Vaginal atrophy is when the walls of your vagina get thin, dry, and inflamed. This can happen when your body makes less estrogen, such as during and after menopause.

This condition and its symptoms together are called genitourinary syndrome of menopause (GSM). You’ll notice it in both your vagina and urinary tract. You may have:

  • Vaginal dryness or burning
  • Itching in your genitals
  • Unusual vaginal discharge
  • More yeast infections
  • Burning when you pee
  • A need to pee often 
  • A hard time holding pee in (incontinence)
  • More urinary tract infections (UTIs)
  • Discomfort or bleeding during or after sex
  • Less natural lubrication when you have sex

Dryness is usually the first sign. Many people have them after menopause. But you may have them in the years before that, a time called perimenopause. GSM is common: Up to 40% of people after menopause have symptoms.

Causes of Vaginal Atrophy

The cause of vaginal atrophy is a drop in estrogen levels. At menopause, a woman’s estrogen levels can fall by about 85%.

When your body has less estrogen, your genital tissues become more fragile. Menopause is the most common reason for GSM, but estrogen levels can also go down because of:

  • Breastfeeding
  • Anti-estrogen medications
  • Some birth control pills
  • Surgery to remove both ovaries
  • Chemotherapy
  • Pelvic radiation therapy
  • Hormone treatment

Treatments

One way to ease these problems is to have sex. Those who have regular sexual activity, by themselves or with a partner, tend to have milder cases of vaginal atrophy than those who don’t. Sexual activity raises blood flow to the vagina and helps it stay elastic.

If you have GSM-related dryness and discomfort, especially when you have sex, vaginal moisturizers or water-based lubricants may help. You use them every few days and just before intercourse. If you’ve tried them and still have pain, talk to your doctor about other treatment options.

If your doctor diagnoses you with this condition, estrogen therapy may be an option. It can thicken your vaginal walls and ease many of the other symptoms of GSM, too.

Estrogen comes in different forms:

  • Creams or suppositories that you put into your vagina
  • A soft, flexible ring that your doctor inserts
  • Pills

There may be side effects, so talk with your doctor to see what’s right for you.

If you have dryness, itching, or burning, don't use perfumes, scented lotion, deodorants, or powders on your pelvic area. Use unscented soap. Don’t wear tight clothes. Panty liners and pads may add to the irritation because they contain synthetic material.

Diagnosis

Your doctor will use three methods to diagnose the condition:

  1. Urine test. Your doctor will get a urine sample for testing, especially if you have urinary issues.
  2. Pelvic exam. Your doctor will look closely at your genitals and feel inside to check your cervix.
  3. Acid balance test. For this test, your doctor may use a paper strip to check the acid balance in your vagina.

Risk Factors

There are two main things that can raise your chances of vaginal atrophy and GSM.

  1. Smoking. Smoking restricts blood flow, including to your vaginal area. It also lowers the natural amount of estrogen in your body.
  2. Not having vaginal births. Those who haven’t had a vaginal birth are more likely to have GSM-related issues than those who have.

WebMD Medical Reference

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