“Vaginal atrophy (also called atrophic vaginitis) is a condition
where the lining of the vagina gets drier and thinner.
This results in itching, burning and pain during sex…”.1

Umbrella
What may the Vaginal Atrophy Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Atrophic Vaginitis
  • Genital Atrophy
  • Genitourinary Syndrome of Menopause (GSM)
  • Urogenital Problems
  • Vaginal Atrophy
  • Vaginal Discomfort
  • Vaginal Dryness
  • Vaginal Symptoms
  • Vulvovaginal Atrophy (VVA)

Definition

What is vaginal atrophy?

DotS the definition of vaginal atrophy may vary. The (United States) Mayo Clinic’s definition is:

“Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause”.2

The (United States) Cleveland Clinic’s definition is:

“Vaginal atrophy (also called atrophic vaginitis) is a condition where the lining of the vagina gets drier and thinner. This results in itching, burning and pain during sex, among other symptoms. The condition also includes urinary tract problems such as urinary tract infections (UTIs) and frequent urination. Vaginal refers to the vagina while atrophy means “a wasting away or diminution.” Recently, the term vaginal atrophy has been replaced with the newer term, genitourinary syndrome of menopause (GSM). This new term helps describe not just the vaginal, but also the urinary symptoms that can be accompanied by the effects of low estrogen”.3

Genitourinary Syndrome of Menopause

What is the genitourinary syndrome of menopause (GSM)?

In Vaginal Atrophy: Overview the Mayo Clinic explain:

“For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms. Because the condition causes both vaginal and urinary symptoms, doctors use the term “genitourinary syndrome of menopause (GSM)” to describe vaginal atrophy and its accompanying symptoms”.4

In Vaginal Atrophy the (Australian) Jean Hailes for Women’s Health (JH) explain:

Vaginal Atrophy

“Vaginal atrophy occurs when the lining of the vagina becomes dry and thin, leading to problems such as itching, burning, and pain during sex. It is caused by a drop in oestrogen levels around the time of menopause. It’s also common to develop urinary (wee) symptoms including urinary leakage and recurrent urinary tract infections (UTIs). Because the condition causes vaginal, urinary and sexual symptoms, and occurs around or after menopause, vaginal atrophy is also known as genitourinary syndrome of menopause (GSM)”.5

Symptoms

What may be symptoms of vaginal atrophy?

In Vulvovaginal Atrophy the European Menopause and Andropause Society explain:

Vaginal Atrophy

“Symptoms include:

  • Irritation
  • Burning
  • Itching
  • Chafing
  • Discomfort
  • Uncomfortable or even painful intercourse
  • Passing urine more frequently
  • More frequent urinary tract infections
  • Greater discomfort with cervical smear tests”.6

Cause

What causes vaginal atrophy?

In Vaginal Atrophy: Symptoms & Causes – Causes the Mayo Clinic elaborate on:

“Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile”.7

Treatment

How can VVA be treated?

In Vaginal Dryness: Treatment Options the NAMS elaborate on:

“The good news is that effective treatment options, such as nonhormone remedies or different forms of low-dose estrogen applied directly to the vagina, are available. These can be combined for optimal symptom relief”.8

The Mayo Clinic explain:

“… make an appointment to see your doctor if you experience painful intercourse that’s not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others)”.9

In Vaginal Dryness: Treatment Options the NAMS elaborate on:

  • “Nonhormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Estrogen Therapy…
    • An effective and safe treatment…
    • Government-approved low-dose vaginal estrogen products…
    • Standard doses of estrogen therapy…
  • Other Prescription Therapies…
    • Ospemifene …
    • Dehydroepiandrosterone (DHEA)”.10

Vaginal Estrogen

Can estrogen be placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use published July 2022, the NAMS explain:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNoteVaginal Dryness” covers this topic in detail)”.11

On page three in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause first published 10 June 2022, Hamoda et al explain:

  • “Low-dose and ultra-low dose vaginal oestrogen preparations can be taken by perimenopausal and menopausal women experiencing genitourinary symptoms and continued for as long as required. All vaginal oestrogen preparations have been shown to be effective in this context and there is no requirement to combine vaginal oestrogens with systemic progestogen treatment for endometrial protection, as low-dose and ultra-low dose vaginal oestrogen preparations do not result in significant systemic absorption or endometrial hyperplasia”.12

Sexual Activity

May regular sexual activity help?

In Vaginal Atrophy: Prevention of Vaginal Atrophy the JH explain:

“Regular sexual activity (with or without a partner) may help prevent vaginal atrophy. Sexual activity improves blood flow to the vagina which helps keep vaginal tissues elastic and flexible. Sexually active women report fewer symptoms of vaginal atrophy compared to women who don’t have regular sex”.13

Health Care Provider

What if I think I have vaginal atrophy?

If you think you have vaginal atrophy, it may be in your best interest to choose to talk to your health care provider about this.

In Vaginal Discomfort: Discomfort Not Directly Related To Menopause the NAMS elaborate on:

“Because vaginal discomfort can arise from so many different sources, persistent symptoms of dryness, irritation, burning, itchiness, or pain should be evaluated by a healthcare provider to determine their cause”.14

In Vaginal Atrophy: When To See Your Doctor the JH note:

“Many women experience the symptoms of vaginal atrophy but don’t seek treatment because they feel embarrassed. Others think there is nothing that can be done and that they just have to ‘grin and bear it’. If you experience any of the signs or symptoms mentioned, make an appointment with your doctor because treatment can be very effective. If pain, irritation or other symptoms continue after treatment, please see your doctor to check for another cause”.15

In Vulvovaginal Symptoms After Menopause the Australasian Menopause Society remind us:

  • “Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; genito-urinary problems often persist and may progress with time. Genito-urinary symptoms are associated both with menopause and with aging”.16

Health Topics A-Z

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Sources

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Sources

  1. Vaginal Atrophy: Overview – What Is Vaginal Atrophy? Last Updated: 27 October 2020. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy Accessed: 28 October 2022
  2. Vaginal Atrophy: Symptoms & Causes – Overview. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 28 October 2022
  3. Vaginal Atrophy: Overview – What Is Vaginal Atrophy? Last Updated: 27 October 2020. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy Accessed: 28 October 2022
  4. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 28 October 2022
  5. Vaginal Atrophy. Last Updated: 01 September 2022. Last Reviewed: 15 October 2021. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/vulva-vagina-ovaries-uterus/vulval-vaginal-conditions/vaginal-atrophy Accessed: 28 October 2022
  6. Vulvovaginal Atrophy. 2022 European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/07/Vulvovaginal-atrophy.pdf Accessed: 28 October 2022
  7. Vaginal Atrophy: Symptoms & Causes – Causes. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 28 October 2022
  8. Vaginal Dryness: Treatment Options. 2018: 1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 28 October 2022
  9. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 28 October 2022
  10. Vaginal Dryness: Treatment Options. 2018: 1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 28 October 2022
  11. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 28 October 2022
  12. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayesena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published 10 June 2022 https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 28 October 2022
  13. Vaginal Atrophy: Prevention of Vaginal Atrophy. Last Updated: 01 September 2022. Last Reviewed: 15 October 2021. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/vulva-vagina-ovaries-uterus/vulval-vaginal-conditions/vaginal-atrophy Accessed: 28 October 2022
  14. Vaginal Discomfort: Discomfort Not Directly Related To Menopause. North American Menopause Society https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/vaginal-discomfort Accessed: 28 October 2022
  15. Vaginal Atrophy: When To See Your Doctor. Last Updated: 18 February 2022. Last Reviewed: 15 October 2021. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/vulva-vagina-ovaries-uterus/vulval-vaginal-conditions/vaginal-atrophy Accessed: 28 October 2022
  16. Vulvovaginal Symptoms After Menopause. Content Created September 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/376-vulvovaginal-symptoms-after-menopause Accessed: 28 October 2022
Topic Last Updated: 10 November 2022 – Topic Last Reviewed: 28 October 2022

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