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Atrophic Vaginitis

Last updated May 2, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Atrophic Vaginitis or Vaginal Atrophy is a disorder that occurs as a result of reduced estrogen production within a woman’s body, particularly in those women, who have attained menopause.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Atrophic Vulvovaginitis
  • Postmenopausal Atrophic Vaginitis
  • Senile Atrophic Vaginitis

What is Atrophic Vaginitis? (Definition/Background Information)

  • Atrophic Vaginitis or Vaginal Atrophy is a disorder that occurs as a result of reduced estrogen production within a woman’s body, particularly in those women, who have attained menopause
  • This leads to inflammation and thinning of vaginal walls, vaginal dryness, burning sensation of the vaginal tract, intense pain during sexual intercourse, among other problems. It can be a nagging psychological stress factor in women with the condition
  • Low hormonal levels of estrogen, increases the susceptibility of urogenital and vaginal area to many secondary infections, and brings about a loss of vitality and mechanical strength of the vaginal walls (hence the term atrophy)
  • The treatment measures include both passive and active measures; some of which include the use of lubricants, and taking prescription estrogen drugs to relieve the symptoms

Who gets Atrophic Vaginitis? (Age and Sex Distribution)

  • Up to 75% of the cases of Atrophic Vaginitis involve postmenopausal women, due to reduced estrogen production
  • Women in whom there is a drop in production of the estrogen hormone, such as lactating mothers, oophorectomy patients (in whom the ovaries have been removed), those on chemotherapy, etc., are prone to Vaginal Atrophy/Dryness

What are the Risk Factors for Atrophic Vaginitis? (Predisposing Factors)

All factors that could lead to a decreased estrogen production level in women are potential risk factors for Atrophic Vaginitis. The risk factors may include:

  • An estimated 40% of woman post-menopause (or even before menopause) face this problem. Hence, the condition is also known by the term Postmenopausal Atrophic Vaginitis
  • Treatment for cancer - both chemotherapy and radiotherapy
  • Prescription drugs and medicines that have anti-estrogen effects
  • Disorders/conditions affecting the function of ovaries, surgical removal of ovarian cysts
  • Any disease or disorder affecting the immune system
  • The period after childbirth; mothers who are lactating
  • Reduced incidence of sexual activity (intercourse) in adult women
  • Deficient production of the hormone estrogen due to cigarette smoking, physiological factors, vaginal changes, depression or intensive stress

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Atrophic Vaginitis? (Etiology)

The primary causative factor for Atrophic Vaginitis is lower levels of estrogen production. Estrogen is an important hormone that keeps the urogenital/vaginal region acidic (lower pH value) and preserves the physical vitality of the urinary (epithelial) and vaginal walls. A lack of estrogen increases the pH value, rendering the body susceptible to vaginal/urinary infections. It also thins the vaginal walls, making it inelastic and dry.

Some of the reasons, why there is a decreased estrogen quantity include:

  • Peri-menopausal period - the period immediately before and after menopause
  • Breastfeeding period (observed in lactating mothers)
  • Due to surgical removal of the ovaries
  • Cancer treatment, such as radiotherapy and chemotherapy
  • Side effects of certain medications that are meant to decrease hormonal levels in the body, as part of treating another condition or disorder (such as infertility, breast cancer, fibroids)
  • Extreme stress and depression

What are the Signs and Symptoms of Atrophic Vaginitis?

Many of the signs and symptoms observed resemble vaginal infections caused due to other reasons. Those pertaining to Atrophic Vaginitis are observed around the vagina and other urogenital parts, and their onset usually takes place after a prolonged period of fluctuating (and reduced) estrogen levels.

The signs and symptoms include:

  • Dryness of the vagina causing itching, soreness, smelly yellow discharge, sensation of lower abdominal pressure
  • Difficulty while having an intercourse - pain and irritation/discomfort, slight bleeding from the vagina, observed due to lack of natural lubrication
  • Secondary infections, such as urinary tract infection, stress incontinence
  • Burning sensation on urination

It has been observed that some of the presentations of Vaginal Atrophy are aggravated by chemical irritants that are contained in certain cosmetics (spray perfumes, deodorants, and soaps), tight-fitting clothes, synthetic wear, pads (worn for longer periods), artificial lubricants, etc.

How is Atrophic Vaginitis Diagnosed?

Given the fact that many of the clinical indications of Atrophic Vaginitis are characteristics of other infections or medical conditions, the patient medical history is considered with a differential diagnosis to eliminate other factors.

Diagnostic tests that are performed include:

  • A physical examination of the pelvic region by the physician may reveal pale, shiny, red walls of the vagina (vaginal epithelium) with inflammation and tenderness. Dryness of the region with decreased vitality may also be observed
  • Pap smear tests
  • Testing for serum hormonal (estrogen) levels
  • Examination of vaginal discharge (wet prep test)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Atrophic Vaginitis?

Complications due to Atrophic Vaginitis include:

  • Mental stress, sexual lethargy/avoidance leading to problems with one’s spouse/partner
  • Increased susceptibility to other infections (yeast and bacteria) in the vagina, or in other adjoining organs, due to reduced pH levels
  • The vaginal walls may crack; the sores may become serious and painful
  • There are certain risks and side effects associated with estrogen therapy. Hence, this mode of treatment requires to be closely monitored

How is Atrophic Vaginitis Treated?

There are many causal factors for Atrophic Vaginitis. Thus, it is advisable to consult the physician and get an evaluation of the presenting symptoms, before attempting any treatment methods (including self-care measures).

Since, the vaginal condition is mainly caused due to deficient levels of the estrogen hormone, an active treatment relates to supplementing the body with this hormone. Passive measures (medicinal applications, alternative treatment, etc.) are meant to keep the vagina well-lubricated and restore its condition. The treatments include:

  • Estrogen replacement therapy, to revitalize the vaginal walls and restore altered pH levels. These medications are administered either orally or through injections, or even intra-vaginally (available in the form of rings and tablets)
  • Creams, lubricants, and vaginal moisturizers, to bring relief from the symptoms and comfort the body (also during sexual intercourse)
  • A healthy sexually-active life with your spouse/partner is recommended for postmenopausal women, in order to encourage natural lubrication and provide vaginal elasticity
  • There are many home remedies and alternative medicines available for vaginal problems associated with menopause. However, it is advisable to consult your physician if you plan on employing these measures

How can Atrophic Vaginitis be Prevented?

  • Atrophic Vaginitis occurs mainly due to a progressive reduction of the estrogen hormone, caused due to various medical factors and conditions. It cannot be prevented
  • There are factors that aggravate its state/condition. Some factors can be controlled through timely recognition and some factors that aggravate the condition, should be avoided
  • Recognizing the health issue and getting it correctly diagnosed, following the treatment methods, and maintaining proper self-care, are beneficial to early recovery

What is the Prognosis of Atrophic Vaginitis? (Outcomes/Resolutions)

  • Atrophic Vaginitis can be treated completely. A proper management of the condition leads to full recovery from the symptoms, bringing relief
  • However, if there are other risk factors involved, or opportunistic infections that develop, then the treatment may be prolonged and intense. The treatment should also include the underlying factors that resulted in the development of Atrophic Vaginitis

Additional and Relevant Useful Information for Atrophic Vaginitis:

  • Atrophic Vaginitis is a common problem, but makes for a very sensitive and emotionally personal issue for women
  • Women are hence encouraged to seek suitable treatment methods. Such treatment modalities should be compatible with their lifestyle and social/religious background, and make them feel comfortable and at ease

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Dec. 16, 2013
Last updated: May 2, 2018