Vulvovaginal Atrophy & Menopause

>> Wednesday, April 17, 2013

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Vaginal atrophy (atrophic vaginitis) is the thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breast-feeding or at any time that your body's estrogen production is low, like during times of stress. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

Vaginal atrophy due to menopause may begin to bother you during the years leading up to menopause (perimenopause), or it may not become a problem until several years into menopause. Regular sexual activity, with or without a partner, helps you maintain healthy vaginal tissues and can decrease problems associated with vaginal atrophy, as sexual activity enhances blood flow to your vagina.

There are some known factors that can accelerate vaginal atrophy due to their affect on hormone production and vaginal health. Cigarette smoking impairs blood circulation, depriving the vagina and other tissues of oxygen. Decreased blood flow to your vagina contributes to atrophic changes. Smoking also reduces the effects of naturally occurring estrogens in the body. In addition, women who smoke can have an earlier menopause. Also, women who never give birth vaginally are more prone to vaginal atrophy, as many hormones are released in response to vaginal stretching.

The risk of vaginal infections (vaginitis) can increase with vaginal atrophy. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection from bacteria, yeast or other organisms.

Atrophic vaginal changes are also associated with changes in your urinary system, which can contribute to urinary problems. You might experience increased frequency, urgency or burning with urination. Some women experience more urinary tract infections or incontinence. Although stress incontinence is common among menopausal women, it doesn't appear to be caused by vaginal atrophy.

The symptoms can be varied, and some women have only one or two mild symptoms, while others can have many, sometimes more severe, symptoms. These can worsen the longer the body is estrogen-deficient. The most common symptoms include vaginal dryness and burning, spotting or even light bleeding after sex, discomfort and pain with sex, shortening of the vaginal canal and thinning of the vaginal walls, frequent urinary tract infections or urinary incontinence with burning and urgency.

Many of you may put off getting help because you feel you are experiencing a "natural" part of aging, and there is nothing that can be done about it. And some of you may be embarrassed about the changes that atrophy can cause, including uterine or bladder prolapse - which is where they begin to fall out of the vagina. Even though this is quite common and very uncomfortable, it's too embarrassing for some women to reach out for help.

Usually a simple pelvic exam and pap smear at your doctor's office is all that is needed to evaluate and diagnose vaginal atrophy or prolapse. If symptoms are bothersome, either vaginal or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen may provide more direct relief of symptoms. You should experience noticeable improvements after a few weeks of estrogen therapy.

If you're experiencing vaginal dryness or irritation, adding back moisture with Replense, K-Y or Astroglide can help. The same is true for dryness with sex, so it is important to use a water-based lubricant, such as Astroglide or K-Y, to reduce discomfort during intercourse. Oils or petroleum-based products can make you more prone to infection.

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