Understanding Vaginal Atrophy?

During the menopausal transition, the state of the vagina often changes. Vaginal dryness and pain are symptoms of vaginal atrophy (atrophic vaginitis) that occur as a result of lowered estrogen levels. The tissues in the vagina weaken, get thinner, dryer, and may get inflamed, causing pain, burning, or discharge. 

Changes to the vagina usually occur at the same time as changes in the urinary tract, so they have recently been combined into a single category – genitourinary syndrome of menopause (GSM). GSM covers a variety of changes to the genitourinary tract – particularly the urethra and vagina. Vaginal atrophy and urinary incontinence (UI) are the most common symptoms of GSM, affecting 40-50% of midlife and aging women.

Women may be very reluctant to speak up and act on vaginal issues due to embarrassment and negative feelings about aging. However, these are conditions that can be treated at home or with the help of a medical practitioner.

Understand more about pain during intercourse and other sexual related issue here.

Self-care & Natural Remedies for Vaginal Dryness, Itchiness and Urine Incontinence

To address vaginal atrophy at home, you can:

  • Use over-the-counter lubricants to hydrate the walls of your vagina. This can also help reduce vaginal infections.
  • Stimulate the muscles of and increase the blood flow to the vaginal wall with vaginal sex and masturbation, as this helps keep your vaginal tissues healthy.
  • Avoid vaginal intercourse when experiencing pain and dryness, as this can result in tearing delicate tissues and may lead to infections.
  • Seek medical care if self-care doesn’t help.
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Therapy & Treatment for Vaginal Dryness, Itchiness and Urine Incontinence

At age 40 find a reliable, educated primary care provider familiar with recognizing and treating the symptoms of perimenopause and menopause. The North American Menopause Society provides a list of menopause practitioners here.

You can try over the counter vaginal moisturizers and lubricants to help increase the moisture in the vagina. If you are using a lubricant, which is typically applied just before intercourse and reduces vaginal pain, check to see if the product contains any petroleum (like petroleum jelly). If you are in the menopausal transition there is still a chance of pregnancy, and petroleum based products can break down latex used in condoms. 

Topically (locally) applied hormone therapy (HT) with estrogen is safe and often effective for reducing dryness in the vaginal lining and improving strength of the vaginal wall. Topical HT comes in the form of creams to apply inside the vagina or tablets and rings that can be placed inside the vagina. Locally applied estrogen can also help to reduce the incidence of urinary tract infection.

The Science

Vaginal Atrophy

Vaginas are part of a woman’s sexuality and reproduction and can be healthy throughout life.

 


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The walls of a vagina are muscular, and with stimulation and estrogen support, can remain strong and thick. The vaginal lining secretes mucus, which makes the walls slippery. Mucus also protects against bacteria and yeast overgrowth.

The effects of menopause-related vaginal thinning and dryness can be mitigated with over-the-counter products, gentle Kegel exercises and safe and effective HT with estrogen.

Statistics

0%

Postmenopausal European women with symptoms of vaginal atrophy

0%

Patients with vaginal atrophy who receive adequate therapy

Myths & Mysteries

If your vaginal dryness is caused by low estrogen levels, your healthcare provider may prescribe topical estrogen therapy. There are three methods of applying vaginal estrogen:

  • Ring: You or your doctor can insert a soft, flexible ring into your vagina. It releases estrogen directly to the vaginal tissues. The ring lasts about three months so it will need to be replaced regularly.
  • Tablets: These tablets are inserted into your vagina with a disposable applicator.
  • Cream: The cream is inserted into your vagina using an applicator.

There are over-the-counter vaginal moisturizers as well. Speak to your pharmacist or your healthcare provider to get a recommendation. Water-soluble lubricants (such as Astroglide or K-Y Jelly) can also be used on an as-needed basis. Non-water-soluble lubricants, such as Vaseline, are not recommended if you are using condoms for either contraception or for prevention of STIs because they can weaken latex and reduce the effectiveness of the condom.  [5]

Therapy for Vaginal Dryness

During the menopausal transition, the state of the vagina often changes. Vaginal dryness and pain are symptoms of vaginal atrophy (atrophic vaginitis) that occur as a result of lowered estrogen levels. The tissues in the vagina weaken, get thinner, dryer, and may get inflamed, causing pain, burning, or discharge.

The lining of the outer urethra is estrogen-dependent. During the menopausal transition, this lining thins and may become weaker than the pressure in the bladder. It is this imbalance that leads to involuntary loss of urine.

Check out the science here

FALSE

Oh, please.

A national study of 5,045 older women [11] showed the following:

Sexual activity among older US women
Age (years) 50-59 60-69  70-79 80+
Masturbated in previous year 54%  46% 36% 20%
Had intercourse (penis-vagina) in previous year 51%  42% 27% 8%
Received oral sex in previous year 34%  25%  9% 4%

FALSE

No, there are many safe and effective non- prescription medications that can be used to lubricate your vagina. A vagina is a muscle, and it needs exercise.

FALSE

Vaginal healthy aging can be had by using non-prescription lubes, HT with estrogen, and regular exercise with masturbation and intercourse.

Compiled References

1. Baber, R. J., Panay, N., Fenton, A., & IMS Writing Group (2016). 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric : the Journal of the International Menopause Society, 19(2), 109–150. https://doi.org/10.3109/13697137.2015.1129166

2. Bulan, S. E. (2019). Physiology and Pathology of the Female Reproductive Axis. In Melmed, S., Koenig, R., Rosen, C., Auchus, R. & F. Goldfine (Eds.), Williams Textbook of Endocrinology (14th ed., pp. 574-641). Elsevier.

3. Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. The Cochrane Database of Systematic Reviews, 10(10), CD005654. https://doi.org/10.1002/14651858.CD005654.pub4

4. Minkin M. J. (2019). Menopause: Hormones, Lifestyle, and Optimizing Aging. Obstetrics and Gynecology Clinics of North America, 46(3), 501–514. https://doi.org/10.1016/j.ogc.2019.04.008

5. Kołodyńska, G., Zalewski, M., & Rożek-Piechura, K. (2019). Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Przeglad menopauzalny = Menopause review, 18(1), 46–50. https://doi.org/10.5114/pm.2019.84157

6. The North American Menopause Society. (n.d.). Changes in the Vagina and Vulva. Retrieved July 11, 2021, from https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva

7. Santoro N. (2016). Perimenopause: From Research to Practice. Journal of Women’s Health, 25(4), 332–339. https://doi.org/10.1089/jwh.2015.5556

8. Krause, M., Wheeler, T. L., 2nd, Richter, H. E., & Snyder, T. E. (2010). Systemic effects of vaginally administered estrogen therapy: a review. Female pelvic medicine & reconstructive surgery, 16(3), 188–195. https://doi.org/10.1097/SPV.0b013e3181d7e86e