Vaginal Atrophy

Overview

Vaginal atrophy, also known as atrophic vaginitis, is a condition that occurs when the vaginal walls thin, dry, and become inflamed due to reduced estrogen levels in the body. This condition commonly affects women after menopause, but can also occur during the transition to menopause (perimenopause) or after surgical removal of both ovaries. Symptoms of vaginal atrophy may include vaginal dryness, burning, itching, painful urination, frequent urination, urinary incontinence, and discomfort during intercourse. Simple treatments are available to manage the symptoms of vaginal atrophy, and maintaining regular sexual activity can help maintain healthy vaginal tissues.

Understanding the disease

Symptoms

Symptoms of vaginal atrophy, also known as genitourinary syndrome of menopause (GSM), may include vaginal dryness, burning, discharge, genital itching, burning with urination, urgency with urination, frequent urination, recurrent urinary tract infections, urinary incontinence, light bleeding after intercourse, discomfort with intercourse, decreased vaginal lubrication during sexual activity, and shortening and tightening of the vaginal canal. If you experience any of these symptoms, it is recommended to consult a doctor for proper diagnosis and treatment.

Risk Factors

Risk factors for developing vaginal atrophy (genitourinary syndrome of menopause) include:

1. Age: The primary risk factor for vaginal atrophy is age, especially during and after menopause when estrogen levels decline.
2. Hormonal changes: Significant hormonal changes, such as those experienced during menopause, pregnancy, or breastfeeding, can increase the risk of developing vaginal atrophy.
3. Surgical removal of ovaries: Women who undergo surgical menopause, which involves the removal of both ovaries, may experience a rapid onset of vaginal atrophy due to the sudden decrease in estrogen production.
4. Certain medications: Some medications, such as some birth control pills, can affect estrogen levels and increase the risk of vaginal atrophy.
5. Smoking: Cigarette smoking can affect blood circulation, reducing the flow of blood and oxygen to the vagina and other nearby areas. Smoking also reduces the effects of naturally occurring estrogens in the body. It's important to note that not all menopausal women will experience vaginal atrophy, and some may develop the condition without any of these risk factors being present.

Development

Vaginal atrophy occurs when there is a decrease in estrogen production in the body, leading to thinning, drying, and inflammation of the vaginal walls. This condition is most commonly experienced by women after menopause, but can also occur during the years leading up to menopause (perimenopause), after surgical removal of both ovaries (surgical menopause), while breastfeeding, or as a result of certain medications or medical treatments that affect estrogen levels.

Assessment and Diagnosis

Triage

You should see a doctor if you experience any unexplained vaginal spotting or bleeding, unusual discharge, burning, or soreness, as these may be signs of vaginal atrophy. Additionally, if painful intercourse is not resolved with the use of a vaginal moisturizer or water-based lubricant, it's important to consult a healthcare professional. If you have symptoms such as vaginal discharge that smells unusual, recurrent urinary tract infections, or urinary incontinence, it's also advisable to make an appointment with a doctor. Remember, many postmenopausal women experience genitourinary syndrome of menopause (GSM), but few seek treatment, so don't hesitate to discuss your symptoms with your healthcare provider.

Diagnosis

To diagnose vaginal atrophy, your doctor may perform a pelvic exam, urine test, or acid balance test. During the pelvic exam, the doctor will feel your pelvic organs and visually examine your external genitalia, vagina, and cervix. For the urine test, you'll be asked to collect and provide a sample of your urine, particularly if you have urinary symptoms. The acid balance test may involve taking a sample of vaginal fluids or using a paper indicator strip to test the acidity of your vagina.

Management and Treatment

Complications

Potential complications of vaginal atrophy may include vaginal infections, urinary problems, and increased risk of urinary tract infections or urine leakage (incontinence). Vaginal atrophy can cause changes in the acid balance of the vagina, making it more susceptible to infections. Additionally, urinary changes associated with vaginal atrophy can contribute to urinary problems such as increased frequency or urgency of urination, burning with urination, and a higher risk of urinary tract infections.

Prevention

Vaginal atrophy is primarily caused by a decrease in estrogen production and can occur due to various factors such as menopause, ovarian surgery, hormonal medications, or cancer treatments. While it's not always possible to prevent vaginal atrophy, regular sexual activity may help maintain vaginal health by increasing blood flow to the vagina. It's essential to maintain good vaginal health by practicing good hygiene, staying hydrated, and using lubricants during sexual activity if needed. If you experience symptoms of vaginal atrophy or discomfort during intercourse, consult your healthcare provider for guidance on managing and treating the condition.

Treatment

There are several treatments available for vaginal atrophy or genitourinary syndrome of menopause (GSM), including:

1. Vaginal estrogen therapy: This is the most effective treatment for relieving symptoms of vaginal atrophy. Vaginal estrogen therapy comes in various forms, such as creams, tablets, or rings. Your doctor will advise on the most suitable option for you.
2. Vaginal moisturizers: Over-the-counter vaginal moisturizers can help relieve vaginal dryness and discomfort during intercourse. Examples include K-Y Liquibeads, Replens, and Sliquid.
3. Lubricants: Water-based lubricants can help reduce friction during intercourse and alleviate dryness. Examples include Astroglide, K-Y Jelly, and Sliquid.
4. Non-hormonal vaginal therapies: Some non-hormonal treatments like the diaphragm or vaginal cone may be recommended for women who cannot use estrogen therapy.
5. Lifestyle changes: Regular sexual activity, even without a partner, can help maintain healthy vaginal tissues. Kegel exercises can also strengthen the pelvic floor muscles and improve symptoms of vaginal atrophy. It is essential to consult a healthcare professional before starting any treatment to discuss the most appropriate and safest option for your specific situation. Remember to keep an open dialogue with your doctor and seek their guidance throughout the treatment process.

Preparing for medical consultation

To prepare for an appointment for vaginal atrophy, you should:

1. Schedule your appointment on a day when you don't have your period, as bleeding may affect the visibility of your vaginal discharge.
2. Avoid using tampons, vaginal sprays, douching, or having sex for 24 hours before the appointment.
3. List your symptoms, including any that may seem unrelated.
4. Make a list of all medications, vitamins, and supplements you're taking or have used in the past.
5. Write down any changes in your relationships or sex life, and bring a photo of yourself that shows any changes in your appearance since experiencing symptoms.
6. Consider bringing a family member or friend to the appointment to help remember important details and provide support.
7. Prepare a list of questions to ask your healthcare provider during the appointment. Remember to be open and honest with your doctor about your symptoms and concerns, and don't hesitate to ask for clarification if needed.