Vaginal Atrophy: Common but Often Untreated

What Is Vaginal Atrophy?

Vaginal atrophy, also known as atrophic vaginitis or genitourinary syndrome of menopause (GSM), is the thinning, drying, and inflammation of the vaginal walls that occurs due to a decline in estrogen. While it most commonly affects individuals after menopause, it can also occur during perimenopause, after childbirth, or following certain medical treatments that affect hormone levels.

Vaginal atrophy is remarkably common, yet often goes unspoken. Many people are surprised to learn that the discomfort they’ve been experiencing—whether it’s dryness, irritation, or painful intimacy—has a name and an explanation rooted in hormonal shifts.

Why Does Vaginal Atrophy Happen?

The main cause of vaginal atrophy is reduced estrogen levels. Estrogen plays a vital role in maintaining the thickness, elasticity, and lubrication of vaginal tissues. When estrogen decreases—whether due to natural menopause, surgical menopause (ovary removal), breastfeeding, or certain medical therapies—the vaginal walls can become thinner, less flexible, and more fragile.

Without sufficient estrogen, the body produces less natural lubrication. The tissues become more susceptible to irritation, small tears, and inflammation. The pH level of the vagina may also shift, which can impact the balance of healthy bacteria and increase the risk of infections or urinary symptoms.

Who Is Most at Risk?

• Those who are breastfeeding
• People who’ve had their ovaries surgically removed
• Individuals undergoing cancer treatment or radiation
• Anyone on medications that suppress estrogen production
• Those with autoimmune conditions or chronic inflammatory diseases

The onset is often gradual, and many are unaware that what they’re experiencing is part of a hormonal shift. Because the symptoms can be subtle at first, they’re frequently overlooked or misattributed to other causes.

What Are the Common Symptoms?

• Vaginal dryness or tightness
• Itching, burning, or irritation
• Discomfort or pain during intercourse (dyspareunia)
• Light bleeding after intercourse
• A feeling of vaginal “shrinking” or loss of elasticity
• Increased urinary urgency or frequency
• Recurrent urinary tract infections
• Mild urinary incontinence

These symptoms may start as occasional annoyances but can progress to daily discomfort if left unaddressed. Intimacy, physical activity, and even sitting or walking can become painful for some individuals.

Why Is Vaginal Atrophy Often Left Untreated?

• Embarrassment: Many people hesitate to bring up intimate concerns during routine medical appointments.
• Assumptions about aging: Symptoms are often dismissed as a natural, untreatable part of getting older.
• Lack of awareness: People may not realize their symptoms are hormonal or that treatment options exist.
• Limited screening: Unless explicitly discussed, vaginal atrophy may go unnoticed during routine care.

The silence around the topic leads many to suffer unnecessarily. The result is reduced quality of life, disrupted intimacy, and emotional distress that could often be avoided with early intervention.

How Is Vaginal Atrophy Diagnosed?

• Personal history: A detailed discussion of symptoms, menstrual and hormonal history, and overall health.
• Pelvic examination: A physical exam to evaluate tissue changes such as thinning, dryness, fragility, or pallor.
• Urinary evaluation: If symptoms include urgency, burning, or frequency, additional tests may be recommended.

There’s no single lab test for vaginal atrophy, and diagnosis is often made based on symptoms and physical findings.

How Is Vaginal Atrophy Treated?

Non-Hormonal Therapies

• Vaginal moisturizers
• Lubricants
• Hyaluronic acid or vitamin E suppositories

Local Hormone Therapy

• Vaginal estrogen creams, tablets, or rings
• DHEA suppositories

Systemic Hormone Therapy

• Estrogen replacement therapy (ERT)

Approaches vary depending on severity, medical history, and personal preferences. Local therapies are often highly effective for vaginal-specific symptoms, while systemic therapy may help with broader menopausal issues.

Can the Condition Come Back After Treatment?

Yes, symptoms may return if treatment is discontinued—especially hormone-based therapies. Vaginal atrophy is a chronic condition linked to ongoing estrogen deficiency, so regular use of treatments may be necessary to maintain comfort and tissue health.

How Does Vaginal Atrophy Affect Intimacy?

• Avoidance of sexual activity
• Strain in relationships
• Loss of confidence or reduced self-esteem
• Emotional distancing

Treatment often restores both physical comfort and emotional closeness, significantly improving intimacy and quality of life.

Is Vaginal Atrophy a Sign of a More Serious Problem?

• Recurrent urinary tract infections
• Chronic urinary urgency or incontinence
• Frequent vaginal infections
• Tissue fragility leading to tearing or bleeding

While vaginal atrophy itself is not life-threatening, untreated symptoms can contribute to secondary complications.

What Can I Do at Home to Support Vaginal Health?

• Stay hydrated
• Avoid irritants
• Wear breathable fabrics
• Stay sexually active
• Practice pelvic floor exercises

Why Is It Important to Talk About Vaginal Atrophy?

Talking openly helps normalize a condition that is common and treatable. Shame or embarrassment should never stand in the way of comfort. Vaginal health is a vital part of whole-body health.

Can Vaginal Atrophy Affect People Who Aren’t Postmenopausal?

• Breastfeeding individuals: Hormonal shifts during lactation may cause dryness and discomfort.
• Those undergoing chemotherapy or radiation: Treatments may cause sudden estrogen decline.
• Surgical menopause: Removal of ovaries leads to abrupt estrogen loss.
• Hormonal or autoimmune disorders: Can mimic or trigger symptoms.

Is There a Connection Between Vaginal Atrophy and Urinary Symptoms?

• Burning sensation during urination
• Increased urgency or frequency
• Incomplete bladder emptying
• Mild leakage with coughing or laughing
• Frequent UTIs

Local estrogen therapy has been shown to significantly reduce urinary symptoms by restoring tissue health.

How Can You Talk to Your Doctor About Vaginal Atrophy?

Bringing up intimate health concerns can feel awkward, but silence delays relief. Simple phrases like, “I’ve noticed dryness and discomfort—could it be hormonal?” can open the conversation.

If a provider dismisses concerns, seeking a second opinion is valid. Compassionate providers recognize vaginal atrophy as medical—not personal.

Does Vaginal Atrophy Affect Emotional or Mental Well-Being?

• Loss of confidence
• Decreased sexual desire
• Shame or embarrassment
• Feelings of isolation
• Relationship strain

Addressing symptoms often restores confidence, self-image, and emotional peace. Validation and open conversation are as important as treatment itself.