Vaginal Atrophy

1 What is Vaginal Atrophy?

Vaginal atrophy refers to the drying and thinning of vaginal walls due to a decrease in the female hormone estrogen.

This condition, also called as atrophic vaginitis, is more commonly seen in women after menopause.

Over a period of time, it may also lead to narrowing and shrinkage of the vaginal opening.

Vaginal atrophy can cause urinary discomfort and also painful intercourse.

Diagnosis is based on review of signs and symptoms, and physical examination.

Hormonal therapy and vaginal lubricants are used in controlling the symptoms of this condition.

Since genital and urinary symptoms are associated with this condition, it is more commonly referred to as genitourinary syndrome of menopause (GSM). 

2 Symptoms

The vaginal and urinary symptoms of vaginal atrophy are:

  • Dryness of vagina
  • Burning sensation of vagina
  • Vaginal discharge
  • Itching in and around the genital area
  • Burning sensation during urination
  • Increased urge to urinate
  • Increased risk of urinary tract infections
  • Urinary incontinence
  • Bleeding after intercourse
  • Pain or discomfort during intercourse
  • Reduced lubrication of vagina
  • Narrowing and tightening of vaginal opening
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3 Causes

Vaginal atrophy is caused by decreased production of the hormone estrogen. This causes the vagina thinner and drier.

Vagina becomes more fragile with less amounts of estrogen. A number of factors reduce the level of estrogen.

This includes:

In some cases the symptoms may appear in the years that lead to menopause, while in certain years it may not make its presence even years after menopause.

Regular sexual activity helps to keep the vaginal tissue healthy.

Risk of vaginal atrophy is more among women who smoke, do not have sexual activity, or have not had any vaginal deliveries.

4 Making a Diagnosis

Making a diagnosis of vaginal atrophy is done by performing several tests.

Pelvic examination and symptoms are the major indicators of the condition.

During a pelvic examination, the external genitalia including vagina and cervix is examined for symptoms of vaginal atrophy. It also helps to rule out chances of other conditions.

Urine test analyzes urine, and this recommended when urinary symptoms are present.

Acid balance test of the vagina is performed with a paper indicator strip by dipping in a sample of the vaginal fluid. 

5 Treatment

Vaginal moisturizer is the most common treatment to control vaginal atrophy. The moisturizer is used every 2-3 days. Water-based lubricants help to reduce the pain and discomfort during intercourse. Petroleum jelly and petroleum-based products are not recommended for lubrications while using condoms.

Symptoms that do not respond to over-the-counter medications are treated with topical estrogen and oral estrogen. Vaginal topical estrogen is the best choice as it reduces the exposure of the patient to estrogen in blood. It provides better relief than oral estrogen.

Oral estrogen enters the entire system, including the blood. Vaginal estrogen can be used in the form of cream, ring, or a tablet. Creams are applied directly on the vagina once every day for 2-3 weeks. Vaginal rings are inserted into the upper part of the vagina. Estrogen tablets are also inserted into the vagina. The dose may vary over a period of time.

Estrogen therapy is another popular method for controlling symptoms. Progestin is used along with estrogen, particularly in person who have not undergone hysterectomy. Oral progesterone and estrogen-progestin are other treatment options. Non-hormonal treatments like moisturizer or lubricants are recommended for patients with breast cancer. Vaginal estrogen is preferred when oral estrogen is not useful in controlling the symptoms.

6 Prevention

Regular sex activity helps to prevent symptoms of vaginal atrophy, as it increases the blood flow to the vagina. 

7 Alternative and Homeopathic Remedies

A few alternative and homeopathic remedies exist for managaing the symptoms of vaginal atrophy.

Diet high in fatty acids is very important in controlling the symptoms of GSM.

Multivitamin/multimineral with additional B complex vitamins are also considered useful.

Over-the-counter moisturizer and lubricants are useful in controlling redness and irritation of vagina.

Regular exercise is also equally important in maintaining health.

8 Risks and Complications

Vaginal atrophy increases the risk of vaginal infections, and urinary problems.

Increased frequency of urination, and burning sensation while urinating are some urinary problems that arise as complications of vaginal atrophy. 

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