Vaginal Atrophy

“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

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”.10

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)”.11

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)”.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 MenoNote “Vaginal Dryness” covers this topic in detail)”.13

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”.14

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”.15

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”.16

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”.17

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

  • “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”.18

Health Topics A-Z

Where may I find Health Topics related to the Vaginal Atrophy?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

Where may I find Links related to Vaginal Atrophy?

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Links

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  1. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT)
  2. Archives: Videos – Deconstruction of the Genitourinary Syndrome of Menopause
  3. Bioidentical Hormones Explained – A British Menopause Society Video
  4. Bioidentical Hormones: Are They Safer?
  5. Caredownthere.com.au
  6. Complementary Medicine Options for Menopausal Symptoms
  7. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  8. Compounded Bioidentical Hormone Therapy [Video]
  9. Current Treatment Options for Postmenopausal Vaginal Atrophy
  10. Deciding About Hormone Therapy Use
  11. Douching
  12. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  13. Early Treatment of Vulvovaginal Atrophy May Prevent Distressing Symptoms
  14. Essential Information: See Your Doctor If
  15. Estrogen (Vaginal Route)
  16. Estrogen (Vaginal Route): Description and Brand Names
  17. Experiencing Vaginal Dryness? Here’s What You Need To Know
  18. FDA Approves Intrarosa for Postmenopausal Women Experiencing Pain During Sex [Food and Drug Administration, United States] [Generic Name: Prasterone]
  19. Five Things You Didn’t Know About Vaginas & Vulvas — Free Health Article
  20. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  21. Hormone Therapy: Is It Right for You?
  22. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  23. Information About Menopause [Multiply Languages] [Videos]
  24. Intercourse Was Becoming Painful – Ask Dr Jean
  25. International Society for the Study of Vulvovaginal Disease: Resource Library – Patients
  26. International Society for the Study of Women’s Sexual Health: Find A Provider
  27. Managing Postmenopausal Vaginal Atrophy
  28. Mayo Clinic Q and A: Managing the Symptoms of Vaginal Atrophy
  29. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women
  30. Medical Advice: Treatment
  31. Menopause
  32. Menopause
  33. Menopause What Are the Symptoms? Menopause Explained – A British Menopause Society Video
  34. Menopause FAQs: Understanding the Symptoms – Q. How can I counteract vaginal dryness during menopause?
  35. Menopause Management: Managing Vaginal Problems
  36. Menopause Symptoms and Relief
  37. Menopause What Are the Symptoms?
  38. Menopause – Is Menopausal Hormone Therapy (HRT) Safe? [Multiply Languages] [Video]
  39. Menopause – What Are the Symptoms? [Multiply Languages] [Video]
  40. Menopause – Will It Affect my Sex Life? [Multiply Languages] [Video]
  41. Menopause: Diagnosis & Treatment
  42. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  43. Menopause: Libido, Vaginal Dryness and Urinary Problems and the Menopause [Video Interview Stories]
  44. Menopause: Relationships, Sex and Contraception and the Menopause [Video Interview Stories]
  45. Menopause: Symptoms & Causes
  46. Mona Lisa Touch – Ask Dr Jean
  47. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  48. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth
  49. New Guidelines To Help Clinicians Manage GSM In Women With Breast Cancer [Genitourinary Syndrome of Menopause]
  50. New Study Reassures Women About the Safety of Vaginal Estrogen
  51. NonHormonal Treatments for Menopausal Symptoms
  52. Pain During or After Sex
  53. Patty Brisben Foundation for Women’s Sexual Health
  54. Vaginal Atrophy Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  55. Recent Review Confirms Safety of Low Dose Vaginal Estrogen: July 2019
  56. Resequedad Vaginal
  57. Severe Postmenopausal Symptoms Decrease Quality of Life, But Can Be Treated
  58. Sex & Relationships: Sex & Menopause [+ Video: 5 Things To Know About Sex In Later Life]
  59. Sex and Menopause: Treatment for Symptoms
  60. Sexual Difficulties In the Menopause
  61. Symptoms of Menopause: Bladder, Vaginal & Vulval Problems
  62. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  63. The Burden of Vulvovaginal Atrophy on Women’s Daily Living: Implications on Quality of Life From A Face-To-Face Real-Life Survey
  64. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  65. The Use of Vaginal Estrogen In Women With A History of Estrogen-Dependent Breast Cancer
  66. The Vaginal Laser Therapy versus Vaginal Estrogen Therapy: The VeLVET Trial [Video]
  67. The Vulva: Irritation, Diagnosis & Treatment – Booklet
  68. Update on Vaginal Laser Therapy
  69. Urogenital Atrophy Explained – A British Menopause Society Video
  70. Vaginal & Vulval Pain: Know the Different Causes and When To Seek Help
  71. Vaginal Atrophy
  72. Vaginal Atrophy
  73. Vaginal Atrophy: Diagnosis & Treatment – Treatment
  74. Vaginal Atrophy: Symptoms & Causes
  75. Vaginal Dryness
  76. Vaginal Dryness
  77. Vaginal Dryness
  78. Vaginal Dryness
  79. Vaginal Laser TherapyVaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  80. Vaginal Dryness and the Menopause
  81. Vaginal Dryness: Alternative Treatments
  82. Vaginal Laser Therapy
  83. Vaginal Moisturizers and Lubricants: Finding Your Way Through the Drugstore Aisles
  84. Video Series-2019 – Talking To Your Clinician About Sexual Health Concerns
  85. Video Series-2019 – Treatment Options for Vaginal Dryness In Survivors of Breast Cancer and In Those With A High Risk of Breast Cancer
  86. Video Series-2020 – How To Talk To Your Primary Care Clinician About Your Overall Health
  87. Video Series-2021 – Common Issues Surrounding Sexuality and Menopause
  88. Video Series-2021 – Treatment Options for Vaginal Dryness and Urinary Issues
  89. Video Series-2021 – What Women Need To Know About Hormone Therapies
  90. Vulva & Vaginal Irritation: Management & Treatment [+ Video]
  91. Vulvovaginal Health
  92. Vulvovaginal Symptoms After Menopause
  93. Webinars: Other Webinars – VVA – The Silent Epidemic [Vulvovaginal Atrophy]
  94. Wild Yam
  95. Will Menopause Affect My Sex Life?
  96. Women’s Wellness: How To Treat Vaginal Dryness After Menopause
  97. Women’s Wellness: Painful Sex After Menopause
  98. Women’s Wellness: Signs and Symptoms of Vaginal Health Problems
  99. Women’s Wellness: Vaginal Atrophy After Breast Cancer

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

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: 10 July 2021
  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: 10 July 2021
  3. Vaginal Atrophy: Symptoms & Causes – Overview. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 10 July 2021
  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: 10 July 2021
  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: 10 July 2021
  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: 10 July 2021
  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: 10 July 2021
  8. Vaginal Atrophy: Symptoms & Causes – Symptoms. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 10 July 2021
  9. Vaginal Atrophy: Symptoms & Causes – Causes. 02 May 2019. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 10 July 2021
  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: 10 July 2021
  11. 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: 10 July 2021
  12. 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: 10 July 2021
  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: 10 July 2021
  14. 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/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 10 July 2021
  15. 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: 10 July 2021
  16. 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: 10 July 2021
  17. 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: 10 July 2021
  18. 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: 10 July 2021

Topic Last Updated: 15 July 2021 – Topic Last Reviewed: 10 July 2021
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