What Are the Signs of Atrophic Vaginitis?

Atrophic vaginitis is a medical condition where the walls of the vagina become thinner, dryer, and inflamed. Even though the disorder occurs in up to 50% of women who are postmenopausal, only 20 to 25% of that population end up seeking treatment.

Atrophic vaginitis may cause pain during sex or lead to urinary tract infections.

The symptoms of atrophic vaginitis start slowly. You may not realize you have a problem until you are five or 10 years into menopause. By this point, you may be experiencing less lubrication (moisture) in your vaginal area during sexual activity.

Some of the most common symptoms of atrophic vaginitis that you may experience include:

• An itching or burning sensation in the vagina
• Vaginal dryness
• Pain during sex
• Light vaginal bleeding after having sex
• Burning sensation when urinating
• A feeling of pressure in the vaginal area
• Constant urinary tract infections
• Urinary incontinence (leaking urine unintentionally)

Atrophic vaginitis also makes the environment inside your vagina less acidic. This causes a drop in the number of beneficial bacteria inside your vagina and an increase in the growth of organisms that can lead to infections in your vagina and urinary tract.

Estrogen, a female hormone, plays a large role in keeping your vagina lubricated. The levels of estrogen in your body typically start falling once you begin menopause. This causes the tissue of your vaginal walls to lose elasticity and become drier and more fragile.

Outside of menopause, your estrogen levels can start falling when you:

• Breastfeed
• Go into early (premature) menopause (when you begin menopause before age 40)
• Have your ovaries removed
• Enter postmenopause
• Take birth control or other medications that affect your estrogen levels
• Have pelvic radiation therapy to treat cancer

You may also experience symptoms of atrophic vaginitis if you take anti-estrogen medication (medication that prevents estrogen from affecting your body), including:

• Tamoxifen
• Aromatase inhibitors
• Leuprolide
• Nafarelin

You should see a doctor if your atrophic vaginitis symptoms disrupt your daily life. Your doctor will start by asking questions about your medical history. If you are still in the childbearing age range, they may ask if you are currently breastfeeding.

Your doctor may also ask whether you are experiencing symptoms of menopause, like:

• Irregular or absent menstrual cycles
• Hot flashes
• Mood swings
• Night sweats
• Problems sleeping at night

Your doctor will ask about any medications you are taking and look at your past surgical history. They may also perform a pelvic exam to look for symptoms of atrophic vaginitis, including:

• A lack of elasticity in your vaginal wall
• A smooth, pale, or shiny vaginal epithelium (outer layer)
• A narrow or shortened vagina
• Dryness at the entrance of your vagina
• A loss of plumpness in your labia (the two pairs of lips that form the outer vagina)
• A lack of pubic hair

If you report pain or bleeding after sex, your doctor may perform an endometrial biopsy to determine whether you have endometrial cancer. The procedure involves removing a small piece of tissue from your uterine lining and examining it for cancer cells.

Your doctor may also do a pap smear to look for additional problems in your cervix.

The treatments your doctor will recommend can vary depending on how severe your symptoms are. If your atrophic vaginitis is mild, your doctor might recommend the following:

• Using a vaginal moisturizer — These lubricants work by sticking to the surface of your vagina. Water-based moisturizers release water that covers your vaginal tissue in a moist film and restores its normal pH. You can also use silicone-based moisturizers outside of sexual activity if you experience vaginal dryness.
• Applying a vaginal lubricant during sex — Your doctor may also recommend using a vaginal lubricant before having sex. You can apply it to the opening of your vagina, a penis, or other tools you use for vaginal penetration.
• Taking a low-dose vaginal estrogen — Taking estrogen can help restore a normal pH balance in your vagina and encourage helpful bacteria production. Estrogen taken orally or through the skin can also reduce dryness in your vagina, thicken its epithelium, and increase your vaginal secretions.

Your doctor may also ask you to cut back on using certain items that may aggravate your atrophic vaginitis symptoms, like:

• Soaps
• Powders
• Pantyliners
• Deodorants
• Lubricants
• Spermicides
• Tight-fitting clothes
• Synthetic materials

You will likely continue to experience symptoms until you find a treatment for your vaginal dryness or return your estrogen levels to a normal balance. Having more regular sexual intercourse may also relieve your atrophic vaginitis symptoms.