Atrophic vaginitis is inflammation of the vaginal canal that happens when estrogen levels are low. With less estrogen, the vaginal lining becomes thinner and drier, which can trigger symptoms like dryness, itching or irritation, and pain during sexual intercourse.
This condition is most common during menopause, when estrogen naturally declines. However, it can also occur after childbirth, during breastfeeding, after surgery to remove the ovaries, or when taking certain medications used in cancer treatment.
Treatment for atrophic vaginitis (also called vaginal atrophy) is guided by a gynecologist. Depending on your symptoms, they may recommend vaginal estrogen, vaginal lubricants or moisturizers, or laser therapy.
Main symptoms
The main symptoms of atrophic vaginitis are:
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Vaginal itching or irritation;
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Pain or bleeding during sexual intercourse;
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Thin, watery vaginal discharge;
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Pain or burning when urinating (dysuria).
Yellowish discharge with an unpleasant odor, blood in the urine, increased urinary frequency, or stress urinary incontinence may also occur.
A higher-than-normal vaginal pH is also common and can increase the risk of recurrent urinary tract infections (UTIs) or vaginal tissue injury.
According to The North American Menopause Society, estrogen deficiency can lead to genitourinary changes that include urinary symptoms such as dysuria, urgency, and recurrent UTIs.
Confirming a diagnosis
The diagnosis of atrophic vaginitis is made by a gynecologist based on your symptoms and a pelvic exam.
The doctor may also order tests such as a Pap smear, urinalysis, hormone level testing, ultrasound, or a vaginal pH analysis.
Possible causes
Possible causes of atrophic vaginitis include:
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Menopause or perimenopause;
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Postpartum period or breastfeeding;
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Uncontrolled diabetes;
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Surgery to remove the ovaries;
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Lack of sexual activity;
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Severe stress or smoking;
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Pelvic radiation therapy or chemotherapy;
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Immune disorders or hypothalamic dysfunction.
Atrophic vaginitis is caused by low estrogen production. Estrogen is a hormone made by the ovaries that helps regulate the menstrual cycle, protects the vaginal lining, and supports normal vaginal secretions.
Atrophic vaginitis may also occur in women receiving hormonal treatment for breast cancer, including medications such as tamoxifen, anastrozole, letrozole, exemestane, or fulvestrant.
Treatment options
Treatment for atrophic vaginitis should be guided by a gynecologist. They may recommend vaginal moisturizers or lubricants to help relieve symptoms.
Hormone therapy with topical estrogen, available as a vaginal cream or tablet, may also be prescribed, such as estradiol or conjugated estrogens.
According to The Menopause Society, low-dose local vaginal estrogen is an effective treatment for vaginal dryness, irritation, and pain during sexual activity. In some cases, a healthcare provider may also prescribe oral estrogen, transdermal patches, or laser therapy.
If a urinary tract infection (UTI) is present, antibiotics may be used to eliminate the infection, and pain relievers can help ease discomfort when urinating.