Vaginal atrophy (atrophic vaginitis) is thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breast-feeding or at any other time your body's estrogen production declines.
For many women, vaginal atrophy makes intercourse painful — and if intercourse hurts, your interest in sex will naturally wane. In addition, healthy genital function is closely intertwined with healthy urinary system function.
Simple, effective treatments for vaginal atrophy are available. Reduced estrogen levels do result in changes to your body, but it doesn't mean you have to live with the discomfort associated with vaginal atrophy.
With moderate to severe vaginal atrophy, you may experience the following vaginal and urinary signs and symptoms:
When to see a doctor
Make an appointment to see your doctor if you experience painful intercourse that's not resolved by using a vaginal moisturizer (Replens, others) or water-based lubricant (Astroglide, K-Y, others), or if you have vaginal symptoms, such as unusual bleeding, discharge, burning or soreness.
Vaginal atrophy is caused by a decrease in estrogen production. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.
A drop in estrogen levels and vaginal atrophy may occur:
Vaginal atrophy due to menopause may begin to bother you during the years leading up to menopause (perimenopause), or it may not become a problem until several years into menopause. Although the condition is common, not all menopausal women develop vaginal atrophy. Regular sexual activity helps you maintain healthy vaginal tissues.
Certain factors may contribute to vaginal atrophy. Among these are:
With vaginal atrophy, your risk of vaginal infections (vaginitis) increases. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection with bacteria, yeast or other organisms.
Atrophic vaginal changes are associated with changes in your urinary system (genitourinary atrophy), which can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more urinary tract infections or incontinence. Although stress incontinence is common among menopausal women, it doesn't appear to be caused by vaginal atrophy. The connection between estrogen deficiency and urinary problems remains unclear.
Preparing for your appointment
Your primary care provider may refer you to a specialist (gynecologist) to evaluate your condition.
Questions your doctor may ask
Tests and diagnosis
Diagnosis of vaginal atrophy may involve:
Treatments and drugs
Mild symptoms of vaginal atrophy may be relieved by use of an over-the-counter lubricant or moisturizer.
If symptoms are bothersome, however, either topical (vaginal) or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen may also provide more direct relief of symptoms.
You should experience noticeable improvements after a few weeks of estrogen therapy. Some symptoms of severe atrophy may take longer to resolve.
If you have a history of breast cancer, oral estrogen therapy generally isn't recommended as it might stimulate cancer cell growth, especially if your breast cancer was hormonally sensitive. Whether low-dose vaginal estrogen is safe for breast cancer survivors is controversial. It's not known whether even a small increase in the level of estrogen circulating in your bloodstream may increase your risk of the cancer coming back. You might choose nonhormonal treatments, such as moisturizers and lubricants, instead.
Oral estrogen therapy
Lifestyle and home remedies
If you're experiencing vaginal dryness or irritation, the following measures may provide some relief:
A variety of alternative medicines are used to treat vaginal dryness and irritation associated with menopause, but few approaches are backed by evidence from clinical trials. Interest in complementary and alternative medicine is growing and researchers are working to determine the benefits and risks of various alternative treatments for vaginal atrophy. Here are some of the approaches under investigation:
Regular sexual activity, either with or without a partner, can decrease problems with vaginal atrophy. Sexual activity enhances blood flow to your vagina, which helps keep vaginal tissues healthy.
Last Updated: 2010-09-17
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