Vaginal atrophy is a condition between 10-40% of women will experience during their lifetime.  This common condition also known as atrophic vaginitis is when the walls of the vagina become thin and dry usually occurring after a woman has gone through menopause. 

Normally the lining of the vagina will appear plump, bright red, and moist.  But as a woman goes through the change of life the vaginal lining becomes thinner, drier, less elastic and turns to a light pink to bluish in color.  The main cause for this change is due to the reduction of estrogen levels as a woman approaches menopause.  Estrogen is a hormone produced primarily by the ovaries and plays a significant role in the regulation of the menstrual cycle and pregnancy.  This decrease in estrogen is what makes the tissues of the vagina thinner, less elastic and more fragile.

But a drop in estrogen is not only caused by menopause.  Other causes making estrogen levels decrease can be the years leading up to menopause known as perimenopause, surgical removal of both ovaries (surgical menopause), pelvic radiation therapy or chemotherapy for cancer or as a side effect of breast cancer hormonal treatment.

There are certain risk factors that may contribute to a woman developing vaginal atrophy which include the following:

·Women who smoke – Smoking cigarettes affect a woman’s genital health in several ways.  It reduces blood circulation and oxygen to the vaginal area, it reduces the naturally occurring estrogens in a woman’s body, and women who smoke tend to have an earlier menopause.

·A woman who did not have a vaginal birth – Research has shown women who did not deliver a baby vaginally have a higher rate of vaginal atrophy

·Lack of or no sexual activity  - When a woman keeps sexually active, this helps increase blood flow to this area making vaginal tissues more elastic

Symptoms of vaginal atrophy

There are certain symptoms indicating if a woman has vaginal atrophy.  Some women will have only mild to moderate symptoms while others will have more noticeable, severe symptoms. 

· Vaginal dryness, burning, or discharge

· Genital itching

· Burning with urination or an urgency to urinate

· More urinary tract infections

· Urinary incontinence

· Light bleeding after intercourse

· Pain or discomfort with intercourse

· Decreased vaginal lubrication during sexual activity

· Shortening or tightening of the vaginal canal

Diagnosing and treating vaginal atrophy

Women who have gone through menopause and are experiencing itching, dryness, or pain with sexual intercourse, most likely do have vaginal atrophy.  However, to get an accurate diagnosis, a woman should make an appointment with her gynecologist for a pelvic exam to rule out any other conditions such as infections that could be causing the vaginal symptoms.

During the pelvic exam, the doctor will palpate or feel the pelvic organs and visually examine the external genitalia, vagina and cervix.  They will also check for signs of pelvic organ prolapse which would be indicated by a bulge in the vaginal walls from pelvic organs such as the bladder or rectum. 

A urine test to collect and analyze the urine will be done along with an acid balance test which takes a sample of vaginal fluids placed on a paper indicator strip testing the acid balance.

Fortunately, there are many methods for treating this condition.  Determining which method is right for a woman is decided between her and her doctor. 

Here are several ways in which to treat vaginal atrophy:

· Vaginal moisturizers – these help restore moisture to the vagina and are applied every two to three days

· Water-based lubricants – these help reduce discomfort during intercourse. 

· Oral estrogen – this is taken by mouth with the estrogen going throughout the entire body

· Topical vaginal estrogen – this provides a direct relief of symptoms better than oral estrogen does.  This type of therapy comes in different forms:

· Vaginal estrogen cream – applied directly into the vagina with an applicator at bedtime

· Vaginal estrogen ring – a soft, flexible ring is inserted into the upper part of the vagina in which the ring releases estrogen while it is in place.  The ring can stay in the vagina for up to three months before it needs to be replaced.

· Vaginal estrogen tablet – the tablet is place in the vagina with a disposable applicator

· Estrogen pills, patches or gels are other therapies to reduce dryness