Vulvovaginal atrophy

What is vulvovaginal atrophy?

Vulvovaginal atrophy is the thinning of your vaginal lining and vulval skin, caused by a drop in oestrogen levels around the time of menopause. Vaginal atrophy affects about 40% of postmenopausal women – and the risk increases with age.

This condition is also known as ‘genitourinary syndrome of menopause’ (GSM), which includes vulvovaginal and urinary symptoms.

Symptoms of vulvovaginal atrophy

Symptoms of vulvovaginal atrophy include:

• dry vagina
• painful sex (dyspareunia)
• reduced vaginal lubrication during sex
• burning and itching in the vagina
• vulval irritation, especially when wearing tight pants or Lycra
• smelly vaginal discharge (sometimes mistaken for thrush)
• shortening and tightening of the vagina
• pale and thin labia (lips) and vagina
• reduced pubic hair
• spotting or light bleeding, including after sex – if this happens, see your doctor straight away.

Urinary symptoms include:

• frequent or urgent need to wee
• pain or burning sensation when weeing
• weeing more often than usual, including at night
• blood in your wee
• wee leakage (urinary incontinence)
• recurrent urinary tract infections (UTIs).

What causes vulvovaginal atrophy?

The vagina, and other tissues in the pelvis, need oestrogen to stay healthy. When oestrogen levels drop around the time of menopause, the tissues become drier, thinner and more fragile. This can increase the risk of irritation and UTIs.

Oestrogen levels may also decrease due to:

• breastfeeding
• medicine that reduces oestrogen levels, for example, oral contraceptives
• medicine or surgery that causes medically induced menopause, for example, some cancer treatments, surgical removal of both ovaries and some hormone medicines.

How is vulvovaginal atrophy diagnosed?

Your doctor will ask about your symptoms and medical history. They will also ask to examine your vulva and vagina for signs of atrophy. If you have discharge, your doctor may take a vaginal swab to check for infection. If you have urinary symptoms, they may also order a urine (wee) test to check for a UTI.

Risks of vulvovaginal atrophy

Vulvovaginal atrophy is more likely to affect women over 50 or women who have gone through menopause. But other factors can increase your risk. For example, if you:

• have had your ovaries removed
• have had chemotherapy or radiation treatment
• are not sexually active – sex increases blood flow to the area and makes vaginal tissues more elastic
• have an immune disorder
• take medicines that affect oestrogen levels
• haven’t given birth vaginally
• smoke.

Treatments for vulvovaginal atrophy

Depending on your situation, you may want to try hormonal treatments.

Vaginal oestrogens

Vaginal oestrogens are available as creams, tablets and pessaries that you insert into the vagina. They are an effective treatment for vulvovaginal atrophy. They deliver oestrogen directly to the vagina without raising oestrogen levels in the rest of the body. Vaginal oestrogen treatment improves blood flow in the pelvis and increases vaginal secretions.

Oestrogen tablets and creams come with an applicator, but you may find it easier to use your finger to insert the tablet or cream it into your vagina. Any excess can be wiped onto the skin of your vulva. You should only insert the oestrogen about 2 to 3 centimetres into your vagina. This will improve the health of your pelvic tissues, including your vulva, vagina, bladder, urethra and pelvic floor muscles.

Menopausal hormone therapy (MHT)

MHT may improve vaginal symptoms and other menopausal symptoms, such as hot flushes and night sweats.

Hormonal treatment may not be suitable if you have a history of cancer with receptors that use oestrogen to grow (oestrogen-receptor-positive cancer). Discuss the risk factors with your doctor.

Can vaginal atrophy be reversed?

You can’t reverse vulvovaginal atrophy, but you can stop it from getting worse by seeking a diagnosis and starting treatment early. Research suggests that MHT eliminates vulvovaginal atrophy symptoms in 75% of cases, while vaginal oestrogen therapy is effective in 80% to 90% of cases. Without treatment, vulvovaginal atrophy may get worse over time.

What you can do about vulvovaginal atrophy

It’s important to take extra care of your vulva and vagina when managing this condition. For example, use a soap-free wash, avoid tight-fitting clothes and try not to rub or scratch affected areas. Learn more about vulval care.

Other self-care treatments are listed below.

Cold compresses

These can help with itching and mild discomfort. Dilute half a teaspoon of bicarb soda in one litre of water, soak a washcloth in the solution and apply it gently to your vulva a few times a day, taking care to pat the area dry (instead of rubbing) afterwards.

Vaginal lubricants

Water or silicone-based vaginal lubricants can make it more comfortable to have sex. Don’t use oil-based lubricants with latex condoms as they can weaken condoms.

Non-hormonal moisturisers

You can buy non-hormonal moisturisers from a pharmacy. These can help to ‘plump up’ and add moisture to cells in your vagina. Look for products that are fragrance-free to avoid irritation.

Flaxseed

Some research suggests flaxseed may help with vaginal dryness. Grind the flaxseed and add 2 tablespoons to your cereal, salad or smoothies each day.

You might also like to try our linseed, banana and date muffins recipe.

Regular sexual activity including masturbation

Regular sexual activity improves blood flow to your vagina, which can keep vaginal tissues elastic and flexible. Sexually active women report fewer symptoms of vulvovaginal atrophy compared to women who don’t have regular sex.

When to see your doctor

Many women have symptoms of vulvovaginal atrophy, such as painful sex, but they don’t seek treatment because they feel embarrassed or think nothing can be done. It’s important to get the right diagnosis and treatment, so see your doctor if you have any symptoms.

Related resources

Download our vulval health fact sheets in English and other languages.