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What is Vaginal Atrophy and Can it Be Reversed?
Symptoms, causes, diagnosis and treatment of atrophic vaginitis and inflammation of the vagina
Vaginal atrophy (also known as atrophic vaginitis, vulvovaginal atrophy, or urogenital atrophy) is the term used to describe the thinning of vaginal tissue, which can lead to irritation and dryness of the vaginal walls.
Vaginal atrophy is caused by a decrease in estrogen, which provides natural lubrication and elasticity to the vaginal walls. While vaginal atrophy can happen to any woman at any age, the most common timeframe for development is during or after menopause.
Vaginal atrophy is actually a very common issue. In fact, as many as 4 in 10 women experience vaginal atrophy during menopause or perimenopause, but it’s often ignored and undiagnosed.
Why? Many women are too afraid or embarrassed to talk to their doctors about it.
If you’re dealing with vaginal atrophy, understand that you’re not alone and that it isn’t a condition you have to “learn to live with.” There are many different treatment options available, from OTC moisturizers to estrogen therapy.
How do I know if I have vaginal atrophy?
If you’re in perimenopause, menopause, post-menopause, or currently breastfeeding, your body may experience a dip in estrogen, leading to vaginal atrophy. Common symptoms include the following:
- Vaginal discharge
- Urinary incontinence
- Frequent urinary tract infections (UTIs)
- Pain or burning while urinating
- Vaginal dryness or itching
- Vaginal burning or inflammation
- Pain during intercourse
- Decreased vaginal lubrication during sexual activity
You don’t have to live with these symptoms indefinitely. Talk with an experienced gynecologist if you think you might be experiencing vaginal atrophy.
Vaginal atrophy causes and risk factors
Vaginal atrophy is a common complaint during and after menopause. Women who smoke, who have never given birth vaginally or who do not engage in sexual activity are more likely to develop vaginal atrophy during this time.
Women who aren't experiencing menopause but have had a drop in estrogen levels may also experience the symptoms of vaginal atrophy. A drop in estrogen can occur:
- During breastfeeding (symptoms usually resolve themselves after the conclusion of breastfeeding)
- During perimenopause (the years leading up to menopause)
- After the surgical removal of the ovaries
- After chemotherapy, pelvic radiation therapy or hormonal treatments for cancer
If you’re experiencing vaginal itching but don't think it is caused by hormones, see our article on vaginal itching.
The use of douches, perfumed toilet paper or soaps, and some drugs, such as antihistamines, can further irritate vaginal dryness and shouldn't be used by women suffering from its symptoms. If you’re experiencing vaginal dryness, try increasing your liquid intake to up to 8 glasses of water a day.
You may also need to be more aware of your sexual arousal, making sure that you’re fully aroused and using a lubricant before penetration.
How sex helps prevent vaginal atrophy
Unfortunately, the dryness and irritation caused by the loss of estrogen can cause pain and discomfort during sex. This is something you want to avoid!
Your vagina is a muscle, and it needs exercise to stay healthy just as your other muscles do. Regular sex, with or without a partner, keeps blood flowing to your vaginal tissues, keeping them healthy and strong.
Reaching orgasm during sex is even better since it causes the vaginal muscles to contract.
The symptoms of menopause affect all women to some degree, but thanks to many treatment options no woman has to suffer through it.
Potential complications of vaginal atrophy
For some women, vaginal atrophy may cause an increase in the vagina's alkalinity. These higher pH levels can put women at a higher risk for a vaginal infection, also called vaginitis.
The thinning and irritation of the vagina are also associated with changes in the urinary tract (called genitourinary atrophy). These changes can contribute to urinary problems, particularly increased frequency and urgency of urination and burning with urination, as well as repetitive urinary tract infections.
The thinned vaginal walls are more prone to tearing and thus can also leave a woman at higher risk of STDs. Women who are sexually active in menopause with different partners still need to use protection to prevent contracting an STD.
Vaginal atrophy treatment options
Fortunately, vaginal atrophy can be effectively treated by an experienced OB-GYN doctor. If you’re experiencing symptoms, make an appointment with a well-woman care provider to receive a proper diagnosis and an effective treatment plan.
During your appointment, your doctor may perform a pelvic exam and pap smear and order a urine test.
Your doctor may initially recommend applying an over-the-counter vaginal moisturizer every couple of days and using a water-based lubricant during sex. For more intense symptoms, you may be prescribed a topical estrogen, which comes in several forms:
- Vaginal estrogen cream is inserted into the vagina with an applicator. Creams provide the fastest relief but can be messy. Do not use vaginal cream as a lubricant since it can be absorbed through your partner's skin.
- Vaginal estrogen tablets are also placed in the vagina with an applicator. You might be instructed to insert one every day for a period of time (around 2 weeks) and then less frequently afterward.
- Vaginal estrogen ring is inserted by your doctor or yourself into the upper part of the vagina. This soft, flexible ring remains in place for 3 months and releases a consistent dose of estrogen.
If your symptoms coincide with other symptoms of menopause, your doctor may recommend higher doses of systemic estrogen therapy through the use of an estrogen pill or patch.
Women who have had breast cancer or who have a strong family history of breast cancer may not be able to use estrogen therapy, particularly systemic therapy. If you have severe symptoms of vaginal atrophy that are not relieved with over-the-counter remedies, your gynecologist might work with your oncologist to prescribe you a low-dose vaginal estrogen, though there is still a concern that estrogen may cause the cancer to return.
Estrogen therapies, while very effective, have associated risks for all women that you should talk about with your doctor and thoroughly understand before beginning their use.
Make an appointment with All About Women to discuss your vaginal atrophy concerns
While vaginal dryness and irritation can be frustrating and cause greater health problems, like urinary tract infections, you don't have to suffer silently.
The well-woman care gynecologists at All About Women in Gainesville, Florida, are here to provide compassionate gynecological care throughout all stages of a woman's life. If you’re experiencing symptoms of vaginal atrophy or other symptoms of menopause, make an appointment with our Gainesville or Lake City office today.