What is Atrophic Vaginitis? Causes, Symptoms, & Treatments for Vaginal Dryness

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

One of the biggest pains of aging can be vaginal dryness—literally. If you’re trying to explain to your significant other or friend why you’re finding everything from sex to using the bathroom more uncomfortable than it used to be, we’re here to help you understand what may be going on.

Up to 40 percent of postmenopausal women have symptoms of atrophic vaginitis—one of the clinical names for vaginal dryness—according to a study published by The American Geriatrics Society, cited by the American Academy of Family Physicians (AAFP) (1).

What Is Atrophic Vaginitis? (aka Vaginal Atrophy, Vulvovaginal Atrophy, or Vaginal Dryness)

Vaginal dryness goes by so many names; it can be confusing to keep them all straight. The most common names are included here and we may refer to them interchangeably throughout the article:

  • Atrophic vaginitis
  • Vaginal atrophy
  • Vulvovaginal atrophy
  • …and, because vaginal dryness is so closely linked to issues with your urinary tract there’s an umbrella term used for these related conditions: genitourinary syndrome of menopause (GSM)

Vaginal Dryness Causes

OK, now that you know the main medical names vaginal dryness can go by, what’s the most common reason many women develop vaginal dryness? In a word: Menopause. Or, in two words: Less estrogen.

During perimenopause and continuing through menopause into postmenopause, estrogen levels drop. As they drop, the lining of the vagina becomes thin, pale and dry, and usually worsens as women progress into postmenopause.

Think of estrogen as a faucet that produces vaginal fluids. So when there’s less estrogen, that faucet starts to turn off and women’s vaginal walls can begin to feel the effects by potentially becoming thinner, drier, and inflamed.

Other common causes? Vaginal dryness can also develop as a result of:

  • The removal of both ovaries due to surgery
  • Pelvic radiation therapy or chemotherapy to treat cancer
  • Side effects from certain breast cancer treatments
  • Taking anti-estrogen medications

…and temporarily from:

  • Dehydration
  • Taking medications that dry mucous throughout the body (like Sudafed)

Other factors that may contribute to more severe symptoms include smoking cigarettes, never having given birth vaginally, and having lower-than-usual levels of estrogen before menopause.

Vaginal Dryness Symptoms

While dryness is usually the first or one of the early warning signs of atrophic vaginitis, other symptoms can appear.

Some of the physical symptoms women experience include:

  • Itching
  • Burning
  • Discharge
  • Spotting or bleeding
  • Urinary issues, such as having to go to the bathroom more often, feeling the need to go or feeling discomfort while urinating, more frequent urinary tract infections (UTIs), and urinary incontinence—aka loss of bladder control.
  • Pain during sex (clinical name: dyspareunia)
  • Less self-lubrication during sex
  • Less enjoyable intercourse
  • Light bleeding after sex
  • Changes to the vaginal canal, including shortening and tightening
  • Sleep problems
  • Greater risk of vaginal infections

Often coupled with the physical changes above, women reported these effects on their emotional and mental well-being as part of the The VIVA (Vaginal Health: Insights, Views & Attitudes) online survey (2) of more than 3,500 postmenopausal women:

  • Negative impacts on their lives (80% of women)
  • Negative impacts on their sex lives (75%) and relationships (33%)
  • Feeling less sexual (68%)
  • Feeling old (36%)
  • Lower self-esteem (26%)
  • Lower quality of life (25%)

Treatments for Vaginal Dryness

Even though many women are affected by the condition, only a small percentage living with vaginal atrophy—20-25 percent—get medical help, according to research cited by the AAFP (1).

If you or someone you know is affected by vaginal dryness, there are a range of options. Some are aimed at relieving the discomfort associated with the dryness and others tackle estrogen loss head on to minimize related symptoms.

Alternative Treatments

Lubricants

Lubricants are a great first line of defense for combatting mild vaginal dryness that occurs during sex, if used before having intercourse. Look out for lubes that are labeled glycerin-free, especially if you’re prone to yeast infections, cautions Dr. Melynda Barnes, MD, Clinical Director at Rory. There are three main types, explains Dr. Barnes:

  • Water-based lubricants: These are most similar to the natural lubrication the body creates, and are safe to use with condoms but may require reapplying
  • Silicone-based lubricants: Last longer than water-based lubes, are good for sensitive skin, and are safe to use with condoms
  • Oil-based lubricants: may increase risk of vaginal infections and are not safe to use with condoms

Moisturizers

As the name suggests, moisturizers help preserve vaginal moisture and can keep itching, burning and discomfort at bay—and, compared to lubes, these will work a little longer. Apply them internally a few times per week and externally every day, as needed.
Having more sex

According to a study published in the Journal of the American Medical Association (JAMA) (3), which investigated a group of 52 postmenopausal women, those who were sexually active (i.e. had sex three or more times per month) were less likely to experience symptoms of vaginal atrophy than those who were less sexually active (i.e. had sex less than ten times a year).

Medications

If lubricants and moisturizers aren’t providing enough relief, estrogen creams or hormone replacement therapy (HRT), two of the main kinds of medicated treatments for vaginal dryness, may be recommended.

Topical Vaginal Estrogen Therapy

Applied directly to the vagina, vaginal estrogen creams and inserts help restore and rejuvenate the lining and glands inside the vagina that produce lubrication. These also help improve the thickness of the vaginal lining. Because the estrogen is applied locally to the vagina and in lower doses, women are less likely to experience systemic side effects compared to oral hormone replacement therapy (more on that treatment option below) (4).

Hormone Replacement Therapy (HRT)

How hormone replacement therapy works is to boost the sinking levels of estrogen and progesterone that are a hallmark of perimenopause and menopause. Hormone replacement therapy is a systemic therapy, meaning it works to address and improve all signs and symptoms associated with perimenopause and menopause—including vaginal dryness, along with hot flashes and mood swings. While HRT helps provide symptom relief it can be associated with several side effects, including headache, upset stomach, vomiting, cramps, bloating, and more, according to the National Library of Medicine (5).

When Should I Talk to My Doctor About Atrophic Vaginitis?

If you’re experiencing any of the signs or symptoms discussed above, talking to a doctor can help you find out if treatment is appropriate for you. When you have the resources you need, coping with vaginal dryness can become more manageable.

References

1. Bachman GA, Nevadunsky NS. Diagnosis and Treatment of Atrophic Vaginitis. Am Fam Physician. 2000 May 15;61(10):3090-3096.

2. Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause. 2013 Oct;20(10):1043-8.

3. Leiblum S, Bachmann G, Kemmann E, Colburn D, Swartzman L. Vaginal Atrophy in the Postmenopausal Woman: The Importance of Sexual Activity and Hormones. JAMA. 1983;249(16):2195–2198. doi:10.1001/jama.1983.03330400041022

4. Krause M, Wheeler TL, Richter HE, Snyder TE. Systemic effects of vaginally administered estrogen therapy: a review. Female Pelvic Med Reconstr Surg. 2010;16(3):188-95.

5. U.S. National Library of Medicine. Estrogen and Progestin (Hormone Replacement Therapy). U.S. National Library of Medicine. Accessed March 12, 2019

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