Atrophic vaginitis is an irritation of the vagina due to lack of estrogen.  Estrogen is the hormone responsible for female sexual characteristics we develop at puberty.  It is produced by the ovaries during the menstrual years, and by fat tissue in the menopausal woman.  Some women take estrogen supplements for this problem.

 The vagina feels dry, tight, and thin.  Bleeding with intercourse can occur. There are normally receptors for estrogen in the bladder neck also, so that a lack of estrogen can be bothersome to the urinary tract. Urinary irritation, frequency, or inability to hold the urine may result. 

Causes of atrophic vaginitis include:

  • Pelvic irradiation
  • Breast-feeding
  • Anti-estrogen medications such as Tamoxifen, Raloxifen (Evista), or Lupron
  • Some birth control pills
  • Some inflammatory conditions like Crohn's Disease, Ulcerative Colitis, Scleroderma, Lichen Planus, Lichen Sclerosis, and others
  • Menopause and perimenopause
  • Surgical removal of both ovaries (surgical menopause)

Symptoms include:

  • Pain with intercourse
  • Vaginal dryness
  • Itching and/or burning of the vulva
  • Burning or pain after urination
  • Vaginal discharge, possibly blood-streaked
  • Tearing of the vaginal tissue

How is it diagnosed?

A pelvic exam, pap smear, hormone levels, and cultures for infection are some of the common things done to make the diagnosis.  If there is a serious condition found, a biopsy may be indicated.

What is the treatment?

Regular sexual activity helps to maintain the vaginal elasticity.  Vaginal estrogen is used when simple measures like KY Jelly or other lubricants are not working.  Vaginal estrogen is made in creams, suppositories, rings, and pill inserts.  Very little is absorbed into the bloodstream so breast cancer is not a concern.  If you are having other menopause symptoms, you may need hormone therapy (HT) beyond just vaginal estrogen.  Ask your physician what is right for you. 

Non-hormonal treatments include:  olive oil, Vitamin E oil, almond or coconut oil.  Replens is an over-the-counter hydrating agent for the vagina inserted daily.

What other things can I do to help this condition?

  • Drink plenty of water
  • Do not use feminine sprays, perfumes, scented toilet paper, or soaps
  • Use a bland soap such as unscented Dove, Neutrogena, or Aveeno
  • Use good feminine hygiene practices (wipe front to back, do not regularly douche)
  • Wear loose-fitting cotton underwear
  • Avoid pantyhose if they bother you
  • Avoid spermicidal gels, foams, and creams
  • Regular sexual relations but not too vigorous
  • Use your estrogen product exactly as instructed

What other conditions present like atrophic vaginitis?

Vaginal infections such as yeast, bacterial vaginosis, and strep infections may cause discharge, odor, swelling, burning, and other discomfort.  If you suspect you have an infection, see your physician before trying any home remedies. Do not douche unless instructed.

What else can make sexual relations unpleasant?

  • Lack of interest in sex (for a variety of psycho-social reasons) can lead to a woman having no lubrication and/or failure to achieve orgasm.
  •  Decreased levels of testosterone or DHEA as menopause approaches can be involved.  You may need supplements of these important hormones as well as estrogen.
  • Anti-depressants, especially the SSRI type, may decrease libido or cause anorgasmia also.


Painful intercourse is never normal.  See your physician for a complete exam.  Atrophic vaginitis is a curable condition.  It may take several weeks once treatment has begun, so be patient.







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