Vaginal Atrophy

What is Vaginal Atrophy or Atrophic vaginitis?

Vaginal atrophy is a condition in which certain vaginal and genitourinary symptoms occur in females due to fall in estrogen hormone levels.

Estrogen hormone is responsible for maintaining your reproductive organs like uterus, cervix, vagina and vulva in good health. When estrogen levels fall, vagina becomes dry, thin, inflamed and smaller in size. Some urinary symptoms like frequent urination, burning urination and painful urination may also be present.

This condition which develops due to the decline of estrogen in the body and is marked by vaginal and genitourinary symptoms is called Vaginal atrophy or Atrophic vaginitis or the Genito-urinary syndrome of menopause. The most common cause of vaginal atrophy is sharp fall in estrogen levels after menopause. Some other conditions can also lower estrogen levels, as we will see below.

Why does the vaginal atrophy occur?

As discussed earlier, estrogen hormone is responsible for maintaining good vaginal health. After menopause, production of estrogen in the body declines and leads to vaginal atrophy, which is characterized by:

• Thinning and dryness of the vaginal mucosa or outer skin.
• Slowing down of natural regeneration of vaginal cells.
• Decrease in vaginal secretions which are very important for lubrication and prevention of infections
• Along with vagina, the urinary bladder mucosa is also affected and the bladder muscles become irritable.

Factors which increase risk of vaginal atrophy

Any factor that reduces the estrogen levels in the body, can produce symptoms of vaginal atrophy. Some factors which reduce estrogen levels and increase the risk of vaginal atrophy are:

• Natural menopause: Estrogen levels fall sharply after menopause as the ovaries stop producing it. Most females have menopause between 45 to 55 years of age.
• Surgical menopause: When ovaries are removed surgically, estrogen levels fall and symptoms of menopause are seen.
• Radiation or chemotherapy for cancer can harm any cell of any organ in the body, including the ovaries, thereby reducing estrogen secretion.
• Anti-estrogen medicines: A group of drugs called anti-estrogens reduce the production and effects of estrogen in the body. Chronic intake of anti-estrogen drugs for treatment of other conditions reduces estrogen activity.
• Cigarette smoking: Smoking cigarettes decreases blood flow to many organs including the vagina.
• Sexual inactivity: Sexual activity promotes blood flow to vagina and other pelvic organs. Reduced frequency of sexual intercourse reduces the blood flow and predisposes to vaginal atrophy.

Symptoms of vaginal atrophy

VAGINAL SYMPTOMS

• Vaginal dryness: This is the main symptom of vaginal atrophy. Vagina becomes dry, thin, inflamed and smaller, causing itching or burning sensations in vagina and making sexual intercourse uncomfortable and painful.
• Painful intercourse (dyspareunia): Intercourse becomes painful due to decreased vaginal lubrication and dryness. It leads to reduced frequency of intercourse which further promotes the symptoms of vaginal atrophy by reducing blood flow to pelvic organs. Moreover, this can reduce couple intimacy and can have far reaching consequences in their relationship.
• Bleeding after intercourse: again due to decreased lubrication and dryness

URINARY SYMPTOMS

• Frequent urination (polyuria)
• Painful urination (dysuria)
• Burning sensation while passing urine
• Frequent urinary tract infections (UTI’S)
• Urge incontinence (you are unable to hold urine and the urine passes on its own)

How is vaginal atrophy diagnosed?

• The most important aspects of diagnosis are your history and a thorough physical examination by your gynaecologist.
• Vaginal and urinary infections are ruled out by doing a simple per speculum vaginal examination and urine complete examination.
• Since vaginal bleeding after intercourse can also occur in malignancies like cervical cancer, so tests like PAP smear, Liquid based cytology (LBC) or a biopsy may need to be done.
• An ultrasound is a routine investigation done, to rule out any other pelvic pathology.

What will happen if I have vaginal atrophy?

Vaginal atrophy is not a disease; it is a normal physiological change that can happen in your body when estrogen leveIs fall after menopause. Not all women have symptoms of vaginal atrophy.

However, if you have any symptoms, there is nothing to worry. These symptoms can be easily taken care of with treatment (see treatment below). However, you should consult your gynaec to make sure that there is no other pathological cause of these symptoms and also to seek proper treatment.

Treatment of vaginal atrophy

There is no specific treatment for vaginal atrophy. Treatment is aimed at relief of symptoms and avoidance of causative conditions:

• As mentioned earlier, a proper history and physical examination by your gynaecologist is very important to confirm the diagnosis of vaginal atrophy and to rule out presence of vaginal or urinary infections. If any infection is detected, it needs to be treated first.
• Lifestyle modifications: Avoidance of smoking and increased sexual activity greatly reduce symptoms. Women should also avoid douches, soaps, creams or perfumed products that act as as local irritants and further increase symptoms of vaginal irritation. In addition regular Kegel’s exercises help to strengthen pelvic floor and reduce urinary incontinence symptoms.
• Vaginal moisturizing lotions can be applied regularly to reduce symptoms of vaginal dryness.
• Lubricants are available which can be used to reduce dryness during sexual activity.
• Hormonal Replacement Therapy (HRT): Since estrogen deficiency is the root cause of all symptoms of vaginal atrophy, hormone replacement therapy with estrogen is the mainstay of treatment and different preparations in forms of creams, gels or tablets can be given. Estrogen is usually administered either as local application in the form of vaginal creams, ointments, rings or tablets. Oral estrogens or estrogen patches are now available and are prescribed in patients with severe or resistant symptoms. Generally, local applications are preferred as they don’t affect the entire body.

Carry home message

Vaginal atrophy or Atrophic vaginitis is a very common condition in perimenopausal women. The symptoms are distressing and many women keep tolerating them due to either lack of knowledge of the condition or feeling embarrassed to talk about it. Simple and effective treatments are available for relief of symptoms and improving the quality of life. You should consult your gynaecologist for proper evaluation of your symptoms and a proper treatment plan for their alleviation. In addition, you should strongly consider imbibing the life style modifications like staying well hydrated, avoiding smoking, avoiding local irritants, doing regular Kegel’s exercises and NOT avoiding frequent sexual relationship. Stay healthy !

For more such interesting information on women's health, kindly visit our website Expert Gynae Care and our YouTube channel @drnidhigarg

To consult Dr. Nidhi Garg, please visit us at Kamal Hospital, Doaba Chowk, Jalandhar-144004 or Visit our website kamal Hospital jalandhar or Expert Gynae Care