Dryness Is Not “Just Part of Ageing”
The Unspoken Syndrome of Menopause and Why BAME Women Are Too Often Left to Suffer in Silence
There are menopause symptoms women mention openly. Hot flushes, night sweats, mood shifts and the sudden sense that your body has changed its rules without warning.
Then there is the symptom that many women carry quietly, often for years, because it feels too intimate to name and too awkward to raise in a ten-minute appointment. Vaginal dryness.
In SistaTalk Menopause, we say the quiet parts out loud, not for shock value, but because silence has a cost. Vaginal dryness is not a minor inconvenience.
It can be painful, confidence-eroding, relationship-shaping and for some women it becomes the symptom that makes them avoid healthcare altogether. It is also one of the most under-recognised and under-treated parts of menopause, even though it is common and treatable.
A symptom that is common should not feel like a private failing. Yet for many Black, Asian and women from minority ethnic backgrounds, the experience is intensified by cultural silence, clinical blind spots and unequal access to menopause support.
What Is Actually Happening In the Body
Vaginal dryness during perimenopause and menopause is most often driven by changing and then falling oestrogen levels. Oestrogen helps maintain the thickness, elasticity, lubrication and blood flow of vaginal and vulval tissues.
When oestrogen declines, the tissues can become thinner and more fragile, lubrication reduces, and the vaginal environment changes.
For many women this shows up as dryness, burning, itching, irritation or pain during sex. For others it presents as recurrent urinary symptoms, discomfort when walking or exercising or a sense of persistent soreness that is hard to describe.
Clinically, this cluster of symptoms is increasingly recognised under the umbrella term Genitourinary Syndrome of Menopause (GSM). In the United Kingdom, NICE now uses the phrasing “genitourinary symptoms associated with menopause” in its guidance.
This matters because language shapes whether clinicians and patients recognise the issue as legitimate, medical and treatable.
How Common is Vaginal Dryness?
If you have felt alone in this, the data tells a different story.
Studies and clinical statements consistently show that genitourinary symptoms of menopause are widespread, with estimates ranging from around one quarter to the majority of postmenopausal women, depending on how symptoms are defined and measured.
The North American Menopause Society reports that between 27% and 84% of postmenopausal women experience GSM and highlights persistent underdiagnosis and undertreatment.
Other reviews place vaginal dryness among the most prevalent post-menopausal symptoms, frequently cited at around 50–60%.
In other words, this is not rare. It is not a niche. It is a mainstream menopause reality that has been pushed into the shadows.
Why It Stays “Unspoken”
Vaginal dryness is not just a physical symptom. It collides with identity, intimacy, self-image, faith, culture and often a lifetime of social conditioning about what women should tolerate.
For many women in Black, Asian, Caribbean, African and other minority ethnic communities, discussions about sex, vulval health and ageing carry layers of taboo. Some women were raised with messages that “good women do not talk about those things,” that discomfort is simply part of being a wife or partner or that seeking help is shameful.
Others carry religious or cultural frameworks that make sexual health conversations feel exposing rather than empowering.
When that is the baseline, it takes a great deal of courage to walk into a clinic and say, “Sex hurts” “I feel dry and sore all the time” or “I dread intimacy now.”
Unequal Access to Menopause Care
There is also a systemic layer that cannot be ignored.
UK research has repeatedly raised concerns about inequalities in menopause care by ethnicity, including delayed support, poorer access to treatment and lower uptake of hormone therapy among minority ethnic groups.
The King’s Fund has highlighted barriers such as language, cultural sensitivity, cross-cultural communication challenges and gaps in clinician training.
When healthcare is uneven, “unspoken” symptoms stay unspoken.
What UK Prescribing Data Tells Us
A large population-based study of nearly two million women in UK primary care (2013–2023) found significant inequalities in hormone replacement therapy prescribing by ethnicity, deprivation and geography.
White women were substantially more likely to receive HRT than non-white women, with markedly lower rates among several minority ethnic groups.
This matters because menopause care is often treated like a single doorway. If women are less likely to access menopause assessment and treatment overall, they are less likely to be offered the full range of options, including local vaginal oestrogen for genitourinary symptoms.
NICE guidance is clear that vaginal oestrogen can be offered for genitourinary symptoms associated with menopause, either alone or alongside non-hormonal moisturisers or lubricants.
Serious adverse effects are very rare and absorption is largely local with minimal systemic impact.
The British Menopause Society similarly describes GSM as a chronic, progressive condition and outlines practical, evidence-based management approaches.
So, the question is not whether effective treatments exist. The question is who is being offered them, who is supported to use them confidently and who is being left to “put up and shut up.”
What US Research Shows About Race and Menopause Care
In the United States, large cohort studies show that menopause symptoms and reporting patterns vary across ethnic groups.
The Study of Women’s Health Across the Nation (SWAN) has reported vaginal dryness prevalence of around 30–40% at baseline in one analysis, with variation by ethnicity and country of origin.
US research also shows disparities in menopause management. Reviews of racial and ethnic differences in diagnosis and treatment consistently find that menopausal hormone therapy is more commonly prescribed to White women than to Black and Hispanic women, with implications for access to treatments such as vaginal oestrogen.
When symptom burden is layered with unequal access to care, the outcome is predictable: greater suffering, later intervention and more women believing something is “wrong with them” rather than recognising a treatable medical condition.
Why the Impact Goes Beyond Sex
Yes, painful sex is part of this story and it deserves to be named without embarrassment. But vaginal dryness affects far more than bedroom intimacy.
It disrupts sleep when discomfort wakes you. It affects movement when walking feels abrasive or sore. It limits exercise when clothing irritates.
It erodes confidence when your body suddenly feels unfamiliar or “older” overnight. It strains relationships when avoidance is misread as rejection or when women endure pain to keep the peace.
It impacts mental wellbeing when private discomfort becomes a constant background presence.
For women of colour, this often sits alongside other pressures. Caring responsibilities, cultural expectations to be resilient and silent, workplace stress and healthcare experiences where symptoms are minimised. It becomes another place where a woman learns to disappear inside her own life.
What Helps and What You Can Ask For
There is no single solution that fits every woman. There are, however, evidence-based options that women deserve to understand.
Non-hormonal vaginal moisturisers can support tissue comfort when used regularly and lubricants can reduce friction during sex. These can be helpful for mild symptoms and alongside other treatments.
For many women, local vaginal oestrogen is highly effective. NICE guidance supports its use for genitourinary symptoms associated with menopause and confirms its safety profile for most women.
Where medical histories are complex, including breast cancer, decisions should be specialist-led and personalised. NICE provides clear pathways because these conversations deserve nuance, not fear.
Globally, clinical position statements agree on one point. GSM is common, under diagnosed and treatable.
The deeper need is not just products it is permission.
Permission to raise it.
Permission to insist it matters.
Permission to expect healthcare that treats quality of life as clinically relevant.
Dignity is a Health Outcome
Vaginal dryness has been normalised as something women should tolerate, joke about or quietly grieve. That normalisation is not neutral. It teaches women to make themselves smaller, even in their own bodies.
For women of colour, this is compounded by long histories of being disbelieved, dismissed or inadequately served by health systems. When menopause care is unequal, the “unspoken syndrome” stays unspoken and women carry pain that never needed to become normal.
The Impact Is Bigger Than Sex
Yes, painful sex can be part of this story and it deserves to be named without embarrassment. But vaginal dryness does not stay neatly contained within intimacy.
For many women, especially those leading teams, running businesses or carrying significant professional responsibility, its impact quietly seeps into every area of life.
At work, persistent physical discomfort consumes cognitive energy. When the body feels irritated, sore or inflamed, concentration drops. Meetings feel longer. Travel becomes harder. Sitting for extended periods, wearing structured clothing or managing long days can feel quietly intolerable.
Many women push through because leadership culture rewards endurance, not honesty. Over time, physical discomfort turns into mental fatigue. Mental fatigue erodes confidence, patience and the sense of operating at full capacity.
For founders and business owners, the impact can be even more pronounced. Entrepreneurship already demands emotional regulation, strategic thinking and constant decision-making under uncertainty.
Add disrupted sleep, bodily discomfort and reduced confidence into that mix and the load becomes heavy but invisible. Some women quietly decline opportunities, delay growth plans or scale back ambitions without ever naming why.
Others overcompensate, working harder while ignoring what their body is signalling. Neither response is sustainable, yet both are common.
In leadership roles, this intersects with image and perception. Many women already feel pressure to appear composed, capable and unaffected. Admitting discomfort can feel risky in environments where menopause remains poorly understood or subtly stigmatised.
For women of colour, this pressure is intensified by stereotypes that frame us as endlessly strong, resilient or expected to cope without complaint. The result is silence layered upon silence.
In relationships, the consequences ripple outward. When vaginal dryness leads to pain, avoidance of intimacy or emotional withdrawal, it can quietly reshape connection.
Partners may misinterpret distance as rejection. Women may feel guilt, frustration, grief or a loss of desire and identity. Some endure discomfort to preserve harmony.
Others retreat emotionally to protect themselves. Where cultural or religious norms discourage open conversation, intimacy becomes another space where women disappear rather than feel supported.
For women of colour, all of this often unfolds alongside additional pressures: caring responsibilities, workplace bias, financial strain and healthcare encounters where symptoms are minimised or misunderstood.
Vaginal dryness then becomes more than a physical condition. It becomes symbolic of how women are trained to tolerate discomfort, adapt silently and prioritise functioning over wellbeing.
This is why reframing matters. Vaginal dryness is not a personal inconvenience. It is a quality-of-life issue that affects leadership effectiveness, business sustainability, emotional connection and long-term health. Addressing it is not indulgent. It is practical. It is strategic. And it is humane.
If you are reading this and thinking, “I thought it was just me” let that thought leave your body. It is not just you. It is common. It is real. It is treatable. You deserve care that does not require you to become your own medical advocate just to be taken seriously.
If this post resonates, add your voice in the comments. Share what you wish someone had told you earlier, what helped you, what you asked your GP for or what you are still navigating. If you know a woman who has been quietly struggling, share this with her.
Community is often the first place we learn that our symptoms are not shameful and that our comfort is not optional.
