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Vaginal Health

Updated 27 February 2019

Atrophic vaginitis

A vaginal condition caused by oestrogen deficiency.

Vaginal atrophy, also known as atrophic vaginitis is a condition where a woman’s vaginal walls thin, dry out and becomes inflamed. This is mainly due to your body producing less oestrogen, which leads to less lubrication in the vagina. Vaginal atrophy usually affects women who’ve been through menopause. 

This condition makes sexual intercourse difficult and may also lead to urinary problems. Other causes include:

  • Chemotherapy for other conditions.
  • Radiotherapy to the pelvis.
  • Anti-oestrogen medication such as Tamoxifen.
  • Normal decreased oestrogen production after giving birth, and especially during breastfeeding.
  • Raised prolactin levels due to pituitary problems.

Symptoms

In most people, vaginal atrophy is mild, and causes no symptoms, or causes only mild symptoms which cause no problems. However, as the vaginal walls become thinner, less elastic and drier, a number of symptoms are possible, and become worse with time if untreated:

  • Dryness.
  • Burning sensation of the vagina.
  • Painful intercourse.
  • Vaginal bleeding or spotting.
  • Itchiness.
  • Unpleasant yellowish vaginal discharge.
  • Painful urination.

Diagnosis

No special tests are needed for the diagnosis, which is purely clinical. However, four tests may be used to assess the severity of the condition if necessary:

1. Vaginal pH - measures the acidity of the vagina. This should be acidic (3.5 - 5.0) but pH values of 6 or more are often found in atrophic vaginitis.

2. Cytology - looking at the cells from a smear of the vagina can detect signs of oestrogen deficiency.

3. Blood hormone levels - these are not very reliable in post-menopausal women, and results may vary widely with different laboratories.

Treatment

Treatment aims to relieve symptoms, and can be continued for as long as you experience symptoms. The most effective treatment for vaginal atrophy is oestrogen therapy. This treatment may be done orally, transdermally (skin patches) or vaginally (creams and pessaries). Water-based gel lubricants are helpful, and sexual activity is encouraged to retain suppleness of vaginal tissues.

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