Overview

Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause.

For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms. Because the condition causes both vaginal and urinary symptoms, doctors use the term "genitourinary syndrome of menopause (GSM)" to describe vaginal atrophy and its accompanying symptoms.

Simple, effective treatments for GSM are available. Reduced estrogen levels result in changes to your body, but it doesn't mean you have to live with the discomfort of GSM.

Symptoms

Genitourinary syndrome of menopause (GSM) signs and symptoms may include:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • Frequent urination
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal

When to see a doctor

Many postmenopausal women experience GSM. But few seek treatment. Women may be embarrassed to discuss their symptoms with their doctor and may resign themselves to living with these symptoms.

Make an appointment with your doctor if you have any unexplained vaginal spotting or bleeding, unusual discharge, burning, or soreness.

Also make an appointment to see your doctor if you experience painful intercourse that's not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others).

Causes

Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

A drop in estrogen levels may occur:

  • After menopause
  • During the years leading up to menopause (perimenopause)
  • After surgical removal of both ovaries (surgical menopause)
  • During breast-feeding
  • While taking medications that can affect estrogen levels, such as some birth control pills
  • After pelvic radiation therapy for cancer
  • After chemotherapy for cancer
  • As a side effect of breast cancer hormonal treatment

GSM signs and symptoms may begin to bother you during the years leading up to menopause, or they may not become a problem until several years into menopause. Although the condition is common, not all menopausal women experience GSM. Regular sexual activity, with or without a partner, can help you maintain healthy vaginal tissues.

Risk factors

Certain factors may contribute to GSM, such as:

  • Smoking. Cigarette smoking affects your blood circulation, and may lessen the flow of blood and oxygen to the vagina and other nearby areas. Smoking also reduces the effects of naturally occurring estrogens in your body.
  • No vaginal births. Researchers have observed that women who have never given birth vaginally are more likely to develop GSM symptoms than women who have had vaginal deliveries.
  • No sexual activity. Sexual activity, with or without a partner, increases blood flow and makes your vaginal tissues more elastic.

Complications

Genitourinary syndrome of menopause increases your risk of:

  • Vaginal infections. Changes in the acid balance of your vagina make vaginal infections more likely.
  • Urinary problems. Urinary changes associated with GSM can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more urinary tract infections or urine leakage (incontinence).

Prevention

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

May 02, 2019
References
  1. AskMayoExpert. Genitourinary syndrome of menopause (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
  2. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 141: Management of Menopausal Symptoms. Obstetrics & Gynecology. 2014;123:202.
  3. Shifren JL. Genitourinary syndrome of menopause. Clinical Obstetrics and Gynecology. 2018;61:508.
  4. DeCherney AH, et al. Menopause and post-menopause. In: Current Diagnosis & Treatment: Obstetrics & Gynecology. 12th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://accessmedicine.mhmedical.com. Accessed March 1, 2019.
  5. Thomas HN, et al. Female sexual function at midlife and beyond. Obstetrics and Gynecology Clinics of North America. 2018;45:709.
  6. Bachman G, et al. Clinical manifestations and diagnosis of genitourinary syndrome of menopause (vulvovaginal atrophy). https://www.uptodate.com/contents/search. Accessed March 3, 2019.
  7. Alligood-Percoco NR, et al. Risk factors for dyspareunia after first childbirth. Obstetrics and Gynecology. 2016;128:512.
  8. Lethaby A, et al. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database of Systematic Reviews. https://www.cochranelibrary.com/. Accessed March 1, 2019.
  9. Biehl C, et al. A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause. Menopause. 2019;26:1.
  10. Di Donato V, et al. Ospemifene for the treatment of vulvar and vaginal atrophy: A meta-analysis of randomized trials. Part I: Evaluation of efficacy. Maturitas. 2019;121:86.
  11. Di Donato V, et al. Ospemifene for the treatment of vulvar and vaginal atrophy: A meta-analysis of randomized trials. Part II: Evaluation of tolerability and safety. Maturitas. 2019;121:92.
  12. NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24:728.
  13. Menopausal symptoms in depth. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/menopause/menopausesymptoms. Accessed March 1, 2019.
  14. Yaralizadeh M, et al. Effect of Foeniculum vulgare (fennel) vaginal cream on vaginal atrophy in postmenopausal women: A double-blind randomized placebo-controlled trial. Maturitas. 2016;84:75.
  15. Imvexxy (prescribing information). Boca Raton, Fla.: TherapeuticsMD Inc. 2018. https://www.imvexxy.com/pi.pdf. Accessed March 18, 2019.