An Overview of Vaginal Atrophy

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Vaginal and vulvar atrophy (VVA), also known as vulvovaginal atrophy, is a condition causing uncomfortable changes to the vaginal area due to menopause. A range of symptoms causing pain and discomfort result from a decrease in estrogen levels. This condition affects about half of women going through menopause. Symptoms such as pain and dryness interfere with sexual activities and health, along with daily activities. This change in the ability to participate in enjoyable activities often causes a decrease in quality of life.

Woman consulting doctor for menopause symptoms

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Symptoms of VVA include vaginal dryness, discomfort, pain, discharge, swelling, and brittle, thin, or rigid vaginal tissue. Sexual intercourse may be uncomfortable as there is less lubrication.

Women with VVA may also experience changes in the frequency of urination and urination urges, burning and pain during urination, itching, spotting shortly after intercourse, and incontinence. All symptoms have the ability to impact a woman’s quality of life.

These symptoms often mimic other reproductive-related diagnoses. This makes it essential to undergo a thorough healthcare provider’s evaluation to determine a definitive diagnosis followed by the appropriate treatment.


Vulvar and vaginal atrophy is caused by cellular changes during menopause. Due to a decline in estrogen production, women often experience changes to the cellular structures of their genitals. These cellular changes cause tissues to display abnormal symptoms which cause discomfort and related issues. Changes in estrogen levels also cause a decrease in blood flow to the vaginal area, which further contributes to vaginal dryness and discomfort.

Women who have recently been treated for breast cancer are more likely to develop vulvar and vaginal atrophy or experience worsening symptoms. This is due to the specific hormonal agents used in chemotherapy treatments for breast cancer. VVA may also develop due to hormonal changes related to lactation and the use of hormonal medications.

Symptoms of vulvar and vaginal atrophy may worsen if a woman is not sexually active (with or without a partner). Regular sexual activity promotes blood flow to the vagina. A lack of regular sexual activity causes the vagina to become shorter and more narrow, which only adds to pain and discomfort during intercourse and other daily activities.


Vaginal and vulvar atrophy is often mistaken for bacterial or viral diagnoses affecting the vaginal area. This is due to similar symptoms of itching, swelling, and pain which come along with both diagnoses. Cosmetic products such as lubricants, soaps, wipes, perfumes, and moisturizers may also act as irritants and cause women to experience vaginal changes. Women with cancerous growths in their vaginal area may also mimic symptoms such as redness, thickening, or skin changes.

A healthcare provider must complete a thorough examination before making a diagnosis of vulvar and vaginal atrophy. This includes a vaginal examination followed by a pH (potential hydrogen) test of the woman’s vagina. Tests to determine pH levels inform a medical professional whether the body environment tested is acidic or basic. An abnormal pH test indicates the potential for illness and other complications. A woman diagnosed with vulvar and vaginal atrophy must have a vaginal pH of 4.6 or more.

Another test completed before making a diagnosis of vulvar and vaginal atrophy is the vaginal maturation index (VMI). The VMI is a laboratory test which analyzes the cells of the vagina for abnormalities which may indicate a diagnosis of vulvar and vaginal atrophy.


Non-hormonal treatments for vulvar and vaginal atrophy include over-the-counter vaginal moisturizers along with water-based vaginal lubricants for symptoms of urinary dysfunction. Lubricants free from glycerin are recommended, as glycerin is a chemical which may cause an increase in symptoms.

It is important to maintain regular and consistent use of these treatments in order to see an improvement in symptoms. Each of these treatments is safe and effective for long-term use, as they are free from hormones. Vaginal lubricants in particular should be applied daily and as needed during sexual intercourse.

There are also hormonal treatments for symptoms of vulvar and vaginal atrophy. These include the administration of vaginal estrogen through a cream or tablet. Preliminary research has shown these hormonal methods are more effective than non-hormonal methods for managing symptoms of vulvar and vaginal atrophy.

Hormonal methods are typically second-line treatments for vulvar and vaginal atrophy. Women who do not respond to non-hormonal methods are then prescribed hormonal methods. 

Estrogen replacement therapy is one of the most effective treatment options for vulvar and vaginal atrophy. However, there are limitations as to the women who are medically able to utilize this method. Women who are at an increased risk for deep vein thrombosis or stroke, both conditions which cause blood clots which cut off blood supply to the body, should not use estrogen replacement therapy. This type of treatment increases a woman’s risk for these conditions and may be fatal for women who already have a family history or other risk factors for these conditions.

A Word From Verywell

Vulvar and vaginal atrophy may impact a woman’s quality of life and ability to engage in intercourse. This makes it very important to take the necessary self-care steps to manage this condition. Be mindful of using cosmetic products in your vaginal area, be sure to wash properly to minimize the risk of infection, and explore the use of water-based lubricants to make sexual intercourse more enjoyable.

Speak with your healthcare provider regarding non-hormonal and hormonal treatment options which may be suitable for you. Aside from traditional medical treatment, speak with your partner regarding your uncomfortable symptoms. Though this may be a sensitive topic, open the lines of communication with your partner. Talking about your difficulties will only prove useful in exploring enjoyable ways to be intimate despite your symptoms of vulvar and vaginal atrophy.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. International Society for Sexual Medicine. What is vulvar and vaginal atrophy?

  2. Cleveland Clinic. Vaginal atrophy.

  3. MacBride MB, Rhodes DJ, & Shuster LT. Vulvovaginal atrophy. Mayo Clinic Proceedings. 2010;85(1), 87-94. doi:10.4065/mcp.2009.0413

  4. Krapf JM, Belkin ZR, & Goldstein AT. Advances in the treatment of vulvovaginal atrophy. Expert Reviews of Obstetrics & Gynecology. 2013;8(5), 457-465. doi:10.1586/17474108.2013.825472.

Additional Reading

By Brittany Ferri
Brittany Ferri, MS, OTR-L, CCTP, is an occupational therapist, consultant, and author specializing in psychosocial rehab.