Vaginal atrophy (VA) is also known as vaginal dryness and atrophic vaginitis, and occurs after the menopause. VA can also affect the vulva and can result in vulvovaginitis, and as a result give rise to the Genitourinary syndrome of the menopause.
VA occurs as a direct result of oestrogen deficiency. This lack of oestrogen will lead to a reduction in blood follow to the vaginal tissues, and cause: a characteristic thinning of the vaginal mucosa, a loss of collagen tissue, and a reduction in vaginal fluids.
The vagina is a sensitive structure, and needs not only adequate blood flow, but also collagen and a natural release of fluid to maintain its integrity. Collagen will provide elasticity to the vagina and allows the tissues to contract and tighten. Collagen gives the vaginal tissue its elasticity, so that the walls of the vagina can contract and tighten.
The vaginal glands produce a lubricating fluid which maintains vagina’s moisture, and also a low vaginal PH. This not only keeps the vagina clean but prevents infections such as BV and thrush. The fluid also prevents urinary tract infections.
Several over the counter medications including allergy and cold medications, and prescription antidepressants can affect the vaginal mucosa resulting in vaginal dryness.
Vaginal dryness may affect women of any age, but in my experience:
VA symptoms will include vaginal dryness, vaginal burning, sore sexual intercourse, a loss of the normal vaginal discharge, occasional bacterial vaginosis, labial itching, and a burning pain on passing urine. The loss of the acidic vaginal pH will also lead to frequent urinary tract infections, occasionally urinary incontinence. The loss of the vaginal mucosa will lead to bleeding after intercourse.
Some women will benefit from using vaginal lubricants and moisturizers, but not KY jelly which dries out. I also advise maintaining pelvic floor exercises, and to avoid vaginal douching and the use of soap in the vagina.
Local oestrogen treatment is effective. The topical treatments include: pessaries, vaginal rings, and creams. I advise patients that it may take a few weeks before these local treatments work, so it is useful to consider a non-hormonal lubricant to use for a few weeks.
Many patients will prefer standard HRT, which is discussed in the menopause pages. Hormone Replacement Therapy (HRT).
I have recently started to offer a SERM, Ospemifene which has a beneficial effect on vulvovaginal symptoms.
In the last 5 years, I have offered patients the Mona Lisa touch treatments, and this C02 laser is very effective, and is perfect for women in whom HRT is contra-indicated. (See Mona Lisa page).
All the treatments which include lifestyle changes will help reduce symptoms. BV is not cured by repeated douching, which will worsen the discharge and symptoms. Stopping smoking will help.
However, HRT whether used vaginally or taken systemically will improve symptoms, by reversing the loss of oestrogen, and improve vaginal blood flow to reverse vaginal atrophy, increase collagen and increase lubrication.
It is effective, but the dose will need to be 5 days out of 7.
They can occur within a year of the menopause.
Initially 3 treatments over 2 months, and then yearly.
The increase in the vaginal ph will increase the risk of vaginal infection and bladder infection.