Atrophic vaginitis is vaginal dryness due to thinning tissue and decreased lubrication.A.D.A.M.

Causes, incidence, and risk factors

Atrophic vaginitis is caused by a decrease in estrogen. Estrogen levels normally drop after menopause.

Estrogen is very important in keeping the tissues of the vagina lubricated and healthy. Normally, the lining of the vagina makes a clear, lubricating fluid. This fluid makes sexual intercourse more comfortable and helps decrease vaginal irritation.Thinning or shrinking of the vaginal tissue causes dryness and inflammation.

The following may also cause estrogen levels to drop and lead to atrophic vaginitis:

• Medications or hormones used to decrease estrogen levels in women, as part of the treatment for breast cancer, endometriosis, fibroids, or infertility
• Radiation treatment to the pelvic area or chemotherapy
• Severe stress, depression, or rigorous exercise

Atrophic vaginitis may occur in younger women who have had surgery to remove their ovaries. Some women develop the condition immediately after childbirth or while breastfeeding, since estrogen levels are lower at these times.

The vagina can also become further irritated from soaps, laundry detergents, lotions, perfumes, or douches. Certain medications, smoking, tampons, and condoms may also cause or worsen vaginal dryness. For more information on these causes of vaginitis, see: Vulvovaginitis.

Symptoms

• Burning on urination
• Light bleeding after intercourse
• Painful sexual intercourse causing a loss in sexual interest
• Slight vaginal discharge
• Vaginal soreness, including itching or burning sensations

Signs and tests

A pelvic examination reveals thin, pale or red walls of the vagina.

A wet prep test of vaginal discharge may be done to rule out other causes for the condition.

Hormonal studies may be done to determine if you are in menopause.

Treatment

There are many treatments for vaginal dryness. Before self treating your symptoms, a doctor must determine if the problem is caused by decreased estrogen, an infection, irritant, medication, or other reason.

• Some lubricants and vaginal moisturizing creams are available without prescription. They will often moisten the area for several hours. This effect can last for up to a day.
• Using a water-soluble vaginal lubricant during intercourse. Do not use petroleum jelly, mineral oil, or other oils. These may increase the chance of infection and may damage latex condoms or diaphragms.
• Avoid scented soaps, lotions, perfumes, or douches.

Vaginal moisturizing creams are also available without prescription. See also: Alternative treatments for vaginal dryness

Prescription estrogen is very effective in treating atrophic vaginitis. It is available as a cream, tablet, suppository, or ring, all of which are placed directly into the vagina. These medicines deliver estrogen directly to the vaginal area. Only a little estrogen is absorbed into the bloodstream.

If hot flashes or other symptoms of menopause are also present, estrogen may be given as a skin patch, or in a pill that you take by mouth. See: Hormone replacement therapy

Women should discuss the risks and benefits of estrogen replacement therapy with their health care provider.

Expectations (prognosis)

Proper treatment will usually relieve the symptoms.

Complications

Vaginal dryness can:

• Make you more likely to get yeast or bacteria infections of the vagina
• Cause sores or cracks in the walls of the vagina
• Cause pain with sexual intercourse. This may affect your relationship with your partner or spouse. Talking openly with your partner may help.

Calling your health care provider

Call for an appointment with your health care provider if you are experiencing vaginal dryness or soreness, burning, itching, or painful sexual intercourse that is not alleviated with a water-soluble lubricant.

References

1. Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.
2. Lobo RA. Menopause: endocrinology, consequences of estrogen deficiency, effects of hormone replacement therapy, treatment regimens. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 42.

Review Date: 11/7/2011.

Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.