Atrophic Vaginitis: Symptoms, Causes, Treatment & Prevention

Duly Care
Jun 20
9 min read

Atrophic vaginitis, often called vaginal atrophy, is a common yet often overlooked condition that affects many women, particularly after menopause. It occurs due to a decline in estrogen levels. While menopause is the most common cause, other factors can also contribute to this condition.

Many women hesitate to discuss these symptoms, assuming they are just a part of ageing. However, atrophic vaginitis is treatable. Understanding its symptoms, causes, and treatment options can help in managing it effectively and improving overall vaginal health.

Key Takeaways

Atrophic vaginitis is caused by a drop in estrogen levels, leading to vaginal dryness, irritation, and discomfort during sex.
Symptoms include vaginal itching, burning, discharge, and increased risk of infections.
Treatment options range from hormonal therapy to natural remedies like vaginal moisturizers and lifestyle changes.
Prevention strategies include staying sexually active, maintaining hydration, and using appropriate vaginal care products.

What Is Atrophic Vaginitis?

Atrophic vaginitis, also referred to as vaginal atrophy, is a condition in which the vaginal walls become thinner, drier, and more inflamed due to a decline in estrogen levels. This hormonal deficiency affects the vaginal tissue’s ability to maintain its natural moisture and elasticity, leading to discomfort and an increased risk of infections.

Although atrophic vaginitis is most commonly associated with menopause (end of a woman’s menstrual cycle, typically occurring between the ages of 45 and 55). It can also occur in younger women due to various hormonal changes, medical treatments, or lifestyle factors that impact estrogen production.

Atrophic Vaginitis vs. Vaginal Atrophy

The terms "atrophic vaginitis" and "vaginal atrophy" are often used interchangeably, but they have distinct meanings.

Vaginal atrophy is a broader term that encompasses all estrogen-related changes affecting the vaginal and urinary systems, including thinning of the vaginal walls, decreased lubrication, and an increased risk of urinary tract infections (UTIs).
Atrophic vaginitis, however, specifically refers to vaginal inflammation resulting from estrogen deficiency. While vaginal atrophy can exist without noticeable inflammation, atrophic vaginitis involves additional symptoms such as irritation, burning, and discomfort.

Causes of Atrophic Vaginitis

Menopause and Ageing

Menopause is the most common cause of atrophic vaginitis, as estrogen levels naturally decline, leading to vaginal dryness and loss of elasticity. Around 50% of postmenopausal women experience symptoms, though many do not seek treatment. Surgical menopause, such as ovary removal, can cause an even more sudden and severe drop in estrogen.

Breastfeeding and Postpartum Hormonal Changes

Estrogen levels drop after childbirth, especially during breastfeeding, causing temporary vaginal dryness. This condition, known as lactational atrophic vaginitis, usually improves after weaning.

Hormonal Treatments and Medications

Certain medications, including hormonal birth control, breast cancer treatments like Tamoxifen, and chemotherapy, can lower estrogen levels, leading to vaginal atrophy.

Smoking and Lifestyle Factors

Smoking reduces blood flow to vaginal tissues, worsening dryness and irritation. A sedentary lifestyle and poor diet can also contribute by affecting circulation and overall tissue health.

Symptoms of Atrophic Vaginitis

Atrophic vaginitis symptoms vary in intensity, with some women experiencing mild discomfort while others face significant disruption in daily life and intimacy. Early recognition of these symptoms can help in seeking timely treatment.

Vaginal Dryness – A persistent feeling of discomfort, tightness, or lack of lubrication, which can make daily activities or sexual intercourse uncomfortable.
Burning and Irritation – A sensation similar to a mild infection, sometimes extending to the vulva, causing increased sensitivity.
Pain During Sex (Dyspareunia) – The thinning and drying of vaginal tissues make penetration uncomfortable or painful, potentially leading to soreness, microtears, and post-intercourse bleeding.
Unusual Vaginal Discharge – Thinner, watery, or yellowish discharge that is typically odourless but may still cause discomfort.
Increased Risk of UTIs – Changes in the vaginal microbiome make it easier for bacteria to thrive, leading to symptoms such as burning during urination, increased urgency, or frequent infections.
Spotting or Light Bleeding – Fragile vaginal walls may develop tiny abrasions, especially after sex or vaginal examinations, leading to light bleeding.

Since these symptoms can overlap with infections or other gynaecological conditions, a medical consultation is necessary for accurate diagnosis and appropriate treatment.

Testing for Atrophic Vaginitis

Atrophic vaginitis is diagnosed through a combination of symptom assessment, physical examination, and laboratory tests.

Medical History and Symptom Discussion – A doctor may ask about vaginal discomfort, sexual health, menstrual history, and relevant medical treatments to determine if estrogen deficiency is the underlying cause.
Pelvic Examination – The vaginal walls are checked for signs of thinning, redness, dryness, and loss of elasticity. Small abrasions or inflammation may also be observed.
pH Testing – Vaginal pH, which is usually between 3.5 and 4.5 in premenopausal women, tends to rise above 4.5 in those with atrophic vaginitis, making the environment more prone to infections. A small strip of pH-sensitive paper is inserted into the vagina, usually placing it against the vaginal wall for a few seconds. The strip changes colour based on the acidity level. The color is then compared to a reference chart to determine the vaginal pH.
Microscopic Examination of Vaginal Cells – A vaginal cytology test can assess cellular changes due to estrogen deficiency and distinguish atrophic vaginitis from infections or other conditions.

In some cases, additional tests, such as vaginal cultures or urine tests, may be recommended to rule out infections or other contributing factors. Early diagnosis allows for effective management, helping women regain comfort and maintain vaginal health.

Treatment Options for Atrophic Vaginitis

Managing atrophic vaginitis involves restoring vaginal moisture, improving elasticity, and relieving discomfort. Treatment options range from hormonal therapy to non-hormonal alternatives and lifestyle modifications, depending on the severity of symptoms and individual health considerations. Consulting a doctor is essential to determine the most suitable approach.

Estrogen Therapy

Since atrophic vaginitis is primarily caused by a decline in estrogen levels, hormonal treatments aim to replenish estrogen and restore the vaginal tissue’s natural lubrication and thickness. Estrogen therapy is particularly effective for postmenopausal women and those who have undergone treatments that lower estrogen levels.

Vaginal estrogen therapy delivers estrogen directly to the affected tissues with minimal systemic absorption, reducing the risk of side effects compared to oral hormone replacement therapy (HRT). There are several forms of vaginal estrogen therapy:

Vaginal estrogen creams are applied directly inside the vagina, usually with an applicator. These creams provide relief by thickening the vaginal lining, increasing lubrication, and reducing inflammation. Most women use them daily at first, then gradually reduce the frequency based on their doctor's recommendations.
Vaginal estrogen tablets are small, dissolvable tablets inserted into the vagina using an applicator. They release a controlled dose of estrogen to improve vaginal moisture and elasticity. Tablets are a convenient and less messy alternative to creams.
Estrogen rings are flexible silicone devices inserted into the vagina, where they continuously release a low dose of estrogen over several months. The ring is usually replaced every 90 days and provides long-term symptom relief without requiring daily application.

Systemic estrogen therapy, such as oral or transdermal estrogen (patches or pills), may also be considered if a woman is experiencing other menopausal symptoms like hot flashes and mood swings.

Non-Hormonal Treatments

For women who cannot or prefer not to use estrogen therapy, non-hormonal options offer effective symptom relief. These alternatives focus on keeping the vaginal tissues hydrated, reducing discomfort, and improving vaginal health.

Vaginal moisturizers help retain moisture in the vaginal tissues and provide long-lasting hydration. Unlike lubricants, which are used before sex, vaginal moisturizers are applied regularly (a few times per week) to maintain vaginal hydration.
Lubricants are essential for reducing pain during sex by providing temporary lubrication. Water-based lubricants are generally recommended because they are gentle, non-irritating, and compatible with condoms. Silicone-based lubricants last longer than water-based ones, while oil-based lubricants should be avoided as they can cause irritation and damage latex condoms.
Ospemifene is an oral medication specifically designed to treat painful sex associated with vaginal atrophy. It is a selective estrogen receptor modulator (SERM) that mimics estrogen’s effects on vaginal tissues without affecting the uterus or other body systems as traditional hormone therapy does. However, it is not recommended for women with a history of breast cancer or blood clots.

Other non-hormonal options, such as laser therapy and CO2 fractional resurfacing, are emerging treatments that stimulate collagen production in vaginal tissues, improving elasticity and moisture. However, these treatments are still under research, and their long-term effects are not fully understood.

Natural Remedies & Lifestyle Changes

Certain lifestyle changes and natural remedies can help prevent or reduce the severity of atrophic vaginitis. While they may not be as immediately effective as medical treatments, they play a crucial role in maintaining overall vaginal health.

Regular sexual activity or vaginal stimulation promotes blood flow to the vaginal tissues, helping to maintain elasticity and natural lubrication. Engaging in sex or using vaginal dilators can prevent the vaginal walls from becoming too thin and tight.
Staying hydrated and eating a balanced diet can support vaginal health. Drinking enough water helps maintain moisture in all body tissues, including the vagina. Foods rich in phytoestrogens, such as soy products, flaxseeds, and nuts, may provide mild estrogen-like effects, though their impact varies among individuals.
Pelvic floor exercises (Kegels) strengthen the muscles around the vagina and improve blood circulation, which may help alleviate symptoms. Regular Kegel exercises can also improve urinary function and reduce the risk of incontinence, which is often linked to atrophic vaginitis.

Some women explore herbal supplements such as black cohosh, red clover, and evening primrose oil, which are believed to have estrogen-like properties. However, their effectiveness is not well-established, and they should be used with caution, especially for women with hormone-sensitive conditions.

Prevention for Atrophic Vaginitis

While some causes of atrophic vaginitis, such as menopause, are unavoidable, adopting preventive measures can reduce the risk of developing severe symptoms.

Maintaining sexual activity is one of the most effective ways to keep vaginal tissues healthy. Regular sex, masturbation, or the use of vaginal dilators helps preserve vaginal elasticity and blood flow.
Choosing gentle hygiene products is essential to avoid irritating sensitive vaginal tissues. Harsh soaps, scented feminine washes, and douching can disrupt the vaginal microbiome, making symptoms worse. Washing the external genital area with mild, unscented soap and water is sufficient.
Quitting smoking can improve blood circulation to vaginal tissues, reducing the severity of vaginal atrophy. Smoking accelerates estrogen decline, which can worsen symptoms and contribute to early menopause.
Staying hydrated and maintaining overall health supports vaginal tissue integrity. Proper hydration ensures that mucous membranes remain moist, reducing vaginal dryness.
Wearing breathable cotton underwear and avoiding tight clothing can help prevent excessive moisture loss and irritation, keeping the vaginal area comfortable.

By combining medical treatments with lifestyle modifications, women can effectively manage atrophic vaginitis, reduce discomfort, and maintain a healthy, functional vaginal environment. Seeking early intervention and discussing symptoms openly with a doctor can significantly improve quality of life and sexual well-being.

Conclusion

Atrophic vaginitis is a common yet often overlooked condition that can significantly impact a woman’s comfort, sexual health, and overall well-being. While it is most frequently associated with menopause, younger women can also experience it due to hormonal changes, medical treatments, or lifestyle factors. Recognising the symptoms early and seeking appropriate treatment can prevent long-term discomfort and complications such as frequent infections or painful sex.

Consulting a doctor is essential to finding the best approach tailored to individual needs. By prioritizing vaginal health and making informed choices, women can improve their quality of life and maintain overall well-being.

Frequently Asked Questions

Can atrophic vaginitis go away on its own?
Atrophic vaginitis does not resolve without treatment because it is caused by declining estrogen levels. However, symptoms can be managed with appropriate hormonal or non-hormonal treatments.
Is atrophic vaginitis only a concern for menopausal women?
While it is most common in postmenopausal women, younger women can also develop atrophic vaginitis due to breastfeeding, hormonal treatments, ovarian removal, or certain medications.
What is the best way to relieve vaginal dryness caused by atrophic vaginitis?
Using vaginal moisturizers regularly and water-based lubricants during sex can help. For more severe cases, vaginal estrogen therapy or other medical treatments may be necessary.
Does atrophic vaginitis increase the risk of infections?
Yes, because changes in vaginal pH and thinning tissues make the area more vulnerable to bacterial infections and urinary tract infections (UTIs).
Are there natural remedies for atrophic vaginitis?
Some women find relief through dietary changes, such as consuming soy-based foods that contain phytoestrogens. However, medical treatments are often more effective in managing symptoms.

Important

This blog, including its text, images, and infographics, is for educational purposes only and not a substitute for professional medical advice. For personalised advice, always consult a doctor.

References

Mayo Clinic Proceedings. Vulvovaginal atrophy. 2010. https://pubmed.ncbi.nlm.nih.gov/20042564/
Menopause. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. 2014. https://pubmed.ncbi.nlm.nih.gov/25160739/
Climacteric: the journal of the International Menopause Society. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. 2014. https://pubmed.ncbi.nlm.nih.gov/24423885/
US National Cancer Institute. atrophic vaginitis. Accessed on 5 February 2025. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/atrophic-vaginitis