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 the estrogen levels that provide natural lubrication and elasticity to the vaginal walls.

vaginal atrophy: thinning of vaginal tissue leading to irritation and dryness of the vaginal walls.

Causes: Vaginal Atrophy Symptoms & Risk Factors

The most common signs of vaginal atrophy include vaginal dryness or burning, pain during intercourse and decreased vaginal lubrication during sexual activity, genital itching and burning or pain with urination.

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 level 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 are 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 are 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 are fully aroused and using a lubricant before penetration.

Regular sexual activity, with or without a partner, can help maintain healthy vaginal tissues through increased blood flow and avoid or lessen the effects of vaginal atrophy.

Complications: Health Conditions Associated with 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 leave a woman also 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.

Prevention: Menopausal Estrogen Therapy & Other Vaginal Atrophy Treatments

Fortunately, vaginal atrophy can be effectively treated by an experienced OB/GYN doctor. If you are experiencing symptoms, make an appointment with your well woman care provider in order to receive a proper diagnosis and an effective treatment plan.

During your appointment, your doctor may perform a pelvic exam and pap smear, or 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 two weeks) and then less frequently afterwards.

  • 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.

Action: Seek Professional Help From Your Well Woman Care Provider

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 North Florida's All About Women are here to provide compassionate gynecological care throughout all stages of a woman's life. If you are experiencing symptoms of vaginal atrophy or other symptoms of menopause, make an appointment with our Gainesville or Lake City office today.

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