Vulvovaginal Atrophy: Causes, Symptoms, Treatment, and Prevention

Vulvovaginal atrophy (VVA), which is also known as genitourinary syndrome of menopause (GSM), is a common condition that affects many postmenopausal women. VVA is a result of the decrease in estrogen levels, which causes thinning, drying, and inflammation of the vaginal walls and vulva.

How it looks like?

Symptoms of VVA include vaginal dryness, itching, burning, and pain during sexual intercourse or vaginal exams. Some women may also experience urinary symptoms such as urgency, frequency, and recurrent urinary tract infections.

Who is at risk for getting Vulvovaginal Atrophy?

VVA is most commonly seen in women who have gone through menopause, but it can also occur in women who have their ovaries removed or who have received certain cancer treatments that affect estrogen levels. Women who smoke, or have never been pregnant, or have had prolonged periods of lactation are also at increased risk for developing VVA.

How common is Vulvovaginal Atrophy?

The prevalence of VVA varies depending on the population studied and the diagnostic criteria used, but it is estimated that up to 50% of postmenopausal women may experience VVA symptoms. Despite the high prevalence of VVA, it is often underdiagnosed and undertreated, leading to decreased quality of life and sexual function for many women.

Treatment options for VVA include topical estrogen therapy, non-hormonal vaginal moisturizers and lubricants, and certain lifestyle modifications such as quitting smoking and avoiding irritants.

• Vaginal dryness: This is one of the most common symptoms of VVA and can cause discomfort and pain during sexual intercourse.
• Vaginal itching or burning: The drying and vaginal thinning tissues can cause itching or burning sensations.
• Painful urination: Some women with VVA may experience pain or burning when urinating.
• Urinary urgency: The thinning of vaginal tissues can cause urinary symptoms such as frequent urination or an urgent need to urinate.
• Recurrent urinary tract infections: Women with VVA may be more prone to urinary tract infections due to changes in the vaginal flora and pH balance.
• Pain during sexual intercourse: Vaginal dryness and thinning can cause pain or discomfort during sexual intercourse, leading to decreased sexual desire or avoidance of sexual activity.
• Vaginal bleeding: Some women with VVA may experience vaginal bleeding or spotting, especially after sexual intercourse.
• Vaginal discharge: The thinning of vaginal tissues can cause changes in vaginal discharge, such as decreased amounts or more watery consistency.

• Breastfeeding: Prolonged periods of lactation can suppress estrogen levels, leading to vaginal dryness and thinning.
• Cancer treatments: Radiation therapy or chemotherapy can damage the ovaries or lower estrogen levels, leading to VVA.
• Surgical removal of ovaries: Removing the ovaries, either through surgery or due to a medical condition, can cause an abrupt decline in estrogen levels.
• Smoking: Smoking has been associated with an increased risk of VVA and other urogenital symptoms.
• Autoimmune diseases: Certain autoimmune diseases, such as Sjögren’s syndrome and lupus, can affect the vaginal and vulvar tissues, leading to VVA.
• Medications: Certain medications such as antiestrogens, aromatase inhibitors, and some antidepressants can lower estrogen levels or affect vaginal lubrication.
• Genetics: Some women may also have a genetic predisposition to VVA, leading to the earlier onset or more severe symptoms.

• Medical history review: Your healthcare provider will ask you questions about your symptoms, medical history, and any medications or treatments you are taking that may be contributing to your symptoms.
• Pelvic exam: During a pelvic exam, your healthcare provider will examine your external genitalia, vagina, and cervix for signs of thinning, dryness, or inflammation.
• Urine test: Your healthcare provider may perform a urine test to rule out any urinary tract infections or other conditions that may be contributing to your symptoms.
• pH balance test: Your healthcare provider may test the pH balance of your vaginal secretions to determine if your vagina is too alkaline, which can be a sign of VVA.
• Blood test: In some cases, a blood test may be ordered to measure your estrogen levels and rule out any underlying medical conditions.
• Biopsy: In rare cases, a biopsy may be necessary to confirm the diagnosis of VVA and rule out other conditions, such as vulvar cancer.

• Lubricants: Water-based or silicone-based lubricants can help alleviate vaginal dryness and discomfort during sexual activity.
• Topical estrogen: Estrogen cream, vaginal tablets, or rings can help restore vaginal moisture and improve vaginal elasticity. These treatments are generally safe and effective but may not be suitable for women with a history of certain cancers or blood clots.
• Medications: Ospemifene and prasterone are two medications that have been approved by the FDA for the treatment of VVA. Ospemifene is a selective estrogen receptor modulator (SERM) that can help improve vaginal dryness and painful intercourse. Prasterone is a hormone precursor that can be converted into estrogen and testosterone in the body, potentially improving vaginal lubrication and sexual function.
• Systemic estrogen therapy: Systemic estrogen therapy involves taking estrogen in the form of pills, patches, or injections. This treatment can improve VVA symptoms as well as other menopausal symptoms but may not be suitable for women with a history of certain cancers or blood clots.
• Vaginal dilators: Vaginal dilators are cylindrical devices that can be inserted into the vagina to help stretch and exercise the vaginal tissues, potentially improving vaginal elasticity and reducing discomfort during sexual activity.
• Topical lidocaine: Topical lidocaine is a numbing agent that can be applied to the vulvar area to help alleviate pain and discomfort.

How to Prevent Vaginal Atrophy?

In addition to medical treatments, there are several lifestyle and home remedies that may help alleviate symptoms of vulvovaginal atrophy (VVA). Here are some self-care tips:

• Use a vaginal moisturizer: A water-based vaginal moisturizer can help alleviate vaginal dryness and discomfort. It is important to avoid using moisturizers that contain fragrances, dyes, or other irritants.
• Avoid irritants: Avoid using scented soaps, perfumes, and other irritants in the genital area that can exacerbate symptoms of VVA.
• Wear cotton underwear: Cotton underwear is breathable and can help reduce moisture and irritation in the genital area.
• Practice safe sex: Using a water-based lubricant and practicing safe sex can help reduce discomfort and irritation during sexual activity.
• Stay hydrated: Drinking plenty of water can help improve overall vaginal and urinary health.
• Quit smoking: Smoking can contribute to vaginal dryness and other symptoms of VVA, so quitting smoking may help alleviate symptoms.
• Exercise regularly: Regular exercise can help improve overall vaginal and urinary health, as well as improve mood and overall well-being.

It is important to discuss self-care options with your healthcare provider to determine the most appropriate course of action based on your individual needs and medical history. In some cases, self-care may be sufficient for managing mild symptoms of VVA, while in other cases, medical treatment may be necessary.

• Virtual consultations: Ongo Care offers virtual consultations with healthcare providers who can diagnose and treat VVA. These consultations can be conducted from the comfort of your own home and can help you access medical care without having to physically visit a healthcare facility.
• Prescriptions: If a healthcare provider determines that medication is necessary for treating your VVA symptoms, they can prescribe medication through Ongo Care and have it delivered directly to your home.
• Self-care advice: Ongo Care healthcare providers can offer advice and recommendations for self-care practices that may help alleviate symptoms of VVA.

Frequently Asked Questions