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 your body has less estrogen than it used to. The change in vaginal tissue is called vaginal atrophy.

How does it occur?

The ovaries produce the hormone estrogen as long as you have menstrual periods. Around the time of menopause, when you stop having periods, the ovaries make very little estrogen. When there is less estrogen in the body, the tissues in and around the vagina get thinner and make less moisture.

Atrophic vaginitis may happen:

• during or after menopause
• while you are breast-feeding
• after removal of both ovaries
• after exposure of your pelvis or abdomen to X-rays
• after chemotherapy.

What are the symptoms?

The symptoms of atrophic vaginitis are:

• vaginal irritation, pain, or bleeding during sex
• vaginal dryness
• itching or burning of the area around the vagina
• burning or pain after you urinate
• leakage of urine
• vaginal discharge, often gray-colored with a bad odor, possibly blood-streaked

If you start having more vaginal discharge than normal, be sure to tell your healthcare provider about it. Your provider will make sure that it isn't caused by a more serious problem.

How is it diagnosed?

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

How is it treated?

Your healthcare provider might recommend that you take estrogen to replace some of the hormone your body is no longer making. This treatment is called estrogen therapy or hormone therapy. The hormones may be taken in different forms, such as pills you take by mouth or a cream that you put into the vagina.

You and your healthcare provider should discuss the risks and benefits of hormone therapy. Hormone therapy may give relief from vaginal dryness and other symptoms of menopause. It also may help prevent osteoporosis. However, hormone therapy may increase the risk for heart disease or stroke. It may also increase the risk of breast cancer and blood clots. Estrogen medicines that are put into the vagina (such as vaginal cream) may have fewer of these risks. They may more directly treat atrophic vaginitis than other forms of hormone medicine.

How long do the effects last?

Without hormone therapy, you may keep having the symptoms. If you use a hormone cream, you may have more normal vaginal moisture and secretions in about 2 to 4 weeks. With other forms of hormone therapy, such as pills, it may take 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. Glycerin or water-based vaginal lubricants, such as K-Y jelly, can help lessen pain during sex. (Petroleum jelly, like Vaseline, is not recommended.) Regular sexual activity, including masturbation or intercourse, can also help keep the vaginal tissue healthy.
• Avoid chemical irritants such as douches, sprays, and bubble bath.
• When you bathe, use a mild soap in the vaginal area.
• Wear loose-fitting, all-cotton underwear or cotton-crotch underwear. Change your underwear every day. Don’t wear underwear when you sleep at night. This will help lessen your chances of getting vaginal infections, which could cause more discomfort.
• If you have itching, avoid wearing pantyhose until the itching stops.
• If you are still having periods, use unscented sanitary pads instead of tampons.
• Don’t use spermicidal foams, gels, or creams if they irritate your vagina. However, if you have not stopped having periods, make sure you practice good birth control if you want to prevent pregnancy.
• Talk to your healthcare provider about using vaginal estrogen cream or estrogen pills.
• If you have been through menopause and have any vaginal bleeding, tell your healthcare provider.