Atrophic Vaginitis

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Introduction

What is atrophic vaginitis?

Atrophic vaginitis is the thinning and inflammation of vaginal tissues due to a drop in estrogen levels. This is accompanied by a decrease in lubrication. Symptoms of atrophic vaginitis include itching, burning and discomfort; sometimes a bad-smelling, yellowish discharge may be present. Sexual intercourse may be painful and may be followed by light bleeding.

Estrogen is a female hormone that plays many roles, including keeping the vaginal tissue healthy and lubricated. Estrogen levels naturally drop during menopause; therefore, atrophic vaginitis mostly affects postmenopausal women. It is estimated that 10% to 40% of all postmenopausal women have symptoms related to atrophic vaginitis (Source: AAFP).

Estrogen levels can also be decreased by medications, excessive exercising, anorexia, stress, or depression. Estrogen-reducing medications include hormones used to treat endometriosis, infertility, fibroids, and breast cancer and also some chemotherapy agents. In addition, treatment of cancer with pelvic radiation can reduce estrogen levels, as does surgical removal of the ovaries. Estrogen levels also drop right after a baby is born and while breastfeeding.

Symptoms of vaginal atrophy typically resolve with treatment, which may include prescription estrogen or over-the-counter moisturizing creams or lubricants. Estrogen can be given in a pill to be swallowed or in a variety of forms, such as creams, gels, suppositories or tablets, to be placed in the vagina.

Infections, irritants, allergic reactions, cancer, and other conditions can cause symptoms similar to those of atrophic vaginitis. Seek prompt medical care if you have symptoms of atrophic vaginitis or if you are being treated for it but symptoms recur or are persistent.

Symptoms

What are the symptoms of atrophic vaginitis?

Symptoms of atrophic vaginitis include pain, itching, or burning of the vagina, as well as discharge. The tissues tend to be thin and dry, so vaginal intercourse may be painful and may be followed by bleeding. Vaginal tissues may also be easily aggravated by irritants, such as powders, perfumes, pads and panty liners, soap, spermicides, and tight-fitting clothes.

Common symptoms of atrophic vaginitis

Symptoms of atrophic vaginitis can range from mild discomfort to severe irritation. Common symptoms of atrophic vaginitis include:

  • Bleeding after intercourse
  • Difficult or painful urination or burning with urination (dysuria)
  • Increased sensitivity to irritants
  • Increased susceptibility to vaginal infections
  • Increased urinary tract infections
  • Pain during sexual intercourse
  • Pain, itching or burning of the vagina
  • Urinary frequency
  • Vaginal discharge, which may be foul-smelling and yellow
  • Vaginal dryness
  • Vaginal redness

    Symptoms that might indicate a serious condition

    In some cases, atrophic vaginitis may occur with other symptoms that might indicate a serious condition. Seek prompt medical care if you, or someone you are with, have atrophic vaginitis along with any symptoms such as:

    • Difficult or painful urination
    • Hematuria (blood in the urine)
    • Red or white patches of the vagina or vulva
    • Thickened area of the vaginal tissue
    • Vaginal bleeding
    • Vaginal discharge, which may be foul-smelling and yellow
    • Vaginal dryness
    • Vaginal pain, itching or burning
    • Vaginal sore

    Causes

    What causes atrophic vaginitis?

    Atrophic vaginitis is caused by a decrease in estrogen level. Estrogen levels naturally drop immediately following delivery, while breastfeeding, and during menopause. They drop abruptly after surgical removal of the ovaries. Other medical interventions, such as hormone therapy, chemotherapy, and radiation therapy, can also lead to decreased estrogen levels, as can excessive exercising, anorexia, stress, and depression.

    What are the risk factors for atrophic vaginitis?

    A number of factors increase the risk of developing atrophic vaginitis. Not all people with risk factors will get atrophic vaginitis. Risk factors for atrophic vaginitis include:

    • Anorexia
    • Breastfeeding
    • Childbirth
    • Depression
    • Excessive exercising
    • Hormonal therapy for such conditions as endometriosis, infertility, fibroids, and breast cancer
    • Menopause
    • Pelvic radiation therapy
    • Some chemotherapy agents
    • Stress
    • Surgical removal of the ovaries

    Treatments

    How is atrophic vaginitis treated?

    Treatment of atrophic vaginitis is directed at relief of symptoms related to vaginal dryness and discomfort. Estrogen replacement is one of the main treatments for atrophic vaginitis. It may be replaced locally, so that very little of the estrogen reaches the rest of the body, or systemically, so that it is distributed throughout the body. 

    Any use of estrogen therapy is controversial in women who have been diagnosed with breast cancer, so be sure to thoroughly discuss this option with your health care provider if you have had breast cancer. Over-the-counter moisturizers may also help alleviate some of the symptoms, as can the use of water-soluble lubricants during intercourse.

    Medications for the treatment of atrophic vaginitis

    Medications used to treat atrophic vaginitis include:

    • Local estrogen therapies (for example, Estrace cream, Estrogel, Vagifem)
    • Systemic estrogen therapies (for example, Enjuvia, Estraderm, Estratab)

    What you can do to improve your atrophic vaginitis

    You can help improve the symptoms of atrophic vaginitis by:

    • Engage in routine sexual activity (partnered or masturbation). It is always important to use safe sex practices.

    • Maintaining a healthy weight

    • Reducing your stress level

    • Using a vaginal moisturizer

    • Using a water-soluble lubricant during intercourse

    What are the potential complications of atrophic vaginitis?

    Complications of untreated atrophic vaginitis can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of atrophic vaginitis include:

    • Decrease in the depth of the vagina
    • Frequent vaginal yeast or bacterial infections
    • Labial fusion (melding together of the “lips” of the vagina)
    • Stenosis (narrowing) of the introitus (the vaginal opening)
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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2019 Jan 4
    1. Vaginal dryness. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000892.htm.
    2. Diagnosis and treatment of atrophic vaginitis. American Family Physician. http://www.aafp.org/afp/20000515/3090.html.
    3. Winneker RC, Harris HA. Progress and prospects in treating postmenopausal vaginal atrophy. Clin Pharmacol Ther 2011; 89:129.
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