Atrophic Vaginitis (Vaginal Dryness)

The vagina is kept supple and moist by fluids and mucus which are made by glands at the neck of the womb. Oestrogen (the female hormone) affects these glands and the tissues in and around the vagina.

After the menopause (the 'change') the ovaries make less oestrogen. The lack of oestrogen leads to a thinning of the tissues around the vaginal area, and number of the small glands that make mucus reduces. You also lose some fat tissue from around the genital area. This causes the vulva and vagina to look slightly different than before the menopause.

As a result the vagina can become shorter, less elastic, dryer with less lubricating mucus. The genital skin looks paler. These changes usually take months or years to develop, and vary between women. Atrophic vaginitis is the medical term for this condition.

After the menopause about 1 in 2 women have some symptoms related to atrophic vaginitis. About 7 in 10 women in their seventies have some symptoms.

The changes described above may occur, but without causing any symptoms or discomfort. However, some of the following symptoms may develop in some women. All of the following symptoms can be caused by other medical conditions, but atrophic vaginitis is a common (and usually treatable) cause of these symptoms.

• Pain when you have sex. This may occur because the vagina is smaller, drier, and less likely to become lubricated during sex than before the menopause. Also, the skin around the vagina is more easily made sore, and this can make the problem worse.
• Discomfort. If the vulva or vagina is sore and inflamed you may develop a persistent discomfort.
• Infection and discharge. The vagina is less resistant to infection after the menopause and sometimes becomes infected. A smelly, unpleasant vaginal discharge may indicate that you have an infection.
• Itch. The skin around the vulva is more sensitive and more likely to itch. This can make you prone to scratch, which then makes the skin more likely to itch. An itch/scratch cycle may develop which can be difficult to break, and can be quite distressing.
• Urinary problems. These may be due to thinning and weakening of the tissues around the neck of the bladder, or around the urethra (opening for urine). A prolapse (dropping down) or weakening of part of the vaginal wall may also cause urinary symptoms. The urinary symptoms that may occur include:
  • Passing water too often (frequency).
  • Not being able to hold on (urgency).
  • Pain when passing urine (dysuria).
  • Leaking urine when you cough (stress incontinence).
  • Leaking on the way to the toilet (urge incontinence).

Not all women have all of the above symptoms. Treatment may depend on which symptoms are the most troublesome. Because the problem is mainly due to a lack of oestrogen, it can be helped by replacing the oestrogen in the tissues.

Hormone Replacement Therapy (HRT)
This means taking oestrogen in the form of a tablet, gel, implant or patches. This may be the best treatment, but some women don't like the idea of taking HRT. Another leaflet discusses the menopause and HRT in more detail.

Oestrogen creams
Sometimes a cream or pessary containing oestrogen is prescribed. This restores oestrogen to the vagina and surrounding tissues without giving oestrogen to the whole body. Usually the cream or pessary is used every day for 2 weeks, and then twice a week for a further month. This treatment usually works well. The treatment can be repeated if the problem recurs. It is important to follow the instructions about the amount of cream to use. Sometimes, if you use oestrogen cream for long periods, you may also need to take a hormone called progestogen for a few days each month.

Lubricating gels
If vaginal dryness is the only problem, or hormone creams are not recommended because of other medical problems, lubricating gels like KY jelly or Senselle may help. You can buy these from the pharmacy. There are also other gels which are specifically designed to help the problem of vaginal dryness by replacing moisture (for example, Replens).

© EMIS and PIP 2004   Updated: November 2002   CHIQ Accredited