What is vaginal atrophy? The condition that affects more than half of postmenopausal people

• Vaginal atrophy is a condition in which the lining of the vagina becomes thinner and drier.
• Vaginal atrophy symptoms include vaginal dryness, pain during sex, burning, and itching.
• You can treat vaginal atrophy with lubricants, prescription creams, and an estrogen ring.

Vaginal atrophy is a condition in which the lining of the vagina becomes thinner and drier. It is common during times of hormonal change, like menopause. In fact, vaginal atrophy affects more than half of menopausal people.

While the condition can result in itching, burning, and painful intercourse, there are ways to treat and manage its related symptoms.

Symptoms of vaginal atrophy

The most common symptoms of vaginal atrophy are vaginal dryness, and pain during intercourse, says Christine Greves, MD, an OB-GYN with the Orlando Health Winnie Palmer Hospital for Women & Babies.

Other symptoms of vaginal atrophy include:

• Itching
• Vaginal burning during urination
• Decreased lubrication during sex
• Light bleeding after intercourse
• Frequent urination
• Urinary incontinence

Vaginal atrophy can also increase your risk of vaginal and urinary tract infections and sometimes cause bleeding, Greves says. This is because thinner and drier vaginal tissue is more prone to tearing.

Important: If you are experiencing vaginal atrophy symptoms and it's affecting your quality of life, reach out to your doctor, Greves says. They will perform a physical exam to diagnose you and recommend the proper treatment based on your symptoms and health history.

What causes vaginal atrophy?

Vaginal atrophy is caused by a reduction in the hormone estrogen, says Huong Nghiem-Eilbrek, MD, an OB-GYN with AltaMed Health Services. Estrogen helps maintain the vagina's elasticity, thickness, lubrication, and pH balance.

This explains why menopause is the leading cause of vaginal atrophy, since during this period you produce less estrogen, Nghiem-Eibrek says.

However, a drop in estrogen that can lead to vaginal atrophy may also be due to:

• Removal of both ovaries (oophorectomy), since estrogen is primarily produced in the ovaries.
• Breast cancer treatment, which may include anti-estrogen medications.
• Childbirth, which results in a drop in estrogen. In fact, a 2018 study of postpartum women found 43% reported vaginal dryness six months after giving birth.
• Breastfeeding, which also reduces estrogen levels. This is because the hormone prolactin that causes lactation can also reduce estrogen levels.

Other risk factors for vaginal atrophy include:

• Smoking, which reduces blood circulation to the vagina.
• Lack of sexual activity, since staying sexually active increases blood flow to the genitals and maintains elastic vaginal tissues.
• No vaginal births. People who have never given birth vaginally are more likely to develop vaginal atrophy than those who have had vaginal deliveries.

Vaginal atrophy treatment

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Vaginal atrophy treatment depends on what symptoms you are experiencing and their severity. For example, if your primary symptoms are dryness and pain during intercourse, using a water-based lubricant during sex may be all you need, Greves says.

However, if using a lubricant doesn't help or you are experiencing other symptoms, like burning during urination or urinary incontinence, you may need different forms of treatment, like:

• Over-the-counter vaginal moisturizers, like K-Y Liquibeads or Replens.
• Prescription estrogen creams, suppositories, or tablets. These are applied to or inserted into the vagina to provide estrogen to the area.
• A vaginal estrogen ring. This is inserted into the upper part of the vagina and releases a consistent dose of estrogen.
• Ospenmfene, which is a prescription drug that helps relieve pain during sex.

Depending on the cause, vaginal atrophy may improve with time, Nghiem-Eibrek says. For example, if you are experiencing symptoms of vaginal atrophy as a result of hormone treatment for breast cancer, your symptoms may subside once you have finished treatment.

Likewise, if you are experiencing vaginal atrophy as a result of low estrogen levels while breastfeeding, your hormone levels should return to normal after weaning.

However, low estrogen levels during menopause can not be reversed, but symptoms can be managed, Nghiem-Eibrek says.

Note: Vaginal atrophy symptoms typically appear in the years leading to menopause or in the months after childbirth. You can reduce your risk of vaginal atrophy by increasing blood flow to the vagina, Greves says. This can be done through regular sexual activity with or without a partner.

Insider's takeaway

Vaginal atrophy causes dryness, burning, itching, and pain during sex. It's caused by reduced levels of estrogen, like during menopause or after childbirth.

Depending on the cause, the condition may or may not resolve on its own. However, symptoms can typically be managed with over-the-counter or prescription moisturizers and medications. Therefore, talk to your doctor about what treatment may be best for you.

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