What is vaginal atrophy?
Vaginal atrophy (or atrophic vaginitis), is when the lining of the vagina begins to thin and become drier. It is also known as urogenital atrophy as the tissues around the urethra (opening that you pee through), bladder, and pelvic floor all have estrogen and progesterone hormone receptors, as does the vagina. When those hormone levels drop around the menopause, the tissues become thinner and the area may become inflamed - manifesting as redness, or itchiness. This can cause discomfort or of pain during sex, and puts you at higher risk of urinary frequency urinary tract infections (UTI's), and even incontinence.
Signs of vaginal atrophy to look out for:
- Vaginal dryness
- Vaginal burning
- Pain or burning with urination
- Spotting after intercourse
- More frequent urinary tract infections
- Urinary incontinence.
Why does vaginal atrophy happen?
Vaginal atrophy happens as a direct result of your estrogen levels dropping. This leads to reduced production of cervical and vaginal secretions and reduced lubrication. The tissues become thinner, more sensitive, less elastic and more fragile, and the acidity of the vaginal area reduces, leading to an increased risk of infection.
Some women may be more prone than others to vaginal atrophy:
- Smoking - Cigarette smoking can affect the blood supply to many areas. This may decrease both the blood and oxygen flow towards your vaginal area, thus reducing overall lubrication
- Vaginal birth - Women who have given birth vaginally are less likely to experience vaginal atrophy
- Sex life - Sexual intercourse increases blood flow to your vaginal area. Keeping a healthy sex life could lower your chances of experiencing vaginal symptoms. If sex is painful at first consider using a lubricant or vaginal moisturiser
- Medications - such as Tamoxifen may cause vaginal atrophy
What can I do to help?
1. Vaginal Cream and Pessaries
Estrogen creams and pessaries (tablets that you insert in to the vagina with an applicator) are very safe to use. Even for those who may not be eligible for systemic HRT, local estrogen creams are often still an option. This is because the dose of estrogen in these products are so low and are only absorbed into the local vaginal blood stream. This minimises any risks to your health. However this treatment is not usually recommended for women who have active breast cancer (discuss this with your doctor for individual advice). These drugs should not be started if you have unexplained vaginal bleeding, which should always be medically assessed..
Most doctors will start you on a cream or pessary to be used everyday for a couple of weeks, and then twice a week (but read the instructions carefully). The maximum benefits following such treatments can take up to 3 months, so we have to be patient. This treatment can be used as long as you need until you begin to notice change. They'll then suggest a dose to help you maintain vaginal health - usually once or twice per week, or intermittent courses.
These treatments can also be used for a few weeks before a cervical smear test, which may make the procedure less uncomfortable. But do not use the cream or pessary the night before your smear, or it could get messy.
Water based lubricants can really help to make sex more comfortable. Make sure that you are choosing a lubricant that is as body identical as possible. Good quality water based lubricants (like Sylk) can help to reduce dryness during sex and make it more pleasurable. This is a great alternative if you are not wanting to use the low-dose vaginal estrogen. Make sure you choose a water based lubricant which is are safe to use with condoms and should not change your vaginal acidity (pH). Oil based lubricants can damage condoms and cause irritation. You do not need to use lubricants regularly but should consider using them before, or during sex.
3. Non hormonal vaginal moisturisers
Vaginal moisturisers such as Replens are water based, and line the vaginal walls giving constant moisture. They give longer lasting relief of symptoms and should be used regularly, a bit like the moisturisers that you use on your face. They can be used with condoms safely.
4. Washing with water
Always avoid perfumed soaps and bubble baths, as they can irritate delicate skin. All you need to clean yourself is warm water in the shower. Keep it as simple as that. If you are worried about an odour, and have pain, it may be worth consulting a doctor to check that there is no infection.
If you think your medication might be effecting your vaginal lubrication or sex drive, speak to your doctor to get advice on alternatives.
5. Don't stay silent
We know this particular symptom can be a really hard one to discuss with a partner or a doctor. It may seem embarrassing, but there are good options for help when we open up and ask. It's nothing to be ashamed of. Opening up with your partner will help them understand and may help to make the topic of sex less stressful for you. Using lubrication can help make sex more enjoyable for both of you. If you are unsure about how to talk about it, have a read of our article. Vaginal dryness is a common and troublesome symptom, but there are things you can do to quickly get help and manage it. It's better to be proactive, and treat it early, rather than wait until things get worse.