Vaginal Atrophy

What Is Vaginal Atrophy?

Vaginal atrophy most often develops after a woman enters menopause. It is caused by a decrease of estrogen in the body. This causes the vaginal walls to become more fragile, less flexible, thinner, drier and inflamed. Women with vaginal atrophy experience a range of symptoms affecting the genitourinary system. These include:

• Blood in your urine (hematuria)
• Burning and itching vulva and vagina
• Frequent urinary tract infections (UTIs)
• Frequent urination
• Painful intercourse (dyspareunia)
• Painful or burning sensation when urinating
• Spotting or bleeding after sex
• Vaginal discharge
• Vaginal dryness
• Urinary incontinence

While vaginal atrophy is most common in women who are in perimenopause and menopause, it can also occur:

• After surgery to remove both ovaries.
• While breastfeeding.
• When taking medications that affect estrogen levels, such certain types of birth control pills.
• After cancer treatments such as radiation, chemotherapy and hormone treatments.

Risk factors for vaginal atrophy and related symptoms include:

• Smoking: Smoking can decrease blood flow and oxygen to the vagina.
• No vaginal births: Women who have never given birth vaginally have an increased risk of developing vaginal atrophy.
• No sexual activity: Sexual activity increases blood flow and helps your vagina maintain elasticity.

Vaginal Atrophy Diagnosis and Treatment

If you are experiencing unusual or unexplained symptoms of vaginal atrophy, make an appointment with your healthcare provider. They will be able to assess your symptoms and perform exams and tests to help diagnose vaginal atrophy. Tests may include:

• A pelvic exam to look for changes in your vulva, vagina and cervix.
• Pap test to look for abnormal cells in the cervix and screen for cervical cancer
• Urine test to look for problems such as a UTI
• Ultrasound to look at internal organs such as uterus, ovaries and bladder
• Vaginal pH test to examine the acid balance of the vagina

There are many effective treatments for the vaginal and urinary symptoms associated with vaginal atrophy, including both over-the-counter and prescription options. They include:

• Vaginal moisturizers: These can be bought over the counter and applied to the vaginal area every few days or as needed.
• Water-based lubricants: These can be used before sexual activity to make intercourse more comfortable. Avoid petroleum-based lubricants if using condoms since the petroleum may break down latex.
• Vaginal dilators: These devices stretch stimulate the vaginal muscles to reverse narrowing of the vagina associated with vaginal atrophy.
• Estrogen creams, suppositories, tablets or vaginal rings: These prescription products deliver topical estrogen directly to the vagina. Depending on the specific form chosen, they may need to applied daily, weekly, or in the case of a vaginal ring, replaced every three months. Topical estrogen is effective at a low dose and provides better relief to the areas directly affected than oral estrogen. Talk to your doctor about which topical estrogen method is best for your symptoms and lifestyle.
• Ospemifene (Osphena): This is a daily prescription pill that can help relieve painful sex symptoms. It is not approved for women who have had breast cancer or have a high risk of developing breast cancer.
• Hormone therapy: If you are experiencing other moderate to severe symptoms of menopause, such as hot flashes, you can elect to undergo hormone replacement therapy in the form of estrogen pills, patches or a higher-dose vaginal ring. While well tolerated by most women, hormone therapy is not for everyone and may not be suitable for people with certain risk factors; talk to your provider about whether hormone therapy is right for you.
• Topical lidocaine: This prescription ointment can be applied before sexual activity to help ease discomfort.