Atrophic vaginitis is a vaginal disorder that usually happens after menopause. When estrogen levels fall, the vaginal walls can become thin, dry, and inflamed. This can be uncomfortable.

Between 10 and 40 percent of women experience symptoms of atrophic vaginitis after menopause, but only 20 to 25 percent will seek medical help.

Others may not do so because they use home treatment or because they feel embarrassed due to the sensitive nature of the condition.

Left untreated, it can affect quality of life.

Fast facts on atrophic vaginitis

  • Atrophic vaginitis refers to dryness of the vagina.
  • Around 40 percent of postmenopausal women experience symptoms, but many do not seek treatment.
  • Symptoms include painful intercourse and an increase in urinary tract infections (UTIs).
  • It is caused by a reduction in estrogen, normally following menopause or treatment with anti-estrogen drugs.
  • Topical treatments and hormone replacement therapy (HRT) may held relieve symptoms.

Symptoms


Atrophic vaginitis can lead to vaginal dryness and discharge.

Here are the main indicators of atrophic vaginitis:

  • vaginal dryness
  • pain during sexual intercourse, or dyspareunia
  • thin, watery, yellow or gray discharge
  • paleness and thinning of the labia and vagina
  • irritation when wearing certain clothes, such as tight jeans, or when on a bike seat
  • more frequent urinary tract infections (UTIs)

Symptoms also present in the urination process. These include:

  • painful urination
  • blood in the urine
  • increased frequency of urination
  • incontinence
  • increased likelihood and occurrence of infections

There may also be a reduction in public hair, and the vagina may become narrower and less elastic.

Causes

The most common cause of atrophic vaginitis is the decrease in estrogen after menopause. It can also occur after childbirth, and it can happen when anti-estrogen drugs are used to treat other conditions.

The ovaries make estrogen until a woman experiences menopause. In the United States, 51 years is the average age at which menopause occurs. Before menopause, the estrogen in a woman’s bloodstream helps protect the skin of the vagina and stimulates vaginal secretions.

When the ovaries stop making estrogen after menopause, the walls of the vagina become thin, and vaginal secretions are reduced. Similar changes can happen to women after childbirth, but these changes are temporary and less severe.

Medications or hormones can be used as part of the treatment for breast cancer, endometriosis, fibroids, or infertility to reduce estrogen levels. This decrease can lead to atrophic vaginitis.

Other causes include:

  • treatment to the pelvic area
  • uncontrolled diabetes
  • chemotherapy
  • severe stress
  • depression
  • rigorous exercise

Atrophic vaginitis may occur in younger women who have had surgery to remove their ovaries. Some women develop the condition at times when estrogen levels are naturally lower, such as during breastfeeding.

Other substances that can cause further irritation to the vagina are soaps, laundry detergents, lotions, perfumes, or douches.

Smoking, tampons, yeast infections, and condoms may also trigger or worsen vaginal dryness.

Diagnosis

The doctor will carry out an examination and ask about medical history. They may ask about the use of agents that can irritate the area and cause or aggravate symptoms, such as soaps or perfumes.

The pH, or acidity, of the vaginal area is also taken. A pH of 4.6 or higher indicates atrophic vaginitis. The normal pH of this area is 4.5 or less.

The doctor may also request an infection screening, especially in cases of discharge or bleeding. A diabetes test may be performed to rule out diabetes.

Examples of infections that may also be presenting include candidiasis, endometritis, and bacterial vaginosis. Atrophic vaginitis can make the area more susceptible to becoming infected. It can occur alongside an infection.

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If the diagnosis is unclear, or malignancy is suspected, a biopsy may be taken to rule out cancer.

A vaginal examination is likely to cause discomfort or pain in a patient with atrophic vaginitis.

Treatment

Topical treatments can help.

A water-soluble vaginal lubricant may help to provide relief during intercourse, for mild cases.


Hormone replacement therapy is one of the treatment options for atrophic vaginitis.

Petroleum jelly, mineral oil, or other oils are not suitable. These may increase the chance of infection and may damage latex condoms or diaphragms.

Hormone replacement therapy (HRT), as a tablet, gel, patch, or implant can supply estrogen to the whole body. It is effective, but there may be side effects. Patients should discuss the risks of long-term HRT with their doctor.

Localized HRT is applied topically and focuses treatment on the affected area. A low-dose estriol cream can be used to stimulate rapid reproduction and repair of the vaginal epithelium cells.

Vaginal tablets, creams, rings, and pessaries can be applied internally to focus the supply of estrogen to the vaginal area.

Regular exercise is important as it keeps blood flow and genital circulation high. Experimenting with the diet can also prove effective. Plant estrogens, linseeds, fish oils, and black cohosh can help relieve atrophic vaginitis.

Prevention

Using vaginal estrogen before the condition becomes severe can be a way to protect the vagina.

Regular sexual activity may help prevent atrophic vaginitis. Using a water-soluble vaginal lubricant can soothe mild cases during sexual intercourse.

As long as the vagina has sufficient levels of estrogen, sexual activity can also show benefits for both the elasticity and flexibility of the region. Women who are sexually active report fewer symptoms of atrophic vaginitis when compared to women who do not regularly have sexual intercourse.

Written by Sy Kraft

Source: Atrophic vaginitis: Symptoms, causes, and treatments

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