What is vaginal atrophy?

Vaginal atrophy, a condition also referred to as atrophic vaginitis, is a condition in which the vagina experiences effects due to hormonal changes which cause thinning, drying and inflammation of the walls of the vagina. The main hormonal culprit – estrogen. Vaginal atrophy is not only experienced during menopause, as it can be experienced during other times of life when hormonal fluctuations are present such as in breastfeeding or other cases in which there are low levels of circulating estrogen.

Vaginal atrophy may not only have an effect on a woman’s sexuality and genitourinary comfort but can also lead to more frequent vaginal infections and urinary symptoms such as urinary frequency/urgency, burning, urinary tract infections and/or urinary incontinence.

Vaginal atrophy causes and risk factors

• As previously mentioned, a decline in the body’s circulating estrogen causes vaginal changes and may occur during various times in a woman’s life which may include changes due to perimenopause, menopause and breastfeeding/postpartum period.
• Certain medical or surgical procedures such as removal of both ovaries, pelvic radiation and/or chemotherapy to treat cancer, as well as the use of certain hormonal treatments to treat breast cancer may cause a woman to experience symptoms of vaginal atrophy.
• Additionally, the use of medications classified as GnRH agonists for treating endometriosis and uterine fibroids may contribute to the presence of vaginal atrophy.
• Excessive exercise resultant in loss of menses and/or eating disorders are also factors that can play a role in the development of vaginal atrophy.
• Women who have certain risk factors are at a higher risk of experiencing the effect of vaginal atrophy and include those who smoke, who have never had a vaginal birth and those who are not sexually active.

Symptoms

Symptoms of vaginal atrophy may include:

• Vaginal dryness, burning and/or discharge
• Itching of the genitals
• Burning with urination and/or urinary incontinence
• Post-coital bleeding (bleeding after sexual intercourse)  which is usually light and/or painful intercourse
• Decrease in vaginal lubrication during sex
• Vaginal canal tightening and/or shortening

Diagnosis and treatment

During an evaluation with your healthcare provider, you will undergo a pelvic exam and possible tests such as urine analyses and a vaginal acid balance test.

Treatment of vaginal atrophy is not a one size fits all approach and your particular treatment will depend on your personal medical history and cause of the condition. Some approaches to treating vaginal atrophy include the use of:

• Over-the-counter vaginal moisturizer and lubricants such as:
• Moisturizers: Replens, Vagisil Feminine moisturizer, etc.
• Water-based vaginal lubricants: K-Y, Astroglide, etc. There are glycerin-free versions of these treatments for those who experience sensitivity to glycerin.
• When using condoms, avoid petroleum jelly and petroleum-based lubricants as a break down of latex condoms will occur.
• Prescription medications may include the use of:
• Topical vaginal estrogen (tablet, cream or ring)
• Oral estrogen
• Ospemifene- used in cases of moderate to severe pain with intercourse.

Other methods to relieving the symptoms of vaginal atrophy include increased foreplay/arousal time during sexual intercourse to allow for better vaginal lubrication and having regular sexual activity with or without a partner. Use of vaginal dilators and/or treatment with pelvic floor physical therapy may also be considered in certain situations.