Vaginal atrophy or atrophic vaginitis is the painful inflammation of the vagina as a result of the tissues becoming thin and shrinking, causing decreased lubrication, soreness, and itchiness. The condition is most often caused by a decrease in estrogen, such as after menopause or while breastfeeding. In addition to being irritating, vaginal atrophy can significantly increase a woman’s risk of chronic vaginal infections, as well as urinary tract infections.
The condition affects up to 40 percent of postmenopausal women, according to the American Association of Family Physicians, and yet, many of these women do not seek treatment. If you or a loved one is suffering from vaginal atrophy, there are numerous treatment options available to alleviate the symptoms of atrophic vaginitis, significantly improve quality of life, and prevent additional urologic conditions. At Comprehensive Urology, our team of skilled urologists can provide the evaluation and care you or your loved one needs and deserves.
Thinning of the vaginal walls and tissues can cause a variety of symptoms, including:
Other physical symptoms include loss of public hair, decreased elasticity, dryness of labia, fusion of the labia minora, turgor of the skin (dehydration), or vulvar lesions.
The main cause of atrophic vaginitis is a decline in the reproductive hormone estrogen, which results in the vaginal tissues becoming thin, fragile, dry, and less elastic. Women frequently experience hormonal fluctuations throughout their lives, but the most common periods in which estrogen levels drop low enough to cause vaginal atrophy include:
Following chemotherapy sessions
Following hormone replacement therapy for breast cancer treatment
During the postpartum period
After the removal of ovaries
Following pelvic radiation therapy
Additional risk factors associated with vaginal atrophy include smoking cigarettes or taking certain medications to decrease estrogen levels or treat endometriosis, breast cancer, fibroids, or infertility, such as Danocrine, Lupron, or Synarel. Women who have never given birth vaginally are also at a higher risk of developing vaginal atrophy.
Possible conditions that may be confused for atrophic vaginitis include allergic reactions to spermicides, lubricants, perfumes, or panty liners, as well as irritation caused by tight-fitting clothing or sanitary pads. Other similar conditions include the fungal infection candidiasis, bacterial vaginosis, or trichomoniasis.
If you suspect that you may have atrophic vaginitis, or a similar issue, do not hesitate to schedule a consultation with the experienced and compassionate urologists at Comprehensive Urology.
A urologist may perform one or more of the following tests to diagnose vaginal atrophy:
Pelvic Exam: A urologist feels a patient’s pelvic organs and examines the external genitalia, cervix, and vagina.
Urine Test: A urologist collects and analyzes a patient’s urine sample. This test may be performed if a patient is dealing with a wide range of urinary symptoms.
Prior to treatment, the urologists at Comprehensive Urology will determine the exact cause of the symptoms, such as a decrease in estrogen, an infection, or allergic reaction. One of the most common and effective treatments for atrophic vaginitis is hormone replacement therapy, which can be administered either topically or orally.
Topical estrogen is available via a vaginal ring, cream, or tablet. Each of these topical treatments can be inserted into the upper part of the vagina where it can be absorbed into the tissue and prevent too much of the hormone from becoming absorbed into the bloodstream. These transvaginal delivery methods are often prescribed as they have a lower risk of endometrial cancer. The dosages and length of topical estrogen replacement therapy will depend on the patient, as well as the method.
Oral estrogen replacement therapy can relieve the symptoms of vaginal atrophy and menopause; however, prolonged use of this method has been found to increase the risk of blood clots, stroke, and breast cancer or heart attack when combined with the hormone progestin.
Mild cases of vaginal atrophy may be successfully treated with over-the-counter vaginal moisturizers or water-based lubricants. Water-soluble lubricants are particularly helpful during sexual intercourse. Women should avoid products with petroleum jelly or other oils, as they may increase the risk of infection, damage diaphragms, or dissolve latex condoms.
Every patient is unique and the compassionate, experienced team at Comprehensive Urology strive to find the most effective personalized treatment plan to suit each patient’s needs and goals. For the best possible outcome, please do not hesitate to schedule a consultation with us.
Common topical estrogen treatments used to treat vaginal atrophy include:
Vaginal Estrogen Cream: Inserted into the vagina via an applicator. Vaginal estrogen cream is usually administered at bedtime, and women may be required to use it daily for one to three weeks, followed by one to three times per week afterwards.
Vaginal Estrogen Ring: Inserted into the upper portion of the vagina. A vaginal estrogen ring releases a steady dose of estrogen into the body and needs to be replaced approximately every three months.
Vaginal Estrogen Tablet: Inserted into the vagina via a disposal applicator. A urologist determines how frequently a patient is required to insert a vaginal estrogen tablet.
Oral estrogen replacement therapy involves the use of daily estrogen pills. It has been shown to help women reduce or eliminate menopausal symptoms and lower the risk of osteoporosis. Conversely, some studies have shown oral estrogen treatments may increase a patient’s risk of strokes, blood clots, and other health issues. Oral estrogen therapy has also been linked to headaches, nausea, swollen breasts, and other side effects.
A urologist conducts an in-depth patient evaluation to determine if an individual is a good candidate for oral estrogen replacement therapy or any other urological treatments. Since oral estrogen can interfere with the liver function, a urologist will not recommend this treatment for patients who are dealing with liver problems.
Vaginal moisturizers help women address discomfort due to vaginal dryness. They have also been shown to help women who experience pain during sexual intercourse.
A vaginal moisturizer can be applied regularly and at least two hours prior to sex. It improves vaginal moisture, as well as alleviates discomfort associated with vaginal dryness.
Comparatively, water-based lubricants help women treat vaginal pain during sex. They can be applied prior to sex and improve the ease and comfort of sexual activity.
While atrophic vaginitis is common among postmenopausal women, it is not necessarily a foregone conclusion. There are certain steps that women can take to help prevent the condition from occurring after menopause or during other periods of decreased estrogen production. In addition to medication and hormone therapy, many women can prevent or significantly reduce the symptoms of vaginal atrophy with the following lifestyle habits:
Avoid smoking, which can reduce estrogen, impair blood circulation, and cause dryness
Regular sexual activity helps improve blood flow and overall function
Kegel exercises can also improve blood flow and encourage lubrication
Regular use of a pH balanced feminine moisturizer For those who may are dealing with vaginal atrophy, it is important to consult with a urologist. That way, a patient can receive a full evaluation and diagnosis and work with a urologist to develop a personalized treatment program to address vaginal atrophy