How Is Vaginal Atrophy Diagnosed?

by Sarah Ludwig Rausch Health Writer

As if we didn’t have enough to deal with, one of the oh-so-fun results of having a vagina can be vaginal atrophy (VA), or genitourinary syndrome of menopause (GSM). If you’ve never heard of this, you’re not alone—it’s believed to be underreported because people don’t understand what it is… or are embarrassed by the symptoms. These can include painful intercourse, vaginal irritation, and urinary urgency. But such symptoms can happen for other reasons, too. How can you be sure it’s VA and not something else? Through an official diagnosis by a medical doctor. Let’s take a look at how that happens.

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Are You the Right Age/Group for Estrogen Loss?

First, it’s helpful to see if you’re at risk for VA. It affects around half of all menopausal people (typical age: 51) because of the natural drop in estrogen that happens then, but it can also happen during perimenopause, the transition period (no pun intended) before menopause—which can happen anytime in adulthood! Other reasons for estrogen loss leading to VA include having little body fat (fat cells produce estrogen), says Shari Lawson, M.D., division director of general obstetrics and gynecology at Johns Hopkins Bayview Medical Center in Baltimore, and having your ovaries removed or taking certain medications. Estrogen levels can also be lower during postpartum especially if the woman is breastfeeding.

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Do You Have These Symptoms?

Maybe you use lubricants but still have pain during sex. Maybe it burns or hurts when you pee. Maybe your nether regions are so dry, itchy, and/or burning, you’re in agony, especially if you sit for long stretches of time (work-from-home, anyone?). These are all possible VA symptoms. If you have recurrent urinary tract infections (UTIs), this may indicate VA too because the same drop in estrogen linked to VA raises your UTI risk, says Amy Park, M.D., section head of female pelvic medicine and reconstructive surgery at Cleveland Clinic in Cleveland, OH.

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Then It’s Time to See Your Doctor

So you’re in the at-risk group for VA and/or you’re experiencing symptoms. Now what? Make an appointment with your obstetrician-gynecologist (OB-GYN). People usually see their OB-GYN for VA when their symptoms really impact their quality of life, Dr. Park says—but you don’t have to wait. VA can affect sexual intimacy and self-esteem, wreaking havoc on your romantic relationship and your general enjoyment of life, she says. Confirming you have VA can give you not only peace of mind, but also access to treatment that can help slow VA’s progression.

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How Your Doctor Makes a Diagnosis of VA

You go to your OB-GYN and tell them what you’re experiencing. What comes next? Doctors typically make a VA diagnosis based on these things:

  • Medical history
  • Symptoms
  • Physical exam

Let’s talk about each in-depth.

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Path to Diagnosis 1: Medical History

Asking about your medical history is standard practice to reach a diagnosis, and in VA, it’s usually no different. Your healthcare professional might ask about: Your complete medical history (any illnesses and diseases you have or have had); Past surgical history (what invasive procedures you’ve had, and when and why); Family medical history (your genetic predisposition to disease); Social history (including do you smoke, drink alcohol, exercise—and what are your sexual activities/habits?); Allergies (are you allergic to any medication or food?); Medications (those you’re taking or may have recently stopped taking).

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Path to Diagnosis 2: Symptoms

Next, your doctor will typically ask questions about your symptoms, Dr. Lawson says. Those can include when symptoms started, when you experience them, and what you’ve tried at home to help. “Sometimes the symptoms don’t correlate with the physical findings because some women aren’t sexually active, so they don’t know if they have vaginal dryness,” Dr. Park says. “They may have more urinary urgency or recurrent UTIs, whereas somebody who is sexually active would have more vaginal dryness complaints. So, it’s important to do both a history and physical exam.”

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Path to Diagnosis 3: Physical Exam

Finally, your doctor will likely perform a vaginal exam. They’ll need to see the appearance of your vaginal tissue, Dr. Park says. “When we look at the tissues, we can see if they’ve started to atrophy,” Dr. Lawson explains. “That basically means that they’re not as plumped up as they were before because of the loss of estrogen.” In premenopausal women with VA, the vaginal lining looks yellow-tinted instead of its usual pink. And because premenopausal women have little wrinkles inside the vagina called rugae, another telltale sign of VA in that group is a smooth vagina, she says.

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Other Signs of VA in a Physical Exam

“Estrogen has a lot of good effects on the vagina,” notes Dr. Park, like thickening vaginal tissues and keeping them lubricated. With VA, the tissue may be thin, fragile, and even bleed a little during a physical exam. Other signs: Little red dots called petechiae and some shortening of the vagina. Yet another sign of VA is when your doctor finds it physically difficulty to do a bimanual exam (when they insert two fingers into your vagina), Dr. Lawson says. This happens because the vaginal opening loses elasticity from a lack of estrogen, making it like a tight band.

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Your Doctor Will Rule Out Other Possibilities

Depending on your symptoms, Dr. Lawson says your doctor might check to make sure that you don’t have a vaginal infection like bacterial vaginosis (BV) or a yeast infection. This could involve what Dr. Park calls a “wet prep,” or a cell smear from the vagina. If you have painful or burning urination, Dr. Lawson says your doctor might want to do a urine culture to check for a UTI. “For the most part, once you’ve ruled out infection and you’ve done the physical exam, you can say it’s probably vaginal atrophy,” she says.

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You’ll Likely Receive Treatment

The first-line therapies for VA are water- or oil-based lubricants for sexual activity (even coconut oil works, says Dr. Lawson) and vaginal moisturizers, all available at your local drugstore. Or using dilator might help loosen vaginal tightness. Or your doctor could prescribe vaginal estrogen. It’s low dose and “hardly has any systemic absorption into the bloodstream,” Dr. Park says. Side effects are typically mild. “Overall, patients tend to benefit quite a bit from using a small amount of vaginal estrogen,” she says.

Sarah Ludwig Rausch
Meet Our Writer
Sarah Ludwig Rausch

Sarah Ludwig Rausch is a health writer and editor whose specialties include mental health, diseases, research, medications, and chronic conditions. She’s written for The Christian Science Monitor, American Cancer Society, Cleveland Clinic, PsychologyToday.com, MedShadow Foundation, the ACT Test, and more.