What is vaginal or vulvovaginal atrophy and what are its causes?

By (gynecologist), (embryologist) and .
Last Update: 01/19/2023

Vaginal atrophy, also known as atrophic vaginitis, is a pathology caused by decreased levels of female sex hormones, i.e. estrogens.

The main symptoms of vaginal atrophy are the thinning and drying of the vaginal walls that occurs after menopause. However, vaginal atrophy can also occur, although to a lesser degree, during lactation or at any other time when estrogen production is reduced.

Apart from causing painful intercourse, vaginal irritation and vaginal dryness, vaginal atrophy causes urinary problems in women. For this reason, vaginal atrophy is also referred to as genitourinary syndrome at menopauseor GSM.

What are the causes of vaginal atrophy?

Vaginal atrophy is a condition caused by a decrease in estrogen levels, causing thinning, dryness and inflammation of the tissues lining the inside of the vagina.

Estrogens are the hormones released mainly by the ovary. Its functions are the appearance of female sexual characteristics, breast formation and the development of the menstrual cycle.

Estrogen levels increase dramatically at puberty and begin to decrease as women approach menopause, that is, as the ovary loses function.

Although the most important estrogen drop occurs at menopause, it is possible that it can also occur previously, either in premenopause, due to medical intervention such as the removal of both ovaries or in cancer treatments such as chemotherapy or pelvic radiotherapy.

Although menopausal women experience a decrease in estrogen levels, not all of them develop vaginal atrophy.

In addition to the menopausal period, there are other situations where a decrease in estrogen levels in women can occur and lead to vulvovaginal atrophy. For example, after childbirth or during lactation, a woman may suffer atrophic vaginitis, although this is less likely. Smoking, intense physical exercise or stress are also risk factors for vaginal atrophy.

Symptoms of vaginal atrophy

Vaginal atrophy usually results in vaginal and urinary tract infections, which is why it is also called genitourinary syndrome in the menopauseor GSM.

However, this condition can also be asymptomatic and the woman has no discomfort. In any case, the main symptoms suffered by women with vaginal atrophy are the following:

  • Vaginal dryness or burning.
  • Reduced vaginal lubrication.
  • Genital itching.
  • Thinning of the vaginal walls.
  • Loss of elasticity of the vagina.
  • Irritation.
  • Changes in the balance of flora and pH of the vagina.
  • Shortening and hardening of the vaginal cavity.
  • Burning sensation when urinating.

These symptoms can lead to light bleeding or discomfort during sexual intercourse, which can cause discomfort in a woman's daily life. Therefore, if the woman presents any of the symptoms listed above, it is best to inform the doctor so that he/she can make a correct study and diagnosis.

Treating vaginal atrophy

Many women are embarrassed or ashamed to go to the doctor to alleviate the symptoms of vaginal atrophy. In this sense, it is important to emphasize that it is something natural that happens to many women and that there are effective treatments that can improve the quality of life of women in this situation.

Regular sexual intercourse, with or without a partner, can reduce the symptoms or discomfort associated with vaginal atrophy by promoting the maintenance of healthy vaginal tissues. However, there are specific treatments for vaginal atrophy. Each of them is described in detail below.

Non-hormonal treatment of vaginal atrophy

First, the use of vaginal moisturizers can improve or restore moisture to the vaginal area. Although this treatment does not diminish the atrophy of the vaginal wall since the estrogen deficit continues, applying vaginal moisturizers several times a week improves mild symptoms such as dryness, pain during intercourse or vaginal itching.

Another treatment that can alleviate the symptoms associated with vaginal atrophy is vaginal lubricants. In addition, lubricants can be used as a complement to moisturizers before sexual intercourse.

It is essential that both moisturizers and lubricants are water and silicone based. In addition, those containing petroleum jelly are not recommended, as they may increase the risk of genital infections by damaging the latex of condoms or diaphragms.

Last, but not least, is ospemifene. These pills are administered orally on a daily basis, thus reducing pain during sexual intercourse. The downside of ospemifene is that women at risk of developing breast cancer cannot take them.

Hormonal treatment

Vaginal atrophy treatments containing hormones are indicated for women with common and very bothersome symptoms. In some cases, the medical specialist may choose to administer estrogens at low doses and for topical use (vaginal) or in higher doses, either orally or by means of skin patches or rings. In the case of topical estrogens, they are especially recommended for women who present only vulvovaginal symptoms.

High-dose estrogens are administered systemically and can produce side effects. For this reason, they are only recommended for very symptomatic women and in cases of vaginal dryness associated with other menopausal symptoms such as hot flashes.

It is important to emphasize that hormonal therapies can produce certain side effects. For this reason, this type of treatment should not be administered without a prescription and without supervision by a specialist.

Hyaluronic acid treatment

Another treatment option for vulvar atrophy is hyaluronic acid infiltration. It is a therapeutic alternative that provides elasticity and hydration to the vaginal area. This technique is performed in the doctor's office and does not require total anesthesia, but the specialist will use local anesthesia to reduce possible discomfort.

Hyaluronic acid is injected with the help of a fairly fine needle into the vaginal mucosa or upper vagina. However, treatment of vaginal atrophy with hyaluronic acid cannot be applied in women who have previous treatment with anticoagulants, coagulation problems or in pregnant women.

After the vaginal injection of hyaluronic acid, the woman should avoid exposure to moisture. Therefore, the patient should not go to swimming pools, saunas or jacuzzis, for example, for at least 10 days.

Natural remedies for atrophic vaginitis

Some natural remedies can help improve the sensation of vaginal dryness caused by vaginal atrophy. For example, turmeric appears to have a beneficial effect on women's health due to its antibacterial properties. For this reason, turmeric would allow the recovery of vaginal discharge if the vaginal atrophy was caused by an infection.

Aloe vera gel is also a good moisturizer for the vaginal area, which would improve the lack of lubrication caused by atrophic vaginitis.

In addition, if vaginal atrophy is induced by a stressful situation, valerian infusion may be the home remedy to reduce vaginal dryness. In the same way, chamomile also reduces itching and irritation of the area.

FAQs from users

How is vaginal or vulvar atrophy cured?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Normally, the first approach to vaginal atrophy is to use vaginal moisturizers to try to restore moisture to the area. In addition, water-based lubricants are often recommended when sexual intercourse is to be performed to avoid possible discomfort.

If these treatments do not improve the symptoms caused by vaginal atrophy, the specialist will opt for a cream-based estrogen treatment. In addition, there are hormonal therapeutic options.

Finally, a treatment with hyaluronic acid infiltrated directly into the vaginal skin can be applied. This provides hydration to the area and reduces vaginal dryness.

What is genitourinary syndrome in menopause?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Genitourinary syndrome in menopause is a set of symptoms caused by the decrease in estrogen levels in women. As a consequence of this estrogen reduction, women present changes in the vagina, but also in the external genitalia.

The main cause of genitourinary syndrome is the onset of menopause, although it is not the only one. Among the most prominent symptoms of this syndrome are vaginal dryness, irritation and inflammation of the area.

Can vaginal atrophy be treated with laser?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Yes, gynecological laser is effective for vulvovaginal atrophy.

The use of laser as a treatment for vaginal atrophy improves lubrication and dryness of the vaginal area. In addition, gynecologic laser also reduces painful intercourse and relieves irritation.

How is vulvovaginal atrophy diagnosed?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

When a woman notices discomfort in the vaginal area, as well as dryness and irritation, she should see a doctor for a proper evaluation.

The first thing the specialist will do is to take a detailed medical history of the patient. Once the anamnesis has been taken, the specialist will proceed to evaluate the vaginal area through a gynecological examination. When the speculum is introduced, the physician will assess whether the walls of the vagina are thinned and irritated.

In addition, the gynecologist will take a sample with the help of a hyposcope to analyze the vaginal secretion and rule out possible infections.

Suggested for you

As mentioned above, most cases of vaginal atrophy are due to menopause. If you are interested in knowing more information about this stage, you can click on the following link: Menopause in women: when it occurs and what symptoms it has.

On the other hand, the vaginal factor is one of the causes of female infertility, although not the only one. If you want to know all the factors that affect a woman's reproductive capacity, you can visit the following article: What causes female infertility - Symptoms and treatments.

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FAQs from users: 'How is vaginal or vulvar atrophy cured?', 'What is genitourinary syndrome in menopause?', 'Can vaginal atrophy be treated with laser?' and 'How is vulvovaginal atrophy diagnosed?'.

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Authors and contributors

 Gorka Barrenetxea Ziarrusta
Gorka Barrenetxea Ziarrusta
M.D., Ph.D.
Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta
License: 484806591
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Adapted into english by:

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