Bodies change with time: parts begin to sag, aches and pains riddle our bones, and grey hairs appear. While we tend to expect these things, we aren’t generally prepared for the ways our genitals may also change with age. Many people with vaginas experience atrophic vaginitis, or vaginal atrophy (VA), yet we don’t often talk about this very common condition. ‍

Vaginal atrophy causes ‍

Vaginal atrophy typically occurs after menopause. Menopause leads to a decrease in estrogen, which prevents the body from stimulating vaginal secretions and thins the walls of the vagina. OBGYN Dr. Corey Babb tells O.school that vaginal atrophy is most often due to menopause, but it can also result from other medical therapies, such as radiation or certain medications. 

While up to 40 percent of people experience some degree of VA after menopause, only 20 to 25 percent seek medical attention. Dr. Caroline Mitchel — an assistant professor of obstetrics, gynecology, and reproductive biology —  told Harvard Health that folks see VA as a “part of aging and just sort of deal with it,” rather than seek further help. ‍

Vaginal atrophy symptoms 

Vaginal atrophy symptoms may include:

• Soreness
• Burning
• Itching
• Painful intercourse
• UTIs
• Thinning of the inner labia.

Dr. Babb explains that VA can be commonly linked to painful sex. “If untreated, some folks may find that the opening to their vagina shrinks in size, so insertion may become almost impossible.” Other common symptoms can include “recurrent urinary tract infections (UTIs)” and “vaginal bacterial infection[s]”. 

“I listen to [patient’s] main fears, explain the impact low estrogen has on the body and reassure them,” nurse practitioner Diane Porterfield-Bourne tells O.school. “However, if [someone] thinks [their] vaginal or vulva feels dry, sore or sex is uncomfortable, it’s important to see your doctor and start on treatment.” ‍

Treatments for vaginal atrophy

‍Treatments for VA range from medications to lubricants and injections. You can try hormonal or non-hormonal treatments. ‍

Vaginal atrophy hormonal treatments 

VA hormonal treatments may include estrogens, progestogens, androgens, and other deficient hormones. They can be taken as oral pills, tablets, injections, creams or vaginal suppositories. ‍

Vaginal atrophy non-hormonal treatments ‍

VA non-hormonal treatments include lubricants, moisturizers, vaginal dilators, and platelet-rich plasma injections (PRP). However, PRP treatment is not approved by the FDA and is still “considered experimental at this time,” according to Dr. Babb. 

“Specially formulated vaginal moisturizers and lubricants can be used, too,” says Bourne. “Many [people] use lubricants before sex as it makes it more comfortable. Your doctor may examine your vulva to ensure you have VA and [that] there are no other problems.”‍

Can you prevent vaginal atrophy?‍

There are steps people can take to prevent or slow down VA. These include utilizing vaginal estrogen during the early stages of menopause and using a water-soluble lubricant during penetrative sex. According to the American Family Physician, having regular sexual activity can also benefit the elasticity and flexibility of the vagina. A study found that those who had penetrative sex three times a week were less likely to have VA compared to those who had sex less than 10 times a year. Of course, penetration may be too painful for some.‍

Sex and vaginal atrophy‍

Dr. Chelsea Page, a sex therapist in Colorado,  notes that VA can impact a person’s life —especially emotionally. If left untreated, a patient may feel frustrated by their pain which can lead to further emotional issues. “It also can have an impact on one’s sexual life and partnership if both partners don't know how to navigate the symptoms of vaginal atrophy and the possible changes in what sex looks like for them.” 

Jane Lewis, coauthor of Me and My Menopausal Vagina, tells O.school that when she first experienced VA symptoms around age 40, she had suicidal ideation because of how her sex life had changed and how her mental health had been impacted. She says she still feels scared about the future, since a loss of control can be debilitating and the stigma surrounding menopause can force folks to be silent about their pain. 

The emotional impact of VA makes it all the more important to speak openly about it. It’s imperative to learn ways to have safe and comfortable sex in order to maintain your mental health and prevent VA from controlling your life outside of the bedroom and within it. 

For those who cannot, or do not want, penetrative sex, intimacy can be enjoyed illustrated in many other ways. Dr. Page says, “If a [cis-heterosexual] couple is focused only on penis-vagina intercourse as the only means for sexual intimacy, then avoidance is very likely. Instead, if the couple learns a widespread ‘menu’ of options to enjoy each other, then the VA doesn't have to rule their sex life.” 

Dr. Page advises couples to not focus on the “end goal,” of “penis-vagina intercourse or orgasm.” She says, “Sexual intimacy is about pleasurably connecting with each other, which can look like all sorts of different ways: kissing and making out, cuddling, naked cuddling, sudsing up in the shower, naked massages, oral sex, use of toys, etc. The possibilities are endless when pleasure and connection are the focus.”‍

The bottom line ‍

If you’re feeling frustrated, in pain, or confused during menopause or post menopause, visit your medical professional for guidance. It’s always beneficial to check in and make sure these symptoms aren’t being caused by something else. Treatment options, worsening conditions, and alleviating your symptoms should be prioritized when chatting with your doctor. Remember, no one should struggle alone and in silence. The most important thing we can do is speak openly and educate others about VA. 

“We have to start really discussing this very common symptom of menopause as it’s the last taboo and so hush-hush,” Jane Lewis tells O.school. “If we are not prepared to start talking, then nothing will change regarding education and awareness.”