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Vaginal Atrophy

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Introduction

Vaginal Atrophy, also known as atrophic vaginitis, is a medical condition, which occurs when your body is deficient in estrogen. Vaginal Atrophy is most common in menopausal and post-menopausal women. It may also occur in young women if there is a deficiency of the hormone estrogen. Doctors also use the term genitourinary syndrome of menopause or GSM for this medical condition in women because it affects both the vagina and urinary tract.

Vaginal Atrophy refers to the drying and thinning of the lining of the vagina. Vaginal atrophy may also lead to a urinary tract infection or UTI. Vaginal Atrophy causes itching, burning, and painful sexual intercourse. Researchers have found that women who have not given birth vaginally are more prone to Vaginal Atrophy or genitourinary syndrome of menopause (GSM). The doctors advise that regular sexual activity can prevent GSM because sexual activity increases the blood flow in the vagina, which keeps the tissues healthy.

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What are the Causes of Vaginal Atrophy?

The cause of Vaginal Atrophy or GSM is a deficiency of the hormone estrogen in your body.

  • ● During menopause, your body produces less estrogen. As a result, the wall of the vagina becomes drier and thinner.
  • ● The vagina also gradually loses its stretchability.
  • ● The vaginal canal narrows and shortens.
  • ● The deficiency of estrogen lowers the normal flow of vaginal fluids, making the lining of the vagina very dry and itchy.
  • ● The acid balance of the vaginal area also changes.
  • ● Your estrogen level can also reduce if you have recently given birth and breastfeeding.
  • ● Estrogen levels also drop if you have had your ovaries removed lately or consuming medicines, such as aromatase inhibitors for breast cancer treatment.

What are the symptoms of Vaginal Atrophy ?

The symptoms of Vaginal Atrophy or GSM include:

  • ● Burning of the vaginal wall
  • ● Excessive itching of the vaginal wall
  • ● Pain during sexual intercourse, also known as Dyspareunia
  • ● Dryness of the vaginal area
  • ● A yellow-colored discharge from the vagina
  • ● Spotting or bleeding
  • ● Pruritus or itching of the vulva
  • ● Feeling of pressure
  • ● Light bleeding after sexual intercourse
  • ● Vaginal lubrication decreases during intercourse
  • ● The vaginal canal shortens or tightens

If Vaginal Atrophy affects your urinary system, you may experience the following symptoms:

  • ● Urge to visit the bathroom more often
  • ● Painful urination, which is called Dysuria
  • ● Urinary tract infection or UTI
  • ● Bloody urine, which is called Hematuria
  • ● Burning sensation during urination
  • ● Stress incontinence

Sometimes you may feel embarrassed to speak about Vaginal Atrophy, but you should seek immediate medical attention if your GSM symptoms worsen. You should visit the doctor if you have unusual bleeding, abnormal discharge, or soreness in the vaginal area.

How is Vaginal Atrophy Diagnosed?

Your doctor will Diagnose Vaginal atrophy or GSM through the following tests:

  • ● A physical pelvic examination where your doctor physically examines your pelvic organs and visually examines signs of vaginal atrophy in your vagina, genitalia, and cervix.
  • ● A urine test will help diagnose symptoms of vaginal atrophy if it has affected the urinary tract.
  • ● An acid balance test is done by either taking a sample of the vaginal fluids or using a paper indicator strip in your vagina to test the vaginal acid balance.

How is Vaginal Atrophy Treated?

Your doctor may conduct the following treatment options to treat your Vaginal Atrophy or genitourinary syndrome:

  • Vaginal moisturizers: An effective vaginal moisturizer like Replens or Sliquid can restore your vaginal area with some moisture. The moisturizer needs to be applied every few days and can relieve excessive dryness or itchiness.
  • Water-based lubricants: Water-based lubricants such as K-Y Jelly and Astroglide can help relieve painful intercourse if applied right before sexual activity. You can avoid petroleum-based lotions because they can destroy latex condoms.

If the options mentioned above do not relieve Vaginal Atrophy, then your doctor may recommend:

  • Topical estrogen: Vaginal estrogen is better than oral estrogen because your doctor can administer it in lower doses. Vaginal estrogen is available in different forms:
  • Vaginal estrogen creams: You can apply vaginal estrogen creams, such as Premarin and Estrace, directly to your vagina. You can do this daily for two to three weeks upon the doctor’s advice.
  • Vaginal estrogen suppositories: You can insert vaginal estrogen suppositories into your vaginal canal daily for some weeks
  • Vaginal estrogen ring: The doctor may insert a vaginal estrogen ring (Femring or Estring), a soft and flexible ring inside the vagina. The ring releases small doses of estrogen and needs to be replaced once in three months.
  • Vaginal estrogen tablet: You can insert a vaginal estrogen tablet in your vagina daily for two weeks as per your doctor’s prescription.
  • Ospemifene: This pill can help ease pain during sexual intercourse owing to vaginal atrophy. The doctor will not prescribe this medicine to breast cancer patients or patients with a history of breast cancer.
  • Prasterone: Prasterone is a vaginal insert that helps relieve pain from sexual intercourse.
  • Systemic estrogen therapy: If your Vaginal Atrophy also has menopausal symptoms, such as hot flashes, your doctor might prescribe oral estrogen.
  • Vaginal dilators: You may use vaginal dilators along with estrogen therapy. These dilators help to stretch your vaginal muscles and reverse the narrowing of your vagina.
  • Topical lidocaine: This is a prescription ointment and should be applied five to ten minutes before sexual activity.

What is the Results of Vaginal Atrophy Treatment?

The treatment of Vaginal Atrophy is generally effective through medicines, ointments, gels, and rings. Severe Vaginal Atrophy treatment includes systemic estrogen therapy, vaginal dilators, or topical lidocaine. But, there are some side effects of Vaginal Atrophy, such as breast tenderness, nausea, indigestion, vaginal bleeding, headache, or stomach pain. The risk of blood clots or breast cancer may also slightly increase with systemic estrogen therapy.

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FAQ's

What are the Complications of Vaginal Atrophy?

Vaginal Atrophy increases your risk of vaginal infections and urinary tract infections (UTI).

How Can you Prevent Vaginal Atrophy?

Regular sexual activity can increase blood flow in vaginal tissues and prevent Vaginal Atrophy.

What are the Risk Factors of Vaginal Atrophy?

Smoking, no vaginal births, and decreased sexual activity can increase your risk of Vaginal Atrophy.

Can Vaginal Atrophy be Reversed?

Yes, Vaginal Atrophy is reversible with estrogen replacement. Although, the side effects of estrogen replacement deter doctors from using this treatment option.

What are the Natural Remedies for Vaginal Atrophy?

Natural lubricants like jojoba, coconut oil, and aloe vera can soothe the vaginal area.

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