“For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms”.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) Hormone Health Network’s (HHN) definition is:

“Vaginal atrophy (also referred to as vulvovaginal atrophy, urogenital atrophy, or atrophic vaginitis) is a condition in which the lining of the vagina becomes thinner and drier. This condition can lead to vaginal and urinary tract problems”.2

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”.3

Vulvovaginal Atrophy

What is vulvovaginal atrophy (VVA)?

DotS the definition of vulvovaginal atrophy may vary. The North American Menopause Society’s (NAMS) definition is:

“During perimenopause, less estrogen may cause the tissues of the vulva and the lining of the vagina to become thinner, drier, and less elastic or flexible—a condition known as “vulvovaginal atrophy”. Vaginal secretions are reduced, resulting in decreased lubrication. Reduced levels of estrogen also result in an increase in vaginal pH, which makes the vagina less acidic, just as it was before puberty”.4

Genitourinary Syndrome of Menopause

What is the genitourinary syndrome of menopause (GSM)?

In Vaginal Atrophy: Overview the Mayo Clinic explain:

Vaginal Atrophy

“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”.5

In Vulvovaginal Symptoms After Menopause the Australasian Menopause Society (AMS) elaborate on:

  • “The changes, which may cause dryness, irritation, itching and pain with intercourse are known as the genito-urinary syndrome of menopause (GSM) and can affect up to 50% of postmenopausal women4. GSM was previously known as atrophic vaginitis or vulvovaginal atrophy (VVA)”.6

Symptoms

What may be symptoms of vaginal atrophy?

In Vaginal Atrophy: What Are the Symptoms of Vaginal Atrophy? the HHN explain:

“You may have no symptoms at all. Or you may have:

  • Vaginal dryness
  • Itching or burning feelings in your vagina
  • Discolored and unpleasant smelling, or copious vaginal mucous
  • Decreased lubrication, discomfort, or pain during sexual intercourse
  • Light bleeding after intercourse or random vaginal spotting
  • Burning sensation when you urinate (pass water)
  • Frequent, strong urges to urinate (overactive bladder)
  • Urinary incontinence (unintended release of urine
Vaginal atrophy can cause vaginal and urinary tract infections (UTIs)”.7

In Vaginal Atrophy: Symptoms & Causes – Symptoms the Mayo Clinic explain:

“Genitourinary syndrome of menopause (GSM), signs and symptoms may include:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • Frequent urination
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal”.8

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”.9

Common or Not

How common is vaginal atrophy?

In NAMS Issues New Guidance on Vulvovaginal Atrophy the NAMS elaborate on:

“Symptoms of vulvovaginal atrophy (VVA), such as lack of lubrication, irritated tissues, painful urination, and pain with intercourse, affect as many as 45% of women after menopause”.10

Treatment

How can VVA be treated?

In NAMS Issues New Guidance on Vulvovaginal Atrophy dated 29 August 2013, the NAMS note:

“The Position Statement explains that bothersome symptoms can be treated successfully, and many treatments are available, ranging from over-the-counter products to prescription hormonal and nonhormonal products. Which therapy to use depends on how severe the symptoms are, whether the therapy is safe and effective for the individual woman, and what she prefers”.11

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)”.12

Vaginal Estrogen

Can estrogen be placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use published in June 2017, the NAMS elaborate on:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly in to 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)”.13

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)”.14

Menopausal Hormone Therapy

What is one of the points of consensus about menopausal hormone therapy (MHT) and vaginal atrophy?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

  • “MHT, including tibolone, is effective in the treatment of vulvovaginal atrophy (VVA), now also considered as a component of the genitourinary syndrome of menopause (GSM). Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for the prevention of recurrent urinary tract infections. Ospemifene, an oral selective estrogen receptor modulator, is also licensed in some countries for the treatment of dyspareunia attributed to VVA”.15

Sexual Activity

Can regular sexual activity help?

In Changes In the Vagina and Vulva: Vulvovaginal Atrophy the NAMS explain:

“Continuing to have regular vaginal sexual activity through menopause helps keep the vaginal tissues thick and moist and maintains the vagina’s length and width. This helps keep sexual activity pleasurable”.16

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”.17

The AMS note:

  • “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”.18

In Vaginal Atrophy: Questions To Ask Your Doctor the HHN include:

  • “Is my condition temporary or long-term?
  • Are there non-prescription (over-the-counter) treatments that might help?
  • What are some other ways to treat my condition?
  • What are the risks and benefits of my treatment options”.19

Health Topics A-Z

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Links

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Sources

Where may I find the Sources quoted?

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Sources

  1. Vaginal Atrophy: Symptoms & Causes – Overview. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 17 February 2020
  2. Vaginal Atrophy: What Is Vaginal Atrophy? Last Updated: October 2017. Hormone Health Network https://www.hormone.org/diseases-and-conditions/womens-health/vaginal-atrophy Accessed: 17 February 2020
  3. Vaginal Atrophy: Symptoms & Causes – Overview. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 17 February 2020
  4. Changes In the Vagina and Vulva: Vulvovaginal Atrophy. North American Menopause Society https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva Accessed: 17 February 2020
  5. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 17 February 2020
  6. 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: 17 February 2020
  7. Vaginal Atrophy: What Are the Symptoms of Vaginal Atrophy? Last Updated: October 2017. Hormone Health Network https://www.hormone.org/diseases-and-conditions/womens-health/vaginal-atrophy Accessed: 17 February 2020
  8. Vaginal Atrophy: Symptoms & Causes – Symptoms. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 17 February 2020
  9. Vaginal Atrophy: Symptoms & Causes – Causes. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 17 February 2020
  10. NAMS Issues New Guidance on Vulvovaginal Atrophy. 29 August 2013:1. North American Menopause Society https://www.menopause.org/docs/default-source/2013/vva-position-statement-release-final.pdf Accessed: 17 February 2020
  11. NAMS Issues New Guidance on Vulvovaginal Atrophy. 29 August 2013:1. North American Menopause Society https://www.menopause.org/docs/default-source/2013/vva-position-statement-release-final.pdf Accessed: 17 February 2020
  12. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 17 February 2020
  13. Deciding About Hormone Therapy Use. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 17 February 2020
  14. Vaginal Dryness: Treatment Options. 2018: 1-2. North American Menopause Society http://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 17 February 2020
  15. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 17 February 2020
  16. Changes In the Vagina and Vulva: Vulvovaginal Atrophy. North American Menopause Society https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva Accessed: 17 February 2020
  17. 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: 17 February 2020
  18. 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: 17 February 2020
  19. Vaginal Atrophy: Questions To Ask Your Doctor. Last Updated: October 2017. Hormone Health Network https://www.hormone.org/diseases-and-conditions/womens-health/vaginal-atrophy Accessed: 17 February 2020
Topic Last Updated:  06 March 2020 – Topic Last Reviewed: 17 February 2020
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