What Is Vaginal Atrophy? 9 Facts You Need to Know
Dry, itchy, and burning… not exactly pleasant words to associate with any part of your body, and yep, that includes the vagina. But unfortunately, vaginal atrophy (VA), also known as genitourinary syndrome of menopause (GSM), is a common condition that results in these and other symptoms of discomfort in many women. Keep reading to get the lowdown on VA with nine key facts you need to know straight from the experts, from why it happens to how to feel better.
VA Symptoms Are Linked to Your Hormones
Estrogen: It’s a magical hormone that plays a major role in women’s reproductive health. But as we age, the body begins to produce less of it, which means changes for the body, explains Evelyn Mitchell, M.D., an obstetrician and gynecologist (OB-GYN) with Keck Medicine of the University of Southern California in Los Angeles, CA. “After menopause, the vaginal lining is not exposed to the amount of estrogen it was previously used to, so the lining becomes very thin, dry, elasticity decreases, there’s less secretion during sex, and the vagina actually will narrow and shorten. This is ultimately what causes VA.”
VA Is a Common Part of Aging
Because estrogen naturally declines in the body with age, that means VA is pretty darn common, Dr. Mitchell says. “It’s an expected and very common thing that happens in the perimenopausal and menopausal period,” she says. Menopause—when your period stops—usually hits sometime around age 51, and vaginal atrophy is just one potential change your body may undergo, but as time goes on without natural estrogen, vaginal atrophy may become more symptomatic and tends to worsen over time as opposed to hot flashes. The Cleveland Clinic says it affects at least half of menopausal women. And just because it’s common, that doesn’t mean it’s not a very real problem for many women that’s worth addressing.
There Are Reasons for VA Besides Menopause
Beyond menopause and aging, estrogen levels can drop for other reasons, resulting in VA. “Sometimes it can happen in premenopausal patients in patients who are on continuous birth control pills, and especially the depo shot, which can also cause decreased estrogen levels and some mild vaginal atrophy before menopause,” explains Dr. Mitchell. The vagina may also become atrophic or dry after pregnancy, particularly in women who are breastfeeding who may have lower levels of estrogen, she adds. Women who have had their ovaries removed or who are taking certain other medications may also experience VA, per the Cleveland Clinic.
Symptoms Can be Very Uncomfortable
With VA, some women have symptoms, and some do not (it’s diagnosed as a physical finding with thinning of the outer genital and vaginal tissues). For those that have symptoms, they can be incredibly frustrating, thanks to uncomfortable dryness, burning, itching, and pain with sex, says Susan D. Reed, M.D., OB-GYN and program director of the Women’s Reproductive Research Program at University of Washington Medicine in Seattle. “You can also have bladder problems with urgency and frequency, and sometimes even some bleeding in the vaginal area due to thin skin,” she adds. It’s not surprising that these symptoms can seriously disrupt your quality of life.
Diagnosis Is Straightforward
To get a proper diagnosis of VA, typically all you need is a pelvic exam by your OB-GYN or other doctor. “We examine the tissue, its elasticity, and sometimes you can see little microtears with atrophy,” says Dr. Mitchell. “Tissue can be very sensitive to the touch, so it can be very uncomfortable to place fingers or a speculum inside. Usually it’s a very obvious diagnosis.” That said, your doc may also do some tests to rule out other infections and test your vaginal pH balance, which will typically be a bit higher in women with VA, she says.
VA Can Affect Your Sex Life
For some women with VA, sex can become uncomfortable or even painful, says Dr. Reed—and who can get in the mood when you’re experiencing burning pain? Everyone deserves sexual pleasure if they desire it—so it’s important to know that you don’t just have to accept the pain of VA if it’s preventing you from having a healthy, satisfying sex life. “You don’t have to suffer and just get through it,” Dr. Mitchell reassures us. “There are lots of options we have to help you actually enjoy sex so it’s not something you’re dreading.” More on those next.
Nonhormonal Treatments Can Help
Here’s the good news: There are products galore designed to help you manage symptoms of VA, in the bedroom and beyond. There are two main categories of treatments: Hormonal and nonhormonal. In the nonhormonal camp, we’re talking about vaginal moisturizers and lubricants, says Dr. Mitchell. “Usually, patients see a huge difference” after using these, she says. Moisturizers can be used daily to help bring moisture to the vaginal tissue, and last longer than lubricants. That said, lubricants are still a must before sex, says Dr. Mitchell, and can help make it more comfortable and pleasurable despite VA.
Hormonal Treatments Are Another Option
There are also hormonal treatment options to consider, especially if moisturizers and lubes aren’t cutting it. “If a lubricant fails, usually a local estrogen therapy is the go-to,” Dr. Reed explains. Studies show that for women with dryness and painful sex, adding estrogen to a lubricant may provide little or no additional benefit. “We have estrogen tablets, vaginal rings, and creams, and these products have been used for years in very low doses.”
Other Healthy Choices Can Improve Vaginal Health
If you have VA, other vaginal health issues—like yeast infections or bacterial vaginosis, which can both occur alongside VA—can add to your discomfort. Taking steps to promote vaginal health and not disrupt the delicate vaginal microbiome, as well as promoting overall health with good nutrition is key, says Dr. Mitchell. “Eating sugary foods can promote yeast formation,” she says. “Avoid using products with fragrance, soaps, powders, or lotions down below, which can make dryness worse and disrupt the environment.” It’s also important to note that vaginal dryness can increase your risk of UTIs—so remember to stay hydrated!
The Bottom Line
VA is all too common, but you certainly don’t have to suffer—there are treatment options that can improve your symptoms and make you more comfortable (and your sex life more enjoyable!). So if you’re starting to experience symptoms, don’t be shy—talk to your doctor. Your yearly exam is also a great time to check in with your OB-GYB about vaginal health. “During our annual exams, we talk about a variety of topics and menopause and menopause symptoms and treatment are a part of that,” Dr. Mitchell says. “That’s the perfect time to talk to your doctor about this.”
All About Vaginal Atrophy: The Cleveland Clinic. (2020.) “Vaginal Atrophy.” my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy
Vaginal Atrophy Causes: Mayo Clinic. (2020). “Vaginal Atrophy.” mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288
Symptoms: Cureus. (2020). “The Genitourinary Syndrome of Menopause: An Overview of the Recent Data.” ncbi.nlm.nih.gov/pmc/articles/PMC7212735/
Treatment Options: International Journal of Women’s Health. (2018). “Current Treatment Options for Postmenopausal Vaginal Atrophy.” ncbi.nlm.nih.gov/pmc/articles/PMC6074805/