Atrophic vaginitis: Symptoms And Causes

atrophic vaginitis nhs

The atrophic vaginitis is thinning, drying and inflammation of the vaginal walls which can happen when your body has less estrogen. The atrophic vaginitis happens most often after menopause [1]. For most women, the atrophic vaginitis makes the sexual intercourse painful, but also, it could lead to distressing urinary symptoms. This condition is causing both urinary and vaginal symptoms, so doctors using the term GSM (genitourinary syndrome of menopause) to describe the atrophic vaginitis and its accompanying symptoms. There are many simple and effective treatments for it.

The reduced estrogen levels are resulting in changes to your body, but this does not mean that you have to live with the discomfort of atrophic vaginitis. You should have regular sexual activity, no matter if it is with or without partner. This can help to prevent the atrophic vaginitis. The sexual activity can increase the blood flow to your vagina and this can help to keep your vaginal tissues healthy. [2]

atrophic vaginitis bleeding

Atrophic vaginitis symptoms

The most common signs and symptoms of atrophic vaginitis [2] include:

  • Shortening and tightening of the vaginal canal
  • Vaginal dryness
  • Decreased vaginal lubrication during sexual activity
  • Vaginal burning
  • Discomfort with intercourse
  • Vaginal discharge
  • Light bleeding after intercourse
  • Genital itching
  • Urinary incontinence
  • Burning with urination
  • Recurrent urinary tract infections
  • Urgency with urination
  • Frequent urination

In the most cases, postmenopausal women experience atrophic vaginitis [1]. But, few women seek for treatment. Women are very often embarrassed to discuss about their symptoms with their doctors and they resign themselves to live with these symptoms. You should make an appointment with your doctor if you have unexplained vaginal spotting or bleeding, soreness, burning or unusual discharge. Also, you should make an appointment with your doctor if you experience painful intercourse which is not resolved by using a vaginal moisturizer or water – based lubricant.

Atrophic vaginitis causes

It is caused by a decrease in the estrogen production. Less estrogen makes your vaginal tissue, and then it is thinner, drier, less elastic and more fragile. There are different reasons which could lead to drop in estrogen levels, such as

  • Side effect of the breast cancer hormonal therapy [3]
  • After menopause [1]
  • After chemotherapy for cancer [3]
  • Over the years leading up to menopause (known as perimenopause) [1]
  • After pelvic radiation therapy for cancer [4]
  • After surgical removal of both ovaries (known as surgical menopause)
  • While you are taking medications that can affect estrogen levels, such as some birth control pills [5]
  • During breast – feeding

The signs and symptoms of atrophic vaginitis may begin to bother you during the years leading up to menopause or they may not become a problem until several years into menopause. This is a very common condition, but not all postmenopausal women experience atrophic vaginitis. The regular sexual activity, with or without partner, can help you to maintain healthy vaginal tissues.

Risk factors

There are some factors which can increase your risk for atrophic vaginitis, such as

  • No sexual activity: The sexual activity with or without partner can increase the blood flow and makes your vaginal tissues more elastic.
  • No vaginal births: In some studies are found that women who have never given birth vaginally have more chances of getting atrophic vaginitis compared to women who have had vaginal deliveries.
  • Smoking: It is known that the cigarette smoking can affect your blood circulation and it can lessen the flow of blood and oxygen to the vagina and other nearby areas. Also, smoking reduces the effects of naturally occurring estrogens in your body. [6]


The atrophic vaginitis of menopause can increase your risk of:

  • Urinary problems: Those urinary changes which are associated with atrophic vaginitis can contribute to urinary problems. You can experience increased frequency or urgency of urination or burning with urination. Some women can experience urine leakage (known as incontinence) or more urinary tract infections. [7]
  • Vaginal infections: Those changes in the acid balance of your vagina can make the vaginal infections more likely. [8]


[1] Lee A, Kim TH, Lee HH, et al. Therapeutic approaches to atrophic vaginitis in postmenopausal women: A systematic review with a network meta-analysis of randomized controlled trials. Journal of Menopausal Medicine. 2018;24(1):1–10. doi:10.6118/jmm.2018.24.1.1

[2] Shen J, Song N, Williams CJ, et al. Effects of low dose estrogen therapy on the vaginal microbiomes of women with atrophic vaginitis. Scientific Reports. 2016;6.

[3] Lester J, Pahouja G, Andersen B, Lustberg M. Atrophic vaginitis in breast cancer survivors: A difficult survivorship issue. Journal of Personalized Medicine. 2015;5(2):50–66. doi:10.3390/jpm5020050

[4] Jensen PT, Froeding LP. Pelvic radiotherapy and sexual function in women. Translational Andrology and Urology. 2015;4(2):186–205.

[5] Coelho FC, Barros C. The potential of hormonal contraception to influence female sexuality. International Journal of Reproductive Medicine. 2019;2019:9701384. doi:10.1155/2019/9701384

[6] Brotman RM, He X, Gajer P, et al. Association between cigarette smoking and the vaginal microbiota: a pilot study. BMC Infectious Diseases. 2014;14:471. doi:10.1186/1471-2334-14-471

[7] Goldstein I, Dicks B, Kim NN, Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sexual Medicine. 2013;1(2):44–53. doi:10.1002/sm2.17

[8] Lee A, Kim TH, Lee HH, et al. Therapeutic approaches to atrophic vaginitis in postmenopausal women: A systematic review with a network meta-analysis of randomized controlled trials. Journal of Menopausal Medicine. 2018;24(1):1–10. doi:10.6118/jmm.2018.24.1.1


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