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What causes a woman not to lubricate?

The cause is often low hormone levels related to menopause. Estrogen is a hormone that helps maintain the vagina's lubrication, elasticity, and thickness. Low levels of estrogen can cause thinning, drying, and inflammation of vaginal walls. This is called vaginal atrophy.

acog.org - Experiencing Vaginal Dryness? Here's What You Need to Know.

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Vaginal dryness can cause irritation, burning, and pain with intercourse. It’s common after menopause, and it also can happen in the years leading up to menopause. Often, my patients notice symptoms when they haven’t been sexually active for a long time. Then they are intimate with a partner and find that sex is painful.

Here’s how I talk with my patients about vaginal dryness.

The cause is often low hormone levels related to menopause.

After and around the time of menopause, your body makes less estrogen. Estrogen is a hormone that helps maintain the vagina’s lubrication, elasticity, and thickness. Low levels of estrogen can cause thinning, drying, and inflammation of vaginal walls. This is called vaginal atrophy.

But there are other causes too.

Low estrogen and vaginal dryness can happen at other times. Estrogen levels can fall after childbirth, with breastfeeding, during cancer treatment, or with anti-estrogen drugs. Then there are non-hormonal factors. Cold and allergy medications and some antidepressants can dry out vaginal tissue. Sjögren syndrome, an autoimmune condition that can cause a dry mouth and eyes, also can cause vaginal dryness.

There may be symptoms besides vaginal irritation or painful sex.

Dryness isn’t always just inside the vaginal canal. Less estrogen means less natural vaginal moisture. This can dry and irritate the vulva, the external female genital area. Women with vulvar dryness often notice irritation when they’re putting on their underwear. Some women also have increased urinary frequency or repeated urinary tract infections (UTIs) along with vaginal dryness. When this group of symptoms happens during menopause, ob-gyns call it genitourinary syndrome of menopause.

Moisturizers and lubricants often help.

For vaginal dryness by itself, I recommend trying over-the-counter moisturizers and lubricants.

Vaginal moisturizers add moisture around and inside the vagina. There are two types. Internal moisturizers are inserted into the vagina, where they help build up vaginal tissue. External moisturizers are made for the vulva. Lubricants decrease discomfort during intercourse. Sexually active women should use lubricants in addition to a vaginal moisturizer. I prefer water-based lubricants, though they don’t last as long as silicone-based products. Skip oil-based lubricants. They can cause irritation and make condoms less effective. See your ob-gyn if irritation and pain during sex don’t improve after 2 months of use, or if you have other symptoms.

Hormonal treatments also may be an option.

I often talk with patients about hormonal treatments when vaginal dryness comes along with urinary symptoms or menopausal symptoms, such as hot flashes. Estrogen creams and tablets are inserted a few times a week into the vagina. Creams must be measured and can get messy. Tablets are a good alternative. Vaginal rings are placed in the vagina by the patient. They release a low dose of estrogen over 90 days. These treatments deliver less estrogen than typical hormone therapy and have fewer risks. Talk with your ob-gyn about the pros and cons of different hormonal options.

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everydayhealth.com - 5 Things That Can Cause Vaginal Dryness & Painful Sex

Causes of vaginal dryness range from physiological factors, such as hormonal changes or medication side effects, to emotional and psychological issues, like a lack of desire or even anxiety. Fortunately, there are nearly as many options for dry vagina relief as there are causes. This may be good news for the two-thirds of women over 60 who list vaginal dryness as one of their top two sexual health problems — the other being lack of interest in sex — as part of a survey of more than 800 women to identify sexual health challenges. The results were published in the August 2015 issue of the Journal of Women’s Health. Vaginal dryness can also be a concern for women younger than 60, however. The first step in treating vaginal dryness is figuring out the source of the discomfort, especially if a dry vagina is causing painful sex. A number of conditions can lead to a lack of vaginal lubrication:

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