All about Vaginal Atrophy

Vaginal atrophy or Atrophic vaginitis is an uncomfortable condition that can affect girls and women of all ages. In this condition the lining of the vagina becomes inflamed due to drying and thinning of tissues as well as lack of the reproductive hormone oestrogen in the body. This occurs most commonly after a woman has reached menopause. Low oestrogen levels may lead to many changes in your body, but it doesn’t mean that it is not curable.

Many women with vaginal atrophy not only suffer from painful urinary symptoms, but also from severe pains during intercourse. Since the urinary and vaginal symptoms of vaginal atrophy are interlinked in nature, experts agree that “Genitourinary syndrome of menopause (GSM) “is a more appropriate term for Atrophic vaginitis.

There are many simple and effective treatments available to cure GSM, so you won’t have to live with this distressing condition.

Symptoms

There are following moderate to severe symptoms of the genitourinary syndrome of menopause (GSM) that you may experience-

• Vaginal Irritation;
• A Vaginal Discharge;
• Vaginal Dryness (reduced vaginal moisture);
• Itching in the genital region;
• Bleeding after intercourse;
• Lack of vaginal lubrication during sexual activity;
• Pain or discomfort during intercourse;
• Shortening/tightening of the vaginal canal;
• Painful urination;
• Urinary Incontinence or involuntary leakage;
• Urgent or frequent urination;
• Other urinary tract infections;

Causes

GSM symptoms are very unpleasant and may not cause any severe problem until several years after the menopause or it may start to worry you during the initial years of menopause.

Genitourinary syndrome of menopause (GSM) commonly occurs due to declining production of oestrogen in the body. This makes vaginal walls thinner, less flexible, more delicate and drier. Reduced oestrogen levels may occur during the following stages–

• During premenopausal years;
• After menopause;
• After chemotherapy treatment for cancer;
• As side effects of chemotherapy for breast cancer;
• After surgical menopause;
• As side effects of radiotherapy treatment of cancer in pelvic region;

When to see a doctor for Vaginal Atrophy?

Researchers have observed that nearly half of the women suffer GSM after menopause, and only a few of them seek treatment. Most of them feel embarrassed and hesitate to discuss their GSM problem with their doctors.

If you experience discomfort during intercourse you may make use of a vaginal moisturizer such as Vagisil Feminine moisturizer, Replens etc., or water-based lubricants like K-Y, Intrigue, glycerine free versions of Astroglide and others. However, if the problem does not resolve even with the use of vaginal moisturizers. Or you have vaginal problems like discharge, irritation, itching or unusual bleeding, then you must consult your doctor.

What are the risk factors for Vaginal Atrophy?

There are certain factors that may increase the risk of Genitourinary Syndrome of Menopause (GSM) including-

• Lack of sexual activity – For women, sexual activity with or without partner, increases the vaginal lubrication, blood flow and elasticity in their vaginal tissues.
• No caesarean birth – According to experts, women who deliver their babies vaginally are less prone to Atrophic vaginitis than those who have never given birth vaginally.
• Cigarette smoking – Women who smoke often are more likely to suffer from GSM. Because smoking affects blood circulation and lowers the oxygen level in the vagina and other tissues. Additionally, women who smoke frequently experience an earlier menopause as smoking affects the natural oestrogen levels in their body.

Complications that arise during GSM–

• Vaginitis or Vaginal infections – This is an uncomfortable condition that occurs due to the change in the chemical balance in the vagina.
• Urinary infections – Some women suffering from vaginal atrophy experience burning during urination, frequent urination, involuntary leakage or other urinary tract infections.

Diagnosis

• Urine test – This involves collecting a urine sample and analysing it for symptoms of Atrophic Vaginitis.
• Vaginal pH test – In this vaginal fluid sample is taken and analyzed or a paper indicator strip is placed in the vagina to test its acidic or alkaline level.
• Pelvic or vaginal examination – A doctor will physically examine the pelvic organs and visually examine the external genital regions like the vulva, internal and external labia. The doctor will also look for symptoms of pelvic organ prolapse such as bulges in vaginal linings or pelvic organs like rectum, uterus, bladder or small bowel.

Treatment

To cure genitourinary syndrome of menopause (GSM), doctors may recommend you to use vaginal moisturizers or water-based lubricants in order to treat vaginal dryness. 

• Vaginal Moisturizer – Vaginal dryness is a common but of course curable problem that both girls and women of all ages experience in their lives. You may use vaginal moisturizers like Replens, Hyalo Gyn, Vagisil Feminine Moisturizer to prevent your vaginal dryness. Apply the moisturizer every 2-3 days and the effect of the moisturizer will help you to restore the moisture in your vaginal region.
• Water-based lubricants – To reduce the distressing experience during sexual activity. You may use water-based lubricants like glycerine free versions of Astroglide, K-Y Touch, etc. Doctors always recommend that women who are sensitive to this product, should not use lubricants that are glycerine-free as it may cause a burning sensation.

If the symptoms are quite severe and not treatable by using over-the-counter moisturizers, then your doctor may recommend topical oestrogen or oral oestrogen therapy.

Vaginal or Topical oestrogen

Topical oestrogen is very effective. It has only a minimal effect on the overall oestrogen levels in a woman’s body. In fact, it provides more relief than using oral oestrogen as it is locally directed. Topical oestrogen therapy comes in several different forms such as:

• Vaginal oestrogen tablet – You can insert a vaginal oestrogen tablet with the help of a disposable applicator into the vagina according to your doctor recommendations.
• Vaginal oestrogen cream – Use this cream in your vagina, usually at bedtime, with the help of an applicator. Generally, you may use it 2-3 times in a week. However, seek advice from your doctor on how to use it and in how much quantity.
• Vaginal oestrogen ring – This is a soft and elastic ring that can be inserted into the upper portion of the vagina with the help of a doctor. It helps in releasing a fixed amount of oestrogen and needs to be changed after every three months.

Systemic oestrogen therapy

When vaginal dryness is interconnected with other symptoms of menopause like normal or painful flashes. Doctors often suggest using gel or higher quantity of oestrogen pills.

If you have not undergone uterus removal therapy (hysterectomy), then your doctor will suggest you to use progestin(progesterone). Additionally, you should also ask your doctor whether hormone treatment will be a good option for you. You can also use oestrogen and progestin combined patches. If you are suffering from a hormonally sensitive breast cancer. Then systemic oestrogen therapy will not be a good option for you. 

In this situation, you can discuss it with your doctor and choose nonhormonal treatments like using moisturizers or lubricants.

If nonhormonal treatments don’t provide any relief. Then your doctor may prescribe you a low dose vaginal oestrogen after consulting with your cancer specialist. But if you have hormonally sensitive breast cancer, then using vaginal oestrogen may increase the risk of your cancer.

In this situation the MonaLisa Touch NZ will be ideal.

The MonaLisa Touch  is a non hormonal, Carbon di oxide fractional laser treatment for symptoms of Vaginal atrophy, including Vaginal dryness, pain with intercourse, early prolapse, and vaginal laxity. Patients who have had breast cancer and irradiation with lack of vaginal lubrication also respond really well to this treatment.

Lichen Sclerosis a condition associated with aging where the external genitalia (including vulva and labia) become whitened with significant irritation and itching has been successfully treated using the MonaLisa Touch.

For more information ring 078383400 or 0800 6962496 or email reception@obgyn.co.nz or check out our website www.monalisatouch.co.nz.

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