Vaginal Atrophy & Vaginal Dryness

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is Vaginal Atrophy?

Vaginal atrophy is a condition that causes the vaginal walls to become inflamed, thinner and drier. It is a very common complaint among women who have been through menopause and those who have suffered from a drop in oestrogen levels. Women who are breastfeeding, which causes a natural drop in oestrogen levels, are also prone to vaginal atrophy symptoms. Vaginal atrophy can also be a side-effect of cancer treatment.

Vaginal atrophy can make sexual intercourse painful and also cause urinary symptoms. A lot of women often resign themselves to living with these symptoms, chalking them up to the ageing process. But you do not have to suffer in silence. Thankfully there are a number of different treatments available that can successfully treat vaginal atrophy symptoms and improve your quality of life. Most of these treatments involve applying oestrogen directly to the vagina through various means, including creams and pessaries. Lifestyle changes, such as taking more time during sexual foreplay or using water-based lubricants to combat vaginal dryness, can also help.

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What are the symptoms of Vaginal Atrophy?

There are a number of common vaginal atrophy symptoms. You may be experiencing some or all of the following:

Vaginal dryness: Vaginal dryness is one of the main symptoms of vaginal atrophy. Vaginal dryness is caused by a change in oestrogen levels which can affect vaginal lubrication. Vaginal dryness can make it difficult or painful to have vaginal sexual intercourse.
Vaginal burning: This is another common symptom, caused by the inflammation of the vaginal walls.
Vaginal discharge: The change in pH levels in the vagina make a woman with vaginal atrophy more prone to infection, which can lead to increased or altered vaginal discharge.
Itching: Inflammation and vaginal dryness can cause genital itching.
Urinary tract infections (UTIs): Falling oestrogen levels alter the pH levels in the vagina, increasing the likelihood of urinary tract infections developing.
Urinary incontinence: Oestrogen gives the vaginal walls elasticity and strength. The hormone also does the same for the lining of the bladder and urethra. So when oestrogen levels drop, this can also cause the bladder to become weaker and more lax, often leading to urinary incontinence.
Pain or discomfort during sex: Due to insufficient vaginal lubrication, you may experience pain or discomfort during sex.
Bleeding after sex: Reduced vaginal secretions can lead to tears in the epithelium, causing bleeding after sex. However bleeding after sex can also be the sign of an infection, such as pelvic inflammatory disease (PID), or a sexually transmitted infection (STI), such as chlamydia.
Problems with urination: Women with vaginal atrophy may experience problems with urination. This may include burning, feelings of urgency or the need to urinate more frequently.

What causes Vaginal Atrophy?

Vaginal atrophy is caused by falling levels of the female sex hormone oestrogen. This can cause the vaginal walls to become thinner, dryer and inflamed. Overall the vagina becomes more fragile. This drop in oestrogen levels can be due to a number of factors:

Menopause: Vaginal atrophy is moe commonly found in women who have been through the menopause. During the menopause, your body produces less oestrogen, causing your vagina to become less elastic.
Surgical menopause: Surgical menopause is caused by the removal of the ovaries (oophorectomy). A woman who has surgery to remove her ovaries will find she goes into menopause immediately.
Perimenopause: The period of time before menopause, when oestrogen levels naturally start to decrease.
Breastfeeding: New mums who are breastfeeding will experience a temporary drop in oestrogen levels.
Medications: Certain medications can affect oestrogen levels. This includes some contraceptive pills and hormone treatments for breast cancer.
Cancer treatment: It is common to experience the symptoms of vaginal atrophy following chemotherapy or pelvic radiation treatment for cancer.

You may also find yourself at a higher risk of vaginal atrophy if you fall into one of the follow risk categories:

Smoking: Cigarette smoke affects circulation and decreases the flow of blood to the vagina. Smoking can also reduce the effect of oestrogen present in the body.
Lack of sexual activity: A lack or absence of sexual activity means there is less blood flow to the vagina to help maintain healthy vaginal tissue. This includes masturbation as well as sexual acitivity with a partner.
No vaginal births: Although vaginal births undoubtedly have an impact on the vagina, research has shown that women who have given birth vaginally are at a lower risk of developing vaginal atrophy than those who haven’t.

How is Vaginal Atrophy diagnosed?

The doctor will carry out a pelvic exam. This involves the doctor feeling your pelvic organs and examining your vagina cervix and your external genitalia. They will be looking for typical signs of vaginal atrophy, including redness, dryness, swelling, lack of elasticity, skin conditions around the vulva and minor lacerations around the opening of the vagina. You may opt to have a chaperone with you during this part of the diagnostic process if you wish.

If you are suffering with urinary symptoms, such as increased urgency or frequency or recurring urinary tract infections, then the doctor will want to take a sample of your urine for testing.

Finally a paper indicator strip will be placed in your vagina to test the pH levels of your vagina. If the pH levels are not balanced, this leads to unpleasant infections.

The doctor will also ask you some questions about your symptoms, your medical history and sexual habits. They ask these questions so they can give you a correct diagnosis and work out the best treatment for you. You should answer these questions openly and honestly. We appreciate that this may be difficult for you, but rest assured that our doctors are highly trained professionals and will treat you with the dignity and respect you deserve.

How is Vaginal Atrophy treated?

There are a number of different vaginal atrophy treatments and the best one for you will depend on your symptoms, age, overall health and what is causing the condition in the first place.

Vaginal atrophy treatments include:

Vaginal oestrogen therapy

This vaginal atrophy treatment involves delivering oestrogen directly into the vagina. This can be done via the application of a cream, vaginal suppository or a vaginal oestrogen ring. The flexible ring is placed in the vagina and releases a consistent dose of oestrogen. However a doctor will need to swap it out for a new ring every three months.

Systemic hormone therapy

More commonly known as hormone replacement therapy (HRT), this is given in pill form and taken orally. This contains a higher dosage of oestrogen which is taken to other parts of the body, not just the vagina. It is used to treat other common menopause symptoms, such as hot flushes. In the longer term, HRT can help to improve bone health in postmenopausal women.

Lubricants and moisturisers

Vaginal moisturisers and water-based lubricants can treat vaginal dryness, vastly improving comfort during sex. You should only use moisturisers that are specifically designed for use on the vagina, avoiding perfumed products which could potentially make symptoms worse. Vaseline, vitamin E, olive and coconut oils and mineral oils should not be used in order to avoid irritation and infection.

Dilators

Dilators are used to dilate (widen) the vagina to allow you to return to having sex. Narrow dilators are used at first, progressing to larger sizes over time until the vagina is wide enough to accommodate a penis for sex without pain. This treatment can be used in conjunction with vaginal oestrogen therapy.

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Frequently Asked Questions

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How can I prevent vaginal atrophy?

Unfortunately you cannot avoid falling oestrogen levels, caused by the menopause for example, although you can combat this with HRT or localised oestrogen therapy.

However, regular sexual activity can increase the blood flow to the vagina and keep it healthy. You should continue to engage in sexual activity if possible as this can actually help prevent vaginal atrophy. This does not necessarily have to involve penetrative sex. The sexual activity does not need to involve a partner either.

If you smoke, you should consider quitting as smoking is a risk factor for vaginal atrophy.

What can I do at home to manage vaginal atrophy?

There are certain things that you can do to manage vaginal atrophy symptoms.

To avoid irritating the vagina further, you should avoid tight-fitting clothing, pads and panty liners where possible. You should also avoid any perfumed soaps, talcum powder and deodorants as these can be detrimental to vaginal health.

When you have sex, try using water-based lubricants to prevent friction and make penetrative sex more comfortable.

When should I see a doctor?

It is important to see a doctor if you are suffering from any vaginal atrophy symptoms, such as vaginal dryness, unusual bleeding, pain, urinary problems or recurring UTIs. If you are using any treatments for vaginal dryness, either prescribed or over the counter, and you find these are no longer working, then you should also talk to your doctor.

If you notice any gynaecological or urinary symptoms, you should see the doctor who may want to carry out further tests to rule out other conditions.

What is the difference between vaginal atrophy and a yeast infection?

Vaginal atrophy and a yeast infection can present in a similar way as both share symptoms such as itching, redness, dryness and pain.

However where vaginal atrophy is caused by a lack of oestrogen, a fungal infection is what is responsible for a yeast infection. Your doctor will want to test you to see whether you have a yeast infection before embarking on vaginal atrophy treatment.

Who is at risk of getting vaginal atrophy?

Women aged over 50 who have experienced menopause are the most likely to have vaginal atrophy. Women who have experienced a drop in oestrogen levels due to perimenopause, removal of the ovaries, breastfeeding or decreased ovarian function due to cancer treatments (chemotherapy or radiotherapy) are at a greater risk of vaginal atrophy. You are also at a higher risk of developing vaginal atrophy if you are a smoker or if you are having little or no sexual activity in order to get the blood flowing in your vaginal area.

Can vaginal atrophy be cured?

The good news is vaginal atrophy can be successfully treated, easing symptoms and vastly improving your quality of life. You don’t have to suffer in silence as there are plenty of treatments which can help.

You can prevent your symptoms from getting worse by quitting smoking and not avoiding sexual activity, both of which can contribute to vagina atrophy symptoms.

Does vaginal rejuvenation help atrophy?

Vaginal rejuvenation is a combination of surgical procedures which can effectively improve the appearance, sensation and function of your vagina and surrounding areas. This includes tightening the vaginal muscles, which can help to relieve some vaginal atrophy symptoms, such as urinary incontinence. Vaginal rejuvenation can also help to reduce vaginal dryness.

However vaginal rejuvenation will not address falling oestrogen levels, so hormone therapy will still be needed alongside this surgery.

What else can cause vaginal dryness?

There are a number of things that can cause vaginal dryness, other than vaginal atrophy.

As well as menopause, breastfeeding and cancer treatments, vaginal dryness may be caused by certain medications (including birth control pills and antidepressants), a hysterectomy (an operation to remove the uterus) or an underlying medical condition, such as diabetes.

You may also experience vaginal dryness if you are not sufficiently aroused during sex, which may lead to pain during intercourse.

If you use performed soaps, deodorants or douches in and around your vagina, you may find that this causes vagina dryness.

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Vaginal Atrophy