Vaginal atrophy

What is vaginal atrophy?

Vaginal atrophy is the thinning, drying, and increasing sensitivity of the vaginal wall from a lack of estrogen, usually around and after menopause. These days it falls under the broader term genitourinary syndrome of menopause (GSM), which also takes in symptoms of the vulva and the urinary tract. Well-known symptoms are dryness, itching, and pain during sex, that is, dyspareunia. Important to know: it is very treatable.

Where it comes from

The engine is estrogen. According to the Dutch-language encyclopedia, atrophic vaginitis, also called vaginal atrophy or the urogenital syndrome of menopause, arises from the shrinking and thinning of the vaginal wall and the drying of the vagina, caused by the absence of estrogen. It often starts in the period before menopause and grows more severe afterward. The Cleveland Clinic describes that without estrogen the lining of the vagina becomes thinner and less stretchable.

How common it is

It is very common, and that is exactly what too few women hear. The Cleveland Clinic writes that at least half of women who reach menopause develop signs of GSM, and that one in four say vaginal atrophy also has a negative influence on other areas of their life. You are far from alone in it, then, even though it is rarely talked about out loud. Many women wait years before raising it with their doctor, partly out of shame, partly because they don’t know anything can be done about it. That waiting is a pity, because the symptoms respond well to treatment.

More than a menopause thing

Menopause is the best-known cause, but not the only one. The Dutch-language encyclopedia also names chemotherapy, radiation, removal of the ovaries, and certain medicines as causes of an estrogen shortage. Around childbirth and during breastfeeding the estrogen level can be temporarily low too, with similar symptoms. In other words: vaginal atrophy is not tied to an age. Younger women who develop it often think it must be something else, precisely because they link the word to menopause. That can make it harder to recognize, while the approach is essentially the same.

What symptoms it gives

The symptoms run wider than the vagina alone. The guideline of the Dutch Society for Obstetrics and Gynecology names vaginal dryness, soreness, irritation, and dyspareunia, plus urinary complaints like needing to go more often and urgency. Because of the thinner wall, small injuries also happen more easily. That makes sex painful, and that pain can in turn get in the way of desire and relaxation, which turns it into an unpleasant vicious circle.

What can be done about it

This is the hopeful part. The NVOG guideline advises, with two or more symptoms of urogenital atrophy, a treatment with vaginal estrogens, and with a single symptom or as a supplement, non-hormonal lubricants and vaginal moisturizers. The symptoms do often come back if you stop the treatment, so it’s more a matter of maintaining than of a one-time cure. What suits you, you decide together with your GP or gynecologist; this is not a self-help story.

What vaginal atrophy is not

“So sex is off the table for me now.” That is exactly the misunderstanding that causes so much suffering. Vaginal atrophy is treatable, and with the right care, calm, and enough lubricant, pleasant, pain-free sex is often simply possible again.

“It just comes with the territory now, so I have to sit it out.” No. Symptoms that touch your life deserve treatment, and it exists. Quietly enduring is not necessary.

What I make of it

I’m not a doctor, and your GP or gynecologist handles the treatment, not me. What I do see as a gigolo is how much shame and quiet grief surround this subject. Women who have come to expect pain tense up on their own, and then it does hurt more. What helps is time, safety, and no hurry at all: taking plenty of time, lots of lubricant, and stopping the moment something doesn’t feel right. For anyone who is under treatment and just wants to rediscover that touch can feel good, a calm, patient meeting can be a gentle way to find that trust again. I don’t solve the medical side, but taking the pressure off, that I do.

Further reading

• Menopause describes the broader hormonal change this comes out of.
• Dyspareunia goes deeper into pain during sex.
• Vaginal atrophy from the Cleveland Clinic gives a clear medical introduction.

Sources

• Behandeling urogenitale atrofie. Dutch Society for Obstetrics and Gynecology. Provides that vaginal atrophy (dryness, soreness, irritation, dyspareunia, and urinary complaints) comes from an estrogen shortage in the tissue of the vulva and vagina, and that with two or more symptoms vaginal estrogens are offered, with lubricants and moisturizers as the non-hormonal option.
• Vaginal atrophy. Cleveland Clinic. Provides that the vaginal wall becomes drier and thinner from less estrogen, that it is now called genitourinary syndrome of menopause, that at least half of women in menopause develop signs of it, and that one in four are bothered by it.
• Atrofische vaginitis. Wikipedia. Provides the definition of the shrinking and drying of the vaginal wall through the absence of estrogen, and that the symptoms often begin before menopause and grow more severe afterward.

Related terms

• Menopause. The hormonal change that usually causes vaginal atrophy.
• Dyspareunia. The pain during sex that is an important consequence of it.
• Lubricant. One of the non-hormonal aids that ease the symptoms.