9 Causes of Vaginal Atrophy

by Beth Shapouri Health Writer

While we know that vaginal atrophy (VA)—also called genitourinary syndrome of menopause (GSM)—is common, what we don’t know is why it happens to some women and not others. Or, what causes it in all cases. But when it does happen, it can cause all kinds of symptoms, including painful sex, burning while peeing, and genital itching. Here are nine circumstances that could at least be partially to blame for this often challenging condition.

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Menopause Itself Is a Cause of GSM

What we do know for certain? “Menopause is caused by declining estrogen production by the ovaries,” says Oz Harmanli, M.D., chief of urogynecology & reconstructive pelvic surgery and professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, New Haven, CT. And that, in turn, leads to vaginal atrophy for a large number of women. That’s because the drop in the hormone has a variety of impacts, including “thinning of the vaginal lining, lowering fluid production by vaginal cells in response to sexual arousal, and decreasing cervical and other genitourinary glandular mucus production,” Dr. Harmanli says.

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Symptoms Can Begin During Perimenopause

Considered the precursor to menopause (which officially begins 12 months after a woman’s last period), perimenopause can cause VA for the same reason as the condition it precedes. “As estrogen levels begin to drop, some women begin to experience symptoms of vaginal atrophy,” Dr. Harmanli says.

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Childbirth and Breastfeeding Can Cause VA

Women who have recently given birth or are breastfeeding may experience VA while their hormones shift postpartum. “This, again, we think is related to lower levels of circulating estrogen,” says Caroline Mitchell, M.D., director of the Vulvovaginal Disorders Program at the Vincent Center for Reproductive Biology at Massachusetts General Hospital and associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School in Boston, since “postpartum and breastfeeding is a time of really high progesterone and lower estrogen.” Symptoms often resolve as the body returns to its normal hormonal level after the fourth trimester and weaning from breastfeeding.

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Ovary Removal Can Lead to VA

VA can also be triggered by the hormonal shifts that come after the removal of the ovaries (a.k.a. a bilateral oophorectomy). Once they’re taken out, “effective estrogen production stops immediately,” says Dr. Harmanli. Sometimes referred to as surgical menopause, it’s typically used as a treatment for diseases such as ovarian cancer and comes with the same hormonal shifts that would come from the natural end of menstruation.

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Douching Can Contribute to VA

While douching itself won’t cause vaginal atrophy, it can make you more susceptible to it. “It adds to that risk by destroying the vaginal flora, which act as vagina’s natural defense system,” says Dr. Harmanli. That’s why doctors strongly recommend against it. Instead, washing externally with a mild soap should do.

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Stress and Anxiety Can Add to VA, too

While not the source of the condition, tension in your life can intensify vaginal pain. “If you're having a bad day, everything feels worse,” says Dr. Mitchell. But, while high-stress times may heighten symptoms, it’s important to remember that the pain is real—and not your fault for being stressed. “The message I try very hard not to give people is that this is all in your head—it’s not.”

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Cancer treatments

Some cancer treatments, like pelvic radiation, chemotherapies, and hormone suppression therapy for breast cancer, lead to decreased estrogen production, which can result in vaginal atrophy. After all, says Dr. Mitchell, some of these treatments actually “put people into early menopause.” Be aware this can happen going into these therapies, and talk to your doctor about potential treatments for VA so you’re prepared.

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Alcoholism is Linked to ‘Escalated’ Menopausal Symptoms

While moderate drinking isn’t a big concern, it’s important to remember that “alcohol is a drug. Too much of it has deleterious effects throughout the body,” Dr. Harmanli says. In fact, a study in the International Journal of Environmental Research and Public Health showed that alcohol dependence escalated perimenopausal and menopausal symptoms and led to a lower quality of sexual life than a control group

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Smoking is Connected With VA

Over the years, smoking has been correlated with VA, thanks to its ability to narrow the blood vessels and cause overall dryness in the body—so much so that cessation is a common piece of advice for those experiencing the condition. Clinicians in a 2020 data review in the journal Cureus concluded that kicking a smoking habit can be helpful for those with VA, since tobacco use has been linked with an increase in estrogen metabolism, which in turn can lead to vaginal atrophy.

Beth Shapouri
Meet Our Writer
Beth Shapouri

Beth Shapouri is an award-winning beauty, health, wellness, and lifestyle freelance writer whose work has appeared in Glamour.com, Elle.com, Health Monitor, Magnolia Journal, Marie Claire, RealSelf.com and more. Career highlights include a multi-year stint as Lead Beauty Writer for Glamour.com and contributing to a New York Magazine package on circumcision that received a National Magazine Award for service.