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What is Vulvovaginal Atrophy?

By Marco Sumayao
Updated Mar 03, 2024
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Vulvovaginal atrophy is the thinning of tissue in the vulva and vagina. The condition is caused by a significant drop in the patient's estrogen levels. The weakened tissue can cause intercourse to be painful and can lead to bleeding, urinary tract infection, and vaginal dryness. Symptoms of vulvovaginal atrophy are most often treated with vaginal moisturizers and lubricants. In severe cases, the condition can be remedied through estrogen therapy.

Most cases of vulvovaginal atrophy develop during key hormonal points in a woman's life. These include breastfeeding, peri- and post-menopause, and post-ovectomy. These stages usually result in a large drop in a woman's estrogen levels, which is necessary for maintaining thickness in the vulva and vaginal walls. Estrogen also aids vaginal lubrication; a sharp decline in the hormone will increase the risk of damage to the vulva and vagina. As a result, the tissue in the affected areas becomes significantly more fragile and prone to injury.

The abnormally-thin tissue and lack of lubrication can make sexual intercourse excruciating for a woman, which, in turn, can cause a major drop in the patient's libido. Vaginal bleeding often occurs in patients with vulvovaginal atrophy after intercourse. The wounds that develop make the patient more prone to bacterial and viral infections, which can lead to more serious medical problems. The thinner tissue also makes the affected area much more sensitive to tactile stimulation, which brings about burning sensations during urination.

Research has found that non-vaginal delivery during birth increases the risk of vulvovaginal atrophy. Vaginal delivery often prepares the vulva and vagina for severe trauma, strengthening it and improving lubrication. Smoking is another risk factor for vulvovaginal atrophy. Cigarettes contribute to the development of the condition by decreasing oxygen flow to the vulva and vagina. In addition, cigarettes have been found to lower estrogen levels in regular smokers.

In most cases, the severity of vulvovaginal atrophy is low enough to be non-threatening and does not require medical attention. Mild symptoms, such as pain during intercourse and vaginal dryness, are most often remedied with the use of artificial lubricants during intercourse. Women can also use moisturizing creams to help maintain proper lubrication outside of intercourse.

More serious cases of vulvovaginal atrophy, however, will require a significant increase in estrogen levels in order to eliminate any vaginal discomfort. Doctors often prescribe estrogen creams to women with severe postmenopausal vaginal atrophy. Women can also take estrogen orally, in the form of pills. Experts recommend that patients consult their endocrinologists before opting for hormonal therapy, as other serious medical problems might develop.

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