Similar to the erectile response in men, vaginal lubrication is controlled by multiple pathways in the brain and spinal cord. Psychogenic lubrication originates in the brain, and occurs through fantasy or exposure to sexually related stimuli. Reflexogenic lubrication occurs through direct stimulation of the genitals via a reflex response in the sacral (lower) part of the spinal cord.

Psychogenic lubrication can be enhanced by establishing a relaxing, romantic, and/or sexually stimulating setting for sexual activity, incorporating relaxing massage into foreplay activities, and prolonging foreplay. Reflexogenic lubrication can sometimes be increased by manually or orally stimulating the genitals.

The simplest method to cope with vaginal dryness is by applying generous amounts of water-soluble lubricants (e.g., K-Y® jelly, Astroglide®, Replens®, etc.). However, most women that use lubricants do not use sufficient amounts. If dryness persists with lubricant use, more generous dosing is needed. Health care professionals do not advise the use of petroleum based jellies (e.g., Vaseline) for vaginal lubrication, since they can leave residues which could cause bacterial infections to develop.

Women have erectile tissue in the clitoris, which has been found to function in highly similar biochemical manner to penile erectile tissue. As previously mentioned, a recent small study of Viagra® in women with MS seems to enhance sexual responsiveness and vaginal lubrication [personal communication, Scott Litweiler, MD]. This was a well-designed study, but had few subjects. More studies are needed to confirm these findings.