A pink, felt uterus against a peach-colored background.
While vaginal atrophy can happen to anyone, it usually happens in older women due to low estrogen levels.

What is Vaginal Atrophy?

Vaginal atrophy is a common condition that affects women in the years leading up to and following menopause. Treatment options are available.

An estimated 40% of postmenopausal women experience vaginal atrophy, although only 20% to 25% of them seek treatment. However, there is no need to suffer in silence as there are various prevention techniques and treatments available.

What is Vaginal Atrophy?

Vaginal atrophy is sometimes known as vulvovaginal atrophy, atrophic vaginitis, or genitourinary syndrome of menopause (GSM). These terms all describe thinning, drying and inflammation of the vaginal and vulval tissues due to a lack of estrogen.

The condition is most common in perimenopausal and menopausal women. However, it can occur at any age and for a variety of reasons.

It can cause several uncomfortable and embarrassing symptoms but treatment is available. In some cases, it may even be possible to prevent vaginal atrophy or reduce its severity by making some simple lifestyle changes.

Vaginal Atrophy Symptoms

The term GSM is actually more accurate than vaginal atrophy since the condition can also affect the vulva and urinary tract. Therefore, it can cause a broad range of symptoms, including:

  • Pale, smooth, or shiny vulval and vaginal tissues.
  • Shortening and tightening of the vagina.
  • Dryness, itching and irritation.
  • Burning sensations.
  • Vaginal discharge.
  • Decreased lubrication.
  • Painful penetration and intercourse.
  • Light bleeding after intercourse.
  • Urinary urgency, frequency, or incontinence.
  • Increased risk of vaginal or urinary infections.
  • Increased risk of pelvic organ prolapses.

These symptoms can vary in severity and may significantly affect one’s quality of life. In some cases, they could contribute to mood disorders, such as depression and anxiety.

What Causes Vaginal Atrophy?

Estrogen exerts a protective effect over the vaginal tissues, external genitalia and urinary tract. It helps to maintain moisture and elasticity, thus preventing fragility and damage. If the body’s estrogen production decreases, some of these protective effects may be lost, leading to vaginal atrophy.

The most common reason for this situation is menopause. However, it can also occur for several other reasons, including:

  • Breastfeeding.
  • Removal of the ovaries (surgical or induced menopause).
  • Cancer treatments, including chemotherapy, pelvic radiation, or estrogen blockers.
  • Other medications, including some forms of birth control.

Additional vaginal atrophy risk factors include smoking, being sexually inactive and having never delivered a baby vaginally.

Preventing and Treating Vaginal Atrophy

Fortunately, there are several effective prevention and treatment strategies for vaginal atrophy.

Lifestyle Adjustments

One of the simplest prevention methods is remaining sexually active. Sexual activity, either with or without a partner, increases blood flow to the genitals. This could help to maintain vaginal health and reduce the symptoms of atrophy.

Using a water-based lubricant can help to make sexual intercourse more comfortable. It may be necessary to reapply it several times. Avoid using products with glycerine or warming ingredients as these can cause irritation. Also avoid using oil-based lubricants with condoms as they can weaken latex and cause breakages.

Increasing the amount of time spent on non-vaginal foreplay can also help to promote arousal and natural lubrication. Discussing these issues with a partner may feel awkward at first but will pay off in the long-run.

Regular application of a vaginal moisturizer can help to relieve symptoms of dryness and irritation. However, it is essential to only use products specially formulated for vaginal use to avoid making matters worse. Likewise, it is important to avoid using scented soaps or other products in the genital area as these could aggravate symptoms. Wearing loose cotton underwear and other clothing may also help to increase comfort and reduce the risk of infections.

Other potentially beneficial lifestyle changes include stopping smoking and drinking enough water to remain hydrated throughout the day.

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Medical Treatments

For moderate to severe cases of vaginal atrophy, there are several medical interventions that may help. They include:

1. Topical Estrogen
There are several treatments that involve applying estrogen directly to the vagina. They include vaginal creams, suppositories, tablets and rings.

Creams, suppositories and tablets are inserted into the vagina using an applicator, usually one to three times each week. The exact dosage will depend upon the product and the severity of the symptoms. Rings are inserted by a doctor and can remain in place for up to three months.

2. Systemic Estrogen
Patients with other symptoms, such as hot flashes, may benefit from systemic estrogen treatment. This could take the form of oral tablets, transdermal gels or patches, or high-dose vaginal rings.

It may or may not be necessary to use a combined estrogen and progesterone product, depending on the patient’s medical history.

Moreover, systemic estrogen treatment is not suitable for everyone. Therefore, it is important to discuss the options with a physician to determine whether the benefits outweigh the risks.

3. Ospemifene
Ospemifene (Osphena) is an oral treatment that may help to relieve painful intercourse in moderate to severe cases of vaginal atrophy. It is not suitable for women who have had breast cancer or those with a higher-than-average risk of breast cancer.

4. Prasterone
Prasterone (Intrarosa) is a treatment that involves inserting dehydroepiandrosterone (DHEA) into the vagina. DHEA is a hormone that assists the production of other hormones, including estrogen. It can help to reduce vaginal atrophy symptoms, including painful intercourse.

Non-Hormonal Treatments

Some patients may be unable to use hormonal treatments, or might simply prefer to try non-hormonal options first.

One possibility is vaginal dilators. They are devices that are designed to stretch the vagina, reducing tightness and discomfort.

Another option is lidocaine gel. It is a local anesthetic that can be applied to the vagina to reduce pain during intercourse.

Regardless of the severity, it is essential that anyone experiencing vaginal atrophy discuss their symptoms with a medical professional. They will ensure that the condition is properly diagnosed and prescribe the safest and most suitable treatment.