How Your Thyroid Affects Vaginal Dryness, Libido and Painful Sex (And what you can do about it at any age!)

How your thyroid affects vaginal dryness, libido & painful sex (and what you can do about it at any age)

Are your issues with your thyroid causing you problems in the bedroom? For many women, it absolutely is. I’ve invited a gynecologist and obstetrician to talk about how our hormones – sexual and thyroid – dictate a lot about what’s going on down there in our “lady parts”, regardless of our age.

Written by Anna Cabeca, DO, FACOG

As a gynecologist I have worked with thousands of women over the years, helping them with a wide range of issues such as PMS, infertility, menopause and sexual health concerns. While these issues span different age groups, a woman’s underlying hormone health is always the primary influence on how she will experience these female “rites of passage” over the course of her life.

Even prior to menopause sexual hormones can get out of balance

As early as your 20’s one key hormone associated with sexual function, DHEA, is already beginning its natural decline. DHEA is an androgen, as is testosterone; and the decline in androgens is particularly associated with diminishing libido (1, 2).

What, libido issues in your 30s? Yes! And other key sex hormones will also start to naturally decline, albeit slowly. Progesterone, estrogen and testosterone, in particular. Our bodies have estrogen and androgen receptors in all of our feminine lady parts: our vagina, vulva, clitoris, uterus and urethra bladder; as well as in the musculature around our pelvic floor…so all of these areas can be affected by hormonal decline.

If you have thyroid issues as welldiagnosed or not – that can exacerbate these problems even more as the thyroid can make reproductive gland activity sluggish, resulting in even less vital hormone production. Research has shown that women having thyroid diseases experience a higher prevalence of diminished libido (3). Thyroid medications themselves can cause symptoms of vaginal dryness (so don’t be shy about discussing your lady part issues with your doctors, especially those prescribing medications).

Thyroid and sexual function are linked

Research has shown that hypothyroidism and hyperthyroidism impair sexual function in women. In one study, women who were successfully treated for hypothyroidism showed normalization of sexual desire, sexual satisfaction, and pain. In the same study, hyperthyroid women normalized desire, arousal/lubrication, satisfaction, and pain (4).

Thyroid hormones and sexual hormones are intimately tied together in something called the HPA axis. This is our body’s overall hormone communication network – controlled by the brain’s hypothalamus – including the adrenals, thyroid and gonads. We know from existing research that hormone imbalances in one area can trigger issues in another.

The state of your lady parts is about so much more than fluctuating estrogen

Yes, estrogen does naturally decline as we age and is the primary hormone responsible for both vaginal dryness and hot flash misery. But as important as estrogen levels are, it is the ratio of estrogen to progesterone that can cause complete havoc – with or without thyroid issues. Let’s talk about when this ratio gets out of balance.

One way is if you are trying to prevent pregnancy. Did you know that being on oral contraceptives can cause vaginal dryness and change the natural protective flora of the vagina, resulting in more infections?

But the impact goes much further than that on our overall sexual function as well as our thyroid health. Taking oral contraceptives suppresses natural estrogen and progesterone production which yes, prevents ovulation, but at a significant cost, especially for those having a thyroid condition.

When taking oral contraceptives progesterone levels decline at a faster rate than estrogen. This hormone shift, where the ratio of progesterone becomes insufficient compared to estrogen, is referred to as Estrogen Dominance.

Symptoms of estrogen dominance include mood swings, anxiety, weight gain, break-thru bleeding, irregular periods, and more. This hormonal imbalance also causes reduced DHEA production (remember I said DHEA was important for libido) and can suppress testosterone (also impacting libido) as well.

Finally, estrogen dominance also increases inflammation which can be a trigger for autoimmune conditions and can worsen hypothyroid symptoms. How? Estrogen dominance increases the activity of TBG (Thyroxine Binding Globulin) which further reduces the levels of free thyroid hormone that our bodies can use.

Estrogen dominance is often a side-effect of oral contraceptives, but it is also a frequent occurrence as women age. Usually in their mid to late-thirties a woman’s progesterone level falls more quickly than her estrogen levels; thus the terrible PMS, migraines, menorrhagia (painful and heavy menstrual periods), uterine fibroids, and functional hypothyroidism are seen.

Chronic stress: a real turn-off for libido and lubrication

Estrogen dominance can also be triggered by stress. I’ve seen this time and time again with women who feel they just aren’t interested in sex and/or just can’t get started.

Our adrenal glands and thyroid are both pituitary-controlled, and both respond to stress by becoming fatigued. Your adrenals respond to this by pumping more and more stress hormone, cortisol. And your body can’t keep this up indefinitely.

Eventually what happens here is called “progesterone steal”.

Our bodies start “stealing” progesterone to make more cortisol. It’s a protective measure as our body’s adrenals thinks it is under attack in some way. Back in caveman times, stress was associated with an attacking animal! So our adrenals shut down reproductive systems and other luxuries to focus all our energy on escaping! Today…there is no wild animal!

But when your body is in this imbalance it still thinks it is in “survival” mode versus “thrive” mode. So it refocuses all of its resources from “lady parts/frisky” to “surviving the threat”. Libido is impacted as is vaginal dryness (and related pain during intercourse).

Lack of progesterone due to progesterone steal is also considered a luteal phase defect, which can directly affect fertility and a healthy pregnancy.

I always recommend your doctor does a full hormone panel, including thyroid, as part of evaluating an infertility issue for this reason. Thyroid issues in particular are under-diagnosed.

Along with the use of bioidentical hormones (testosterone, DHEA) to increase libido and address related vaginal dryness, I’ve often recommended progesterone cream and other natural therapies to support the adrenals and a healthier stress response (maca is one of my favorites).

In our 30’s and 40’s, pelvic health and additional vaginal atrophy is seen

As women’s sexual hormones decline further as they age, this starts to affect the muscles and tissues around the pelvic area, vagina, uterus, rectum and bladder. Along with irregularities with menstrual cycles, break-thru bleeding and infertility issues we also start to see a variety of symptoms referred to as vaginal atrophy, including:

  • A reduction in elasticity of the vagina, and thinning of the skin
  • An increase in vaginal pH and decrease in healthy vaginal flora
  • Continued decreases in natural lubrication
  • Things may start to just “hurt” down there, especially during sex
  • Involuntary urine leakage may occur (peeing while coughing, laughing, jogging, etc.)

For women having thyroid issues, this is when we often start to see cases of Candida overgrowth. Any number of factors increase that risk including the use of oral contraceptives, pregnancy, recurrent vaginal yeast infections, antibiotics, etc.

Post pregnancy: If you’ve had a pregnancy you’ve already put some wear and tear on your pelvic muscles and should be exercising them doing Kegels to help them recover. Postpartum and/or breastfeeding can cause vaginal dryness, and low postpartum progesterone levels can bring on postpartum depression.

New or worsening thyroid issues can also be seen as a result of pregnancy. One study found that subclinical hypothyroidism is the most common maternal thyroid disorder, with some 0.11-3.90% of women having thyroid issues during pregnancy (5).

Just living life affects women’s sexual health!

Along with stress there are a number of everyday exposures that can impact a woman’s libido, vaginal dryness and pain during intercourse.

Many endocrine disruptors mimic estrogens, and I believe this to be a huge risk factor for most women (and an even greater problem for women having thyroid issues due to the effect that estrogen dominance has on thyroid hormone levels). And where do these excess estrogens tend to hide away? In adipose tissue, aka, your fat.

Parabens and other hormone disruptors found in many lubricants (so check those labels!) and personal care products – even your skincare – surround you, as do many toxins in the environment. And as a side-note, ladies, hormone disruptors that mimic estrogen are blamed for total testosterone levels in your men dropping about 22% between 1987 and 2004! Another reason I recommend grass fed beef that are given no hormones. Yes, this excess estrogen is the cause of those “man-boobs” as well as Low-T challenges [6]!

Other underlying health conditions are additional risk factors for problems with our lady parts. Thyroid disease of course, but also diabetes, pre-diabetes and obesity have been shown to increase a woman’s risk for incontinence in particular. And studies have shown that incontinence issues impact a woman’s self-esteem and libido.

A decreased sex drive as well as vaginal dryness can also be seen as a side-effect of many prescription medications. Antibiotics can also impact vaginal pH and increase the risks for infections there as well. So it is always important to discuss libido and vaginal dryness symptoms with your doctor.

Is it a thyroid issue or is it menopause?

There definitely is a blur between the two in terms of how we feel! They share symptoms – and some misery – for sure. But thyroid issues are a disease state, and menopause is a natural transition.

But how do you know whether your symptoms are thyroid related or menopause? And should we care?

Well, first of all we need to consider thyroid disease when we experience menopause-like symptoms, including libido changes, vaginal dryness, pain during intercourse, vaginal infections and the like. A survey done by the American Association of Clinical Endocrinologists found that only one in four women who have talked about menopause with their physician have also been tested for thyroid disease [7]! We need to change that thinking. And yes, we need to diagnose both thyroid and vaginal atrophy conditions so we can adequately address them. Some thyroid conditions and many vaginal atrophy conditions can be improved with lifestyle interventions.

Lab testing is important. Along with testing for estrogen, progesterone and testosterone levels, I recommend a full thyroid panel and four other tests that provide a good adrenal snapshot. Those tests are Vitamin D Hydroxy (it is really a pro-hormone, not a vitamin, and is vital to all the other hormones), DHEAs, A1C (blood glucose) and HSCAP (to get a read on inflammation). And please note that if you are on oral contraception these tests won’t be accurate.

Help me find my libido, my moisture and my happy place again

I can’t get into ALL the things you can do in one article, certainly lifestyle interventions such as eating a healthy diet, reducing the vices (alcohol, caffeine, smoking, sugar and processed white foods), exercising and improving your stress management all can help.

First, some dietary suggestions

Foods that tend to produce a libido-enhancing effect usually contain compounds that improve one of three things:

  • blood flow
  • brain or nerve circuit function, or
  • hormonal balance

Omega 3 Fatty Acids are great libido boosters! Seafood especially (wild caught of course), because of the higher concentrations of omega-3 fatty acids, essential for cellular diffusion and brain and nerve cell health.

Omega-3’s are also a precursor of prostaglandins, hormone-like substances that play a large role in sexual health. Walnuts and almonds are another major source of essential fatty acids. Almonds in particular are vital to the production of male hormones (which are present in both males and females) and help to regulate sex drive.  Omega’s are also important for healthy elastic vaginal tissue as they are part of our cell membranes.

Foods containing the amino acid arginine aid in sexual function by enhancing blood flow. Arginine is an amino acid the body uses to synthesize nitric oxide within the endothelium (lining) of the blood vessels. Nitric oxide causes blood vessels to expand, increasing blood flow and inducing engorgement of the sex organs to facilitate intercourse.

Some foods in which arginine occurs naturally are peanuts, cashews, walnuts, green vegetables, oatmeal, dairy (but many people are sensitive to dairy and other foods and can be a trigger for thyroid issues), root vegetables, garlic, ginseng, chickpeas and seeds.        

Anti-oxidant foods are also important for sexual health and stamina, as anti-oxidants neutralize free radicals, harmful molecules produced in a process called oxidation. Some common anti-oxidant fruits and vegetables are tomatoes, red peppers, garlic, and spinach.

And then there is maca – it truly is “Mighty”! Maca is a tuber root vegetable grown for centuries in Peru. It contains a combination of starches, amino acids, minerals, fatty acids, and vitamins which is nature’s perfect formulation for balancing hormones. It is an excellent natural choice for women, since rather than supplying hormones for the body, it works on the pituitary, hypothalamus and adrenal glands nourishing them to make endogenous hormones in the appropriate amounts within the body itself.

Are you “tinkling” or “twinkling” (leaking is such a libido breaker!)

Over time, we inevitably experience weakening of our pelvic floor muscles…. if we don’t take action to prevent that from happening we can experience tinkling at the most inconvenient times!

Yes as we get older, many of us experience incontinence issues. We sneeze, we cough, we’re doing an exercise…and oops, there it is. The embarrassing leak.

I know I’ve had them!

Yes, pregnancies, improperly done exercises, squats or pilates for instance, as well as being sedentary effects our pelvic floor muscles. Darn! But it can definitely get better!

Exercising our pelvic floor muscles with Kegel exercises are important no matter how old we are! But many women do them wrong.

Soothe irritated vaginal tissues (and calm that chronic stress…remember what it does to you!)

Try using some essential oils…better yet, mix them in with my DIY lubricant. Favorites of mine that have also been shown to soothe irritated vaginal tissues include: Roman chamomile or Cape chamomile, Salvia sclarea, rose, lavender and frankincense. Just remember to never use essential oils straight into the vagina! Use in my recipe or a carrier oil, and test it on your inner arm before using in the vagina. A few drops in a warm bath is also a great de-stress activity.

Consider hormone replacement therapy if needed for vaginal dryness and irritation, pain, weakened pelvic musculature and low libido

Oral estrogen hormone replacement therapy (HRT) side-effects should be cautiously evaluated, especially for women having thyroid conditions or breast cancer concerns. As noted above, oral estrogen can interfere with the amount of available thyroid hormone in the blood. HRT may increase the T(4) dosages requirements for women being treated for primary hypothyroidism [8]. While oral HRT has been considered helpful for hot flashes it hasn’t been found to significantly resolve vaginal dryness issues.

Estrogen therapy (locally applied) may be a better solution to address vaginal moisture and irritation. This therapy has not been found to improve libido, however.

Androgen therapy (locally applied) is a great natural alternative for you to discuss with your doctor. I have been prescribing DHEA, testosterone and other natural hormones – as have some of my peers – for almost two decades with impressive results. The research is validating DHEA as a viable and healthy solution. The FDA approved the first DHEA vaginal suppository to address pain during intercourse, called Intrarosa, as one example. Research has also shown DHEA can positively affect libido, arousal and sexual satisfaction.

A feminine cream containing DHEA may also help

DHEA applied locally at the vagina has been shown to improve vaginal dryness and irritation, vaginal and vulva discomfort, and even libido. Research has shown it can improve the musculature of the deeper layers of the vagina (decreasing symptoms of urinary leakage and pelvic prolapse). DHEA is naturally secreted by the adrenal gland and ovary and is a very protective hormone with research indicating it is beneficial for brain health, bone health and breast health, too [9].

The important thing is to take action

Your sexual health is important to your physical, mental and spiritual health. And it is a critical part of your relationship. So don’t just accept these common lady part issues! And make sure your doctor focuses on your overall health, thyroid and sexual. They are very intertwined and there are many things you can do to improve your overall hormonal balance and happiness. 

About Anna Cabeca, DO, FACOG

Dr. Anna Cabeca is an Emory University trained gynecologist and obstetrician, a menopause and sexual health expert, and an international speaker and educator. Her area of specialty over the past several decades has included bio-identical hormone treatments as well as natural hormone balancing strategies.


[1] S. Leiblum, G. Bachmann, E. Kemmann, D. Colburn, L. Schwartzman. Vaginal atrophy in the postmenopausal woman. The importance of sexual activity and hormones. JAMA. 1983;249(16):2195-2198.

[2] N.E. Avis, S. Brockwell, J.F. Randolph Jr, et al. Longitudinal changes in sexual functioning as women transition through menopause: results from the Study of Women’s Health Across the Nation. Menopause. 2009;16(3):442-452.

[3] Pasquali, D, et al. Female sexual dysfunction in women with thyroid disorders. J Endocrine Invest. 2013 Oct;36(9):729-33.

[4] Oppo, A., et al. Effects of hyperthyroidism, hypothyroidism, and thyroid autoimmunity on female sexual function. J Endocrinol Invest. 2011 Jun;34(6):449-53.

[5] Wang, Q., et al. Assessment of thyroid function during pregnancy: the advantages of self-sequential longitudinal reference intervals. Arch Med Sci. 2011 Aug;7(4):679-684.

[6] Travis, T.G., et al. A Population-Level Decline in Serum Testosterone Levels in American Men. The Journal of Clinical Endocrinology & Metabolism. 2007 Jan;92(1):196-202.

[7] WebMD. Thyroid and Menopause: Confusing the Symptoms. Retrieved from:

[8] Mazer, N.A. Interaction of estrogen therapy and thyroid hormone replacement in postmenopausal women. Thyroid. 2004;14 Suppl 1:S27-34.

[9] Lopez-Marure, R., et al. Dehydroepiandrosterone inhibits events related with the metastatic process in breast tumor cell lines. Cancer Biol There. 2016 Sep;17(9):915-24.

Take Back Your Thyroid Health! Sign up and never miss a post - it's FREE

I appreciate every share! Thank you.

About Dana Trentini

Dana Trentini founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.


  1. Debra Stewart says

    A few years ago, I was told by my doctor to take DHEA 50mg. I did, and I lost 45% of my hair! Thankfully, I realized it & stopped immediately. It took approximately one year for my hair to fully grow back in. It was devastating.

  2. vaginal itching during pregnancy says

    yes, vaginal dryness causes many sexual health issues as I have also found that if your vagina is dry then it can cause scratch during penetration.
    all your information is just best to know and treat the dryness. thank you.

  3. Monday i had a total thyroidectomy, i am on heavy painkillers, levo, antidepressants, stool softener. now i haven’t been peeing alot, i do know i need to up my liquid intake. i have noticed since i ave been home i was a bit itching but i thought that was do to the painkillers. of course i did itch, everywhere. i didn’t noticed until now Thurs. four days after surgery that my lips are swollen. no burning when i pee, clear discharge, just sore lips. I did but new pj set for when i was in hospital.

  4. So I was having a lot of issues with weight and chronic fatigue. I had my thyroid checked and it was normal but because I was taking a supplement with extra iodine my doctor checked my iodine levels and found them to be really low even with the extra iodine in my diet. I am now actively taking iodine supplements and what a difference it has made. I have more energy, I sleep better at night and a lot of those other issues are slowly resolving themselves. I would really look into this as the root cause of many peoples issues with their thyroid. Iodine deficiency also affects more than just your thyroid it affects your digestive system as well as your ovaries and probably some other parts as well. According to one article over 70% of people are iodine deficient. People don’t use as much salt and the salt they now use contains very little iodine. This creates a major health issue. I’d seriously research the effects of iodine deficiency. I am taking 500 mcg daily now and plan to bring myself up to 1000 mcg as it seems to be a safe level. Japanese people eat a lot of foods with iodine and have less health issues overall and they generally take in over 3000 mcg on a daily basis. So I would seriously consider this a root cause of your health issues. Anyway something to think about.

  5. Nicole, this is well said and often adding topical DHEA like with Julva feminine cream for a sustained period can help with repair and rejuvenation in women with LS. I do recommend concurrent therapy with a topical antifungal at least for the first 2 weeks as well. I agree that looking deeper for the cause such as Lyme is a very important step.

    • Thank you so much Dr. Cabeca for answering comments here at Hypothyroid Mom. Much appreciated. It is a pleasure to include you on my site and congratulations on the 1 year anniversary of Julva. I’m using your cream and love it 🙂

  6. Lichen Schlerosis is usually a primary INFECTION of Staphylococcus aureus (with delta toxin), Corynebacterium (usually Corynebacterium mastitidis and Corynebacterium bovis but can be others) and Lyme (Borrelia burgdorferi). Patients can also have secondary INFECTION of yeast species including candidia albicans. Lack of response to estrogens is a sign that lichen schlerosis is progressing to squamous cell carcinoma usually within 4 years. Hypothyroid patients are especially at risk for skin infections because of the increased interstitial space between cells.

    • Nicole, this is well said and often adding topical DHEA like with Julva feminine cream for a sustained period can help with repair and rejuvenation in women with LS. I do recommend concurrent therapy with a topical antifungal at least for the first 2 weeks as well. I agree that looking deeper for the cause such as Lyme is a very important step.

      • Dr Cabeca, What topical antifungal do you suggest and is this important to do with a topical DHEA? What do you think of Intrarosa and do you think Julva is a better approach. Thank you in advance and thank you for all the ways you are helping women. Karen

  7. Laura Ingham says

    Unless I missed it, you didn’t address the issue of Lichen Schlerosis which is yet another auto immune disease and affects the Vulva etc.?

  8. Hi Aleta, can you tell me how you found out or knew you had mold in your home? I live in an apartment and suspect there may be a mold issue here.

  9. Hypothyroid women with pain should also make sure that they are tested for vaginal INFECTIONS. High vaginal pH is usually a sign of an infection. In some patients pain on intercourse is also a sign of endometriosis and an infection of gardnerella, α-Streptococcus, Enterococci and/or Escherichia coli. Most gynecologists will tell you that the pain is in your head and not test for hypothyroidism and will not treat any infection or do the proper testing. If you have an infection this will also impact your ability to convert T4 to T3 and it may affect your body’s ability to transport active T3 to damaged tissues. There should also be a stronger push to test for Reverse T3 in patients with infections.

  10. This is exactly how I feel, almost everything that was mentioned in the top half of this article resonated with me. It’s pretty sad to be in your early 30s and want nothing to do with sex. . i mean even the tickling. . I can’t seem to make things better. . I have quit gluten and I try to eat healthy fats and low carbs. . I have done extensive blood panels and nothing yet. . Thanks for sharing such a great article, its nice to know that this is all linked to something thyroid related, even if I still cant figure out how to get my libido back-

  11. Great information regarding Thyroid levels, also find interesting facts on 7downloads

  12. My vitamin D3 has been low since 2014 when I insisted my doctor check my level.
    All the women in my family have low D3( below 25) yesterday it’s down to 22.7.
    My mother has severe osteoporosis and I am an x-ray tech who was trained on DEXA years ago.
    I did my own research on the T score and Z score so I could understand what I was advised to give my patients regarding calcium and vitamin D3,K .
    Under the supervision of the doctors I worked for of course!
    I can not get my D3 levels above 25 and had been told my thyroid levels are normal.
    I am experiencing chronic pain in my spine due to DDD and OA, muscle pain and weakness, severe and chronic fatigue, insomnia, HTN and a host of other terrible things that are affecting my job, life and mental health .
    I am 53
    I found your site today after getting my yearly physical and blood drawn for my D3.
    It’s was 24 in August 2017 and now down to 22.7.
    I did switch from taking the gummies at night (2000 ) to a soft gel of 5000 because it was on sale..
    So I did stop taking it for awhile.
    I don’t know why.
    I am now wondering if my thyroid levels were overlooked.
    I will go back into my e chart to check it.
    Bottom line is that had I not asked my primary care physician to check my level when I first saw her a few years ago when I presented with my chronic pain , muscle weakness and depression I wouldn’t have known I am definitely deficient.
    Now add plantar fasciitis with chronic ankle swelling to the mix.
    Thank you for your blog and am hoping to get some answers.
    My sister also has low D and we both had terrible fibroid uterus (mom too) so it runs in the family.
    What Thyroid levels should I ask my doctor to check?
    Im also going to get the liquid D3 with k and take it with dinner.
    My doctor doesn’t seem to know much about this subject or she is making loads of money on my appointments.

    • I felt the urge to reply to you. I have dealt with the D3 problem for three years. My daughter from 9-13 had six –yes six broken bones. Her level was a 17. This was all from mold in my home. I remediated carpet, paint cabinets, duct work, etc and we both take the D3 drops found at Earthfare or WholeFoods (about $10) and take about 6-7000 units per day. Mine is up to 37 and Stella is up to 32 and we’ve almost made it one year with no broken bones. Please, check your air quality in your home and most likely the home you shared with your mom and sister. I am experiencing the same health problems as my mom and her house is so mold ridden I cannot visit her without tremors and sores and vomiting (-!: an insomnia like a crazy person) I finally moved and bc I didn’t replace furniture the leather held the mold and infiltrated my HVAC in my new house. Yikes! Had it sucked out and. Leaned with peroxide and Lysol (I swear this works!) look through the yeast overgrowth sites –even one on here is spot on! But my supplements saved my life. My liver began to go nuts and my hemoglobin and rbcs. All of it was/is mold. Not black mold. Just cladosporium aspergillosis and penicillum. I have researched it extensively I wouldn’t pass any advice along I hadn’t done for myself. Good luck and I’m sending good thoughts your way –kindly, Aleta R.

      • Kristal Jetkins says

        Hi Aleta, can you tell me how you found out or knew you had mold in your home? I live in an apartment and suspect there may be a mold issue here.

Speak Your Mind