Vaginal atrophy (also called atrophic vaginitis) is a vaginal disorder that usually happens after menopause where the lining of the vagina gets drier and thinner. This results in itching, burning and pain during sex, among other symptoms. The condition also includes urinary tract problems such as urinary tract infections (UTIs) and frequent urination.
Recently, the term vaginal atrophy has been replaced with the newer term, genitourinary syndrome of menopause (GSM).
Between 10 and 40 percent of women experience symptoms of atrophic vaginitis after menopause.
The main indicators of vaginal atrophy includes –
• Vaginal dryness
• Pain during sexual intercourse, or dyspareunia
• Thin, watery, yellow or gray discharge
• Paleness and thinning of the labia and vagina
• Irritation when wearing certain clothes, such as tight jeans, or when on a bike seat
• More frequent urinary tract infections (UTIs)
Symptoms also present in the urination process. These include –
• Painful urination
• Blood in the urine
• Increased frequency of urination
• Increased likelihood and occurrence of infections
There may also be a reduction in pubic hair, and the vagina may become narrower and less elastic.
During menopause, your body makes less estrogen. Without estrogen, the lining of the vagina can become thinner and less stretchy. The vaginal canal can also narrow and shorten. Less estrogen lowers the amount of normal vaginal fluids. It also changes the acid balance of the vagina. Women who have just had a baby and are breastfeeding also have a drop in estrogen. These symptoms also occur in women who have had their ovaries removed or are taking certain medications (such as aromatase inhibitors for breast cancer treatment).
☆ The first sign of vaginal atrophy is usually a decrease in vaginal lubrication.
Other causes include –
• Treatment to the pelvic area
• Uncontrolled diabetes
• Severe stress
• Rigorous exercise
Risk Factors –
Women age 50 and over, in menopause, are the most likely to experience vaginal atrophy.
Other factors that increase your likelihood of developing vaginal atrophy include –
• Lack of sexual intercourse.
• Decreased ovarian functioning due to chemotherapy or radiation.
• Immune disorders.
• Medications that contain antiestrogen properties including Tamoxifen (Nolvadex), Medroxyprogesterone (Provera) and Nafarelin (Synarel).
• Nonfluctuating estrogen levels.
• Oophorectomy (removal of the ovaries).
• Postpartum loss of placental estrogen.
• 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).
Diagnosis of Atrophic vaginitis involve –
• Pelvic exam, during which your doctor feels your pelvic organs and visually examines your external genitalia, vagina and cervix.
• Urine test, which involves collecting and testing your urine, if you have urinary symptoms.
• Acid balance test, which involves taking a sample of vaginal fluids or placing a paper indicator strip in your vagina to test its acid balance.
Treatment can focus on symptoms or the underlying cause.Over-the-counter moisturizers or water-based lubricants can help treat dryness.
If symptoms are severe, your doctor may recommend estrogen replacement therapy.
Estrogen improves vaginal elasticity and natural moisture. It usually works in just a few weeks. Estrogen can be taken either topically or orally.
▪︎ Topical Estrogen
Topical estrogen is available in several forms:
• A vaginal estrogen ring, such as Estring. Estring is a flexible, soft ring inserted into the upper part of the vagina by you or your doctor. It releases a constant dose of estrogen and only needs to be replaced every three months. Estrogen rings are higher-dose estrogen preparations and may increase a woman’s risk for endometrial cancer. You should speak with your physician about your risk and possible need for progestin as well.
• A vaginal estrogen cream, such as Premarin or Estrace. These types of medications are inserted into the vagina with an applicator at bedtime. Your doctor may prescribe the cream daily for a couple of weeks, then step down to two or three times per week.
• A vaginal estrogen tablet, such as Vagifem, is inserted into the vagina using a disposable applicator. Usually, one dose per day is prescribed at first, which is later stepped down to one or two times per week.
▪︎ Oral Estrogen
If your health history doesn’t include cancer, progesterone may be prescribed in addition to estrogen in pill or patch form.
Women taking progesterone and estrogen may have some bleeding after menopause. While the cancer risk for women taking both progesterone and estrogen is minimal, you should still see your doctor to have any episodes of postmenopausal bleeding evaluated.
Ayurvedic Treatment –
There are following Ayurvedic ways to treat vaginal atrophy-
• Abhyanga or oil massage
It is essential as a daily routine. If you have a dominant Vata, you should use sesame oil for a body massage before your bath. For a dominant Pitta, coconut oil helps, and Kapha dominants should use mustard oil for abhyanga. For self-massage, use warm oil and apply on the entire body, from the scalp to the soles of your feet.
Tube fomentation (nadi sweda) and bolus fomentation are applied to the genitals for effective results. Fomentation is the process by which the sweat or perspiration is produced in the body by using various methods. Nadi sweda is done by taking steam coming through a hollow tube to the body, especially to the effected parts.
• Herbal tampons
These are given to the individual to insert into her vagina. This helps to cure the inflammation, pain, infection and rejuvenates the tissues.
Enema is a process of using Vata pacifying herbs to calm down the vitiated doshas, which is the main cause of virginal dryness.
Mix triphala herb powder with water and wash your vagina with this solution. It will cure the burning sensation due to dryness.
Make a paste with turmeric and milk. Apply this paste to the vagina. This homemade remedy lubricates the vagina and treats dryness. Turmeric has anti-microbial properties that protect the vagina from any infection.
Soak a tampon in guduchi oil and inserted it into the vagina. You can also administer with a douche. But this treatment should be done by consulting a qualified Ayurvedic practitioner.
This powerful herb is used for treating several health conditions including vaginal dryness. It keeps the walls of the vagina supple and healthy.
Mix ghee and organic shatavari, and apply locally to enhance lubrication.
• Shatavari and Ashwagandha douche
Boil shatavari and ashwagandha in sesame oil, cool it, and use as a vaginal douche. This should only be done by consulting a qualified Ayurvedic practitioner.
• Sesame oil
Sesame oil is quite effective as a natural vaginal lubricant. Dip a ball of cotton in sesame oil and apply it to the vaginal walls. Do this for a week and see the result.
• Coconut oil
Coconut oil can restore the natural hydration of the body. Dip a ball of cotton in coconut oil and apply it to the vaginal walls. Coconut oil is a source of vitamin E, which will naturally promote the secretion of moisture in the vaginal tissues.
• Aloe vera gel
This is also an effective remedy for vaginal dryness. Aloe is a natural moisturizer and reduces dryness and itching in the vagina due to dryness. You can also mix milk and aloe vera gel and apply it.
Fenugreek is very effective in treating vaginal dryness. It restores estrogen levels in the body and provides relief to the condition. Fenugreek seeds produce an estrogen-like effect and help to increase vaginal lubrication. Soak a teaspoon of fenugreek seeds in water overnight. Drink the water in the morning
• 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.
• Wearing cotton underwear and loose-fitting clothing can improve symptoms. Loose cotton clothing improves air circulation around the genitals, making them a less ideal environment for bacteria to grow.
• Vitamin E oil can also be used as a lubricant. There’s also some evidence that vitamin D increases moisture in the vagina. Vitamin D also helps the body absorb calcium. This helps to slow or prevent postmenopausal bone loss, especially when combined with regular exercise.
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