Women with estrogen-positive breast cancer cannot use any form of oestrogen, including vaginal estrogen.
This is one of the most persistently harmful myths in women's health after cancer. And it is causing real, unnecessary suffering.
Vaginal estrogen, the low-dose, locally applied treatment used for vaginal dryness and GSM, is not the same as systemic hormone therapy. It stays where it is applied. It does not circulate through the body in any meaningful way. When blood is drawn from a woman using vaginal estrogen, her levels remain in the postmenopausal range. It does not raise circulating estrogen.
This is not a fringe view. It is the position of every major menopause organisation globally, including the Australasian Menopause Society, the International Menopause Society, and the British Menopause Society.
As Dr Kelly Casperson, urologist, sexual health specialist, and one of the most credible voices globally on this topic, explained when she joined me on the Dear Menopause podcast: "Many, many, many studies on the safety of vaginal estrogen with breast cancer survivors... vaginal estrogen is so low dose that it doesn't go into your bloodstream. It doesn't make you premenopausal again."
She makes another point worth sitting with. We don't call prostate cancer "testosterone-positive prostate cancer." The framing of "estrogen-positive" breast cancer contributes to a fear that a hormone your body naturally made for decades is now your enemy. It isn't. As Dr Casperson puts it, hormones are like food. You had to remove the food to starve the cancer. But vaginal estrogen, at the dose used to treat vaginal dryness and GSM, is such a small amount that the evidence, across study after study, does not support the fear.
One more significant development worth mentioning: there was a black box warning on vaginal oestrogen products. A serious warning label was added in the wake of the 2002 Women's Health Initiative that listed risks including stroke, blood clots, and probable dementia. This warning was applied to all forms of estrogen indiscriminately, despite vaginal estrogen not being systemic. Since the recording of my podcast episode with Dr Casperson, the FDA in the United States has removed that black box warning from vaginal estrogen. This reflects what menopause experts have said for years: the warning was not justified by the evidence.
If your doctor has told you that you cannot use vaginal oestrogen because of your breast cancer diagnosis, that conversation deserves to be revisited. Not dismissed! Revisited, with evidence in hand and questions ready.
Treatment Options for Vaginal Dryness After Breast Cancer
Vaginal Estrogen
For most women, vaginal estrogen is the most effective treatment for vaginal dryness, itching, and GSM after cancer treatment. It is available by prescription as a cream or a pessary in Australia. It works by restoring the local tissue environment that low estrogen has disrupted, including the vaginal microbiome, which is what protects against recurrent urinary tract infections.
Because of the myths discussed above, many women with a breast cancer history are never offered it, or are told it is not appropriate for them. The evidence does not support a blanket refusal. If you are being told no, ask for the clinical basis for that decision, and ask whether your clinician is familiar with the current position statements from the AMS and the IMS on this topic.
Vaginal Moisturisers
Different from lubricants, vaginal moisturisers are used regularly, several times a week, not only before sex, to help maintain tissue hydration over time. They don't address the underlying hormonal cause, but they can meaningfully reduce day-to-day discomfort from vaginal dryness.
One product launching in Australia in June 2026 that's worth knowing about is Fluvadin Plus by Biolae, Fluvadin Plus is a hormone-free vaginal ovule containing hyaluronic acid, which works to restore natural moisture and support tissue repair. It's TGA-listed, paraben-free, applicator-free, and backed by clinical research showing improvement in vaginal dryness symptoms within two weeks for most women. For anyone who can't or doesn’t want to use estrogen, this is exactly the kind of option worth having on your radar.
I have no commercial relationship with Biolae. I'm sharing this because it's a genuinely useful option for women who can't use estrogen, and it's an Australian-owned, female-founded company.
For any moisturiser you choose, look for products that are pH-balanced and free from glycerin, parabens, and added fragrance.
Lubricants
For use during sex, lubricants can make a significant difference to pain and comfort. Water-based or silicone-based options are generally well tolerated. Avoid anything with added fragrance, warming agents, or flavours.
Pelvic Floor Physiotherapy
Consistently underutilised. A physiotherapist who specialises in pelvic floor conditions can work directly with both the muscular and tissue health of the pelvic floor, which is significantly affected by estrogen loss. This is not only about incontinence. It addresses pain, function, and quality of life, and is often partially covered by private health insurance.
DHEA (Prasterone)
A vaginal insert that the body converts locally to both estrogen and testosterone, with minimal systemic absorption. Available in Australia on prescription as Intrarosa and worth discussing with your treating team if other approaches have not been effective.
Non-hormonal options work best when started early and used consistently, not only when things become urgent.
The Testosterone Piece Nobody Mentions
One more thing worth raising, because it came up in my conversation with Dr Casperson and it changed how I understood my own experience.
Testosterone is not just a male hormone. Ovaries produce four times as much testosterone as estrogen. It is present in all bodies, and it plays a direct role in genital tissue health, arousal, lubrication, and the ability to orgasm.
When treatment-induced menopause strips both estrogen and testosterone from the body suddenly, the impact on sexual function can be profound. And yet testosterone is almost never part of the conversation women have with their oncologists or GPs about vaginal dryness and sexual health after cancer.
In Australia, a female-dose testosterone product exists (Androfeme), though it is expensive and sadly was recently denied listing on the PBS. Some women use a small portion of a male testosterone product under medical supervision. This is not a self-prescribing path, it requires a willing clinician and proper assessment. But it is a conversation worth initiating.
As Dr Casperson told me: "Testosterone helps all domains of female sexual health. Lubrication, arousal, orgasm, desire, and overall sense of wellbeing in regards to their sex life."
If that is relevant to your experience right now, add it to the list of things to raise.
Frequently Asked Questions
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For most women, yes, including many with estrogen-receptor-positive breast cancer. Vaginal estrogen is applied locally at a very low dose and does not meaningfully raise circulating oestrogen levels in the blood. Major menopause bodies globally, including the AMS support its use in breast cancer survivors. That said, every woman's situation is different, and this is a conversation to have with a clinician who is up to date on the current evidence, not one to be shut down with a blanket refusal. If you're being told no without explanation, ask for the evidence behind that decision.
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Because the estrogen drop is faster and more severe. Natural menopause involves a gradual hormonal decline over years, giving the body some runway to adapt. Treatment-induced menopause — caused by chemotherapy, surgical removal of the ovaries, or hormone-suppressing medications like aromatase inhibitors — can trigger a sudden, significant drop in estrogen within weeks. The tissues affected by estrogen loss have no time to adjust. This is why vaginal dryness and GSM symptoms after cancer treatment are often more intense and more rapid in onset than in natural menopause.
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Vaginal moisturisers used regularly (not just before sex), pH-balanced lubricants for use during sex, pelvic floor physiotherapy, and DHEA (prasterone) vaginal inserts are all options. None of these replaces vaginal estrogen where it is clinically appropriate, but they can make a meaningful difference to daily comfort and sexual function. Discuss all options with a clinician who has experience in menopause after cancer, not all GPs are equally informed on this. And if you need a recommendation for a trusted, informed GP within Australia, book a 1:1 Consultation with me.
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Yes. Unlike hot flushes, which often ease with time, vaginal dryness and GSM do not self-resolve. Without treatment, symptoms typically continue and can worsen progressively. This is one of the most important reasons to address it early rather than waiting until things become severe. I waited, and my condition escalated significantly before it was properly diagnosed and treated. Earlier intervention makes a meaningful difference.
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It is common, but it is not something you have to accept. Pain during sex after breast cancer treatment is a recognised and treatable consequence of treatment-induced menopause and the resulting changes to vaginal and vulvar tissue. It has a medical name (dyspareunia) and there are effective treatments. If you are experiencing it, it is worth naming directly with your GP or gynaecologist. You do not need to use softer language. Say: "I am experiencing pain during sex since my cancer treatment. I want to discuss treatment options."
What to Say to Your Doctor
The single most important thing I can tell you: don't do what I did. Don't spend six to twelve months putting up with vaginal dryness, itching, or pain because the conversation feels uncomfortable. These are medical symptoms. You deserve a medical response.
Here are the specific things worth raising at your next appointment:
"I've been experiencing vaginal dryness, itching, or discomfort since my treatment. I'd like to discuss whether vaginal estrogen is appropriate for me."
If your doctor says no because of your breast cancer diagnosis, ask them to explain the clinical basis for that. Ask whether they are familiar with the current position statements from the International Menopause Society or the AMS on vaginal estrogen safety in breast cancer survivors.
"I've been having recurrent urinary tract infections since my treatment. Is there a connection to my menopause, and what are the treatment options beyond antibiotics?"
Recurrent UTIs in postmenopausal women are frequently connected to low estrogen and the resulting changes to the vaginal microbiome. This is treatable, and vaginal estrogen can reduce the risk of recurrence by 50 to 60 percent. Ongoing antibiotics alone is not the answer.
"I'm experiencing pain during sex, or I've lost interest in sex entirely since my treatment. I'd like to talk about what's available to help."
You are allowed to say this. You are allowed to want your sex life back. Surviving cancer is not the finish line. Living well — including intimately — is part of what you are entitled to fight for.
If the appointment doesn't go the way you hoped, ask for a referral to a gynaecologist or specialist menopause clinic with experience in cancer survivors. A dermatologist who specialises in vulvar conditions, as was the case for me, can also be important if symptoms have escalated or there is any question about changes to the skin in that area.
The Bigger Picture
Here is what I keep coming back to.
Vaginal dryness after breast cancer treatment affects the majority of women who go through it. The majority of those women are not being treated. Not because effective, safe options don't exist, they do. But because the conversation isn't happening. Because women are embarrassed. Because clinicians don't always raise it. Because myths about estrogen in breast cancer survivors have been repeated so often, they've calcified into assumed policy.
As Dr Casperson said plainly: "If you don't know why these things are happening, you can't treat it in the best, safest way that actually can resolve the problem."
I spent six to twelve months assuming this was something I had to manage alone. I tried everything I could without a prescription. I finally had the conversation, got through a confusing and inadequate response, got a referral, had a biopsy, and eventually — eventually — got the care I needed.
I tell you this not to frighten you, but because the earlier the conversation happens, the better the outcome. The symptoms I had were manageable when they started. By the time they were diagnosed properly, they were severe. That gap, between manageable and severe, is exactly the gap a timely conversation with the right clinician could have closed.
You don't have to suck this up as the price of surviving. This is a solvable problem. And you deserve to have it solved.
Want to Know What to Ask at Your Next Appointment?
The free guide I've put together is designed specifically for women navigating life after cancer treatment — including the exact questions to bring to your GP about vaginal dryness, GSM, and your options.
And if you'd like to work through your specific situation or are looking for a recommended, trusted and informed GP, whether you're still in treatment, recently finished, or years out and still struggling, that's exactly what a 1:1 consultation with me is for.
Further Listening
For a deeper dive into the evidence around vaginal estrogen safety and sexual health after menopause, listen to my conversation with Dr Kelly Casperson on the Dear Menopause podcast. Dr Casperson is a urologist and one of the most respected voices globally on female sexual health and menopause. She covers GSM, vaginal dryness, vaginal oestrogen, and testosterone in a way that will leave you informed, equipped, and — if you've been told no without explanation — a little bit furious.
Sonya Lovell is the founder of Menopause After Cancer and the host of the Dear Menopause podcast. She was diagnosed with breast cancer at 47 and experienced treatment-induced menopause. She is not a medical professional. Nothing in this post constitutes medical advice. Always work with your treating team when making decisions about your care.
References
Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014.
Crandall CJ, Hovey KM, Andrews CA, et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women's Health Initiative Observational Study. Menopause. 2018.
Falk SJ, Bober S. Vaginal health during breast cancer treatment. Curr Oncol Rep. 2016.
Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016.
Australasian Menopause Society. Genitourinary Syndrome of Menopause | Information Sheet. https://hub.menopause.org.au/Play?pId=e3cb85a0-2da9-40a0-8974-057ee3b2bf30
Castelo-Branco C, Mension E, Torras I, et al. Treating genitourinary syndrome of menopause in breast cancer survivors: main challenges and promising strategies. Climacteric. 2023.
Krishnamurthy J, Tandra PK. Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Common Complication with Effective Treatment Strategies. J Oncol Pract. 2019.
