Vaginal atrophy

Vaginal atrophy used to be a medical term for thinning and drying of the vagina's inner lining, often after menopause. Another name for it was atrophic vaginitis. These terms are no longer used. The physical changes they described are now considered to be part of a group of symptoms that affect the genitals and lower urinary tract, called genitourinary syndrome of menopause (GSM).

GSM happens when the body has less of the hormone estrogen. It can involve painful sex, a frequent or urgent need to urinate, and other distressing symptoms.

Having less estrogen doesn't mean you have to put up with the discomfort of GSM. Treatment can bring you relief.

Genitourinary syndrome of menopause symptoms can include:

• Dryness, burning or itching in the vagina.
• Thin, watery, sticky, yellow or gray fluid that comes out of the vagina.
• Frequent or urgent need to urinate, or a burning feeling during urination.
• Losing control of the bladder, also called urinary incontinence.
• More-frequent infections of the urinary tract and vagina.
• Pain during sex due to less lubrication, or light bleeding after sex.
• Shortening and tightening of the vaginal canal.

Genitourinary syndrome of menopause happens when the body makes less estrogen. Lower estrogen causes the tissues in the vagina to become thinner, drier, less elastic and more fragile.

A drop in estrogen levels may happen for reasons such as:

• After menopause.
• During the years leading up to menopause, called perimenopause.
• After surgery to remove both ovaries, which leads to early menopause.
• During breastfeeding.
• While taking medicines that can affect estrogen levels, such as some birth control pills.
• After chemotherapy or pelvic radiation therapy for cancer.
• As a side effect of hormonal treatment for breast cancer.

GSM symptoms might begin to bother you during the years leading up to menopause. Or they might not become a problem until a few years into menopause. Although the condition is common, not everyone who goes through menopause gets GSM. Regular sexual activity or masturbation can help keep the tissues in the vagina healthy.

Certain factors may play a role in GSM, such as:

• Smoking. Cigarette smoking affects blood flow. Less blood and oxygen may reach the vagina and other nearby areas. Smoking also reduces the effects of the estrogen your body makes.
• No vaginal births. People who have never given birth through the vagina may be more likely to develop GSM symptoms than those who have had vaginal births.
• No sexual activity. Sex or masturbation boosts blood flow and makes tissues in the vagina more elastic.

Genitourinary syndrome of menopause raises your risk of:

• Vaginal infections. Changes in the acid balance of your vagina make vaginal infections more likely.
• Urinary problems. Changes in the urinary tract linked with GSM can play a role in these problems. You might need to urinate more often or urgently, and it might burn when you go. Some people with GSM also leak urine or have more urinary tract infections or urine leakage.

Regular sexual activity, either with or without a partner, may help prevent genitourinary syndrome of menopause. Sexual activity increases blood flow to the vagina, which helps keep tissues in the vagina healthy.