Atrophic Vaginitis

What is atrophic vaginitis?

Atrophic vaginitis is shrinkage, irritation, and dryness of the vagina caused by a change in vaginal tissue. This change happens when the level of estrogen in your body decreases. The change in vaginal tissue is called vaginal atrophy.

How does it occur?

The ovaries produce estrogen as long as you have menstrual periods. When you go through menopause and stop having periods, the ovaries stop making estrogen. Less estrogen in the body causes the vagina to become dryer. The tissues in and around the vagina become thinner and produce fewer secretions.

Atrophic vaginitis may occur:

• During or after menopause.
• After removal of both ovaries.
• After exposure of your pelvis to X-rays.
• After chemotherapy.
• After radiation therapy to the abdomen.

What are the symptoms?

The symptoms of atrophic vaginitis are:

• vaginal irritation, pain, or bleeding during intercourse
• vaginal dryness
• itching or burning of the vulva (the area around the vaginal opening)
• burning or pain after urination
• vaginal discharge, often gray-colored with a bad odor, possibly blood-streaked (Any spotting like this should be reported to your provider promptly to make sure that it isn't caused by a more serious problem.)
• urinary incontinence (leakage of urine)

How is it diagnosed?

You will have a pelvic exam to check the health of your vaginal tissue. Your provider may measure the level of estrogen in your vaginal tissue by taking a sample of cells (like taking a Pap test). You may also have blood tests to check the levels of hormones in your blood.

How is it treated?

Glycerin or water-based vaginal lubricants, such as K-Y jelly, can help lessen pain during sexual intercourse. Regular sexual activity, including masturbation or intercourse, can also help keep the vaginal tissue healthy.

Your healthcare provider might recommend that you take estrogen to replace some of the hormone your body is no longer producing. This treatment is called estrogen therapy or hormone therapy. Hormones can help vaginal tissue return to normal. The hormones may be taken in different forms, such as pills, skin patches or lotion, and vaginal rings or cream.

You and your provider should discuss the risks and benefits of hormone therapy. Hormone therapy can give relief from vaginal dryness and other symptoms of menopause. It also helps prevent osteoporosis. However, hormone therapy increases the risk for heart disease or stroke. It can also increase the risk of breast cancer and blood clots.

If you have no symptoms and are not sexually active, you may not need any treatment.

How long do the effects last?

Without hormone therapy, the symptoms may continue. If you use an estrogen cream, normal vaginal moisture and secretions will return in about 2 to 4 weeks. If you use other forms of hormone therapy, such as pills, normal moisture may return in 4 to 8 weeks.

How can I take care of myself and prevent the symptoms of atrophic vaginitis?

To help reduce or prevent symptoms of atrophic vaginitis during or after menopause:

• Use a lubricant if you have mild pain during sex. Petroleum jelly is not recommended.
• Avoid chemical irritants such as douches, sprays, and bubble bath.
• Wipe front to back after urinating or having a bowel movement.
• Drink plenty of liquids.
• Bathe as usual, using a mild soap in the vaginal area.
• Wear loosely fitting, cotton underwear. Change your underwear every day. Do not wear underwear in bed at night.
• If you have itching, avoid wearing pantyhose until the itching stops.
• Talk to your healthcare provider about using estrogen cream in the vagina or estrogen pills.
• If you still have spotting, use unscented sanitary pads instead of tampons.