Atrophic Vaginitis; Symptoms, Diagnosis, Treatment

Atrophic Vaginitis/ Vaginal dryness or atrophic vaginitis is a common symptom of menopause. It is characterized by a lack of moisture in the vaginal area, which can cause itching, irritation, burning or stinging sensations. During intercourse, vaginal dryness can also lead to pain and light bleeding.

Alternative Names of Vaginal dryness

Vaginitis – atrophic; Vaginitis due to reduced estrogen; Atrophic vaginitis

Causes of Atrophic Vaginitis

In addition to hormonal causes, other physiological, environmental, and emotional factors can cause or contribute to vaginal dryness.

• Autoimmune diseases (e.g., Sjogren’s syndrome)
• Infections (bacterial, viral, or sexually transmitted)
• Certain medications (e.g., antihistamines, cold medications, antidepressants)
• Cancer treatments
• Smoking and alcohol consumption
• Douching
• Allergic reaction to chemicals in soaps, detergents, etc.
• Anxiety Stress and anxiety can affect sexual desire and may lead to vaginal dryness.
• Sjogren’s syndrome This rare autoimmune disease can cause dryness in the eyes, mouth, and vagina.
• Low sexual desire A low libido or other sexual problems may give way to dryness, and conversely, the dryness may worsen libido.

Symptoms of Vaginal dryness

Many women find that the symptoms of vaginal dryness can affect the way they feel about themselves, sex, and life in general. There are a wide range of possible sensations, though the following are the most common symptoms involved with vaginal dryness.

• Itching
• Light bleeding during sex
• Painful intercourse
• General discomfort
• Burning
• Stinging
• Irritation
• Frequent urination
• Discomfort when wearing pants
• Pressure in the area

While these symptoms are common, certain factors can aggravate or worsen vaginal dryness during menopause.

• Burning on urination
• Light bleeding after intercourse
• Painful sexual intercourse causing a loss in sexual interest
• Slight vaginal discharge
• Vaginal soreness, including itching or burning sensation

Treatment of Vaginal dryness 

There are several treatment options for women with vaginal dryness: vaginal moisturizers or lubricants, vaginal estrogen, a pill called ospemifene (brand name: Osphena), and a vaginal tablet called prasterone, or dehydroepiandrosterone (DHEA). All vaginal dryness treatments work temporarily. The vaginal dryness will return when the treatment is stopped unless the ovaries make more estrogen.

Vaginal lubricants and moisturizers — Vaginal lubricants and moisturizers can be purchased without a prescription. These products do not contain any hormones and have virtually no side effects.

Lubricants are designed to reduce friction and discomfort from dryness during sexual intercourse. The lubricant is applied inside the vagina or on the penis just before having sex. Products designed as vaginal lubricants (eg, Astroglide) are more effective than lubricants that are not designed for this purpose, such as petroleum jelly (Vaseline).

Oil-based lubricants, such as petroleum jelly, baby oil, or mineral oil, may damage latex condoms and/or diaphragms and make them less effective in preventing pregnancy or sexually transmitted infections. Polyurethane condoms can be used with oil based products. Also, lubricants that are made with water or silicone can be used with latex condoms and diaphragms.

Natural lubricants, such as olive, avocado or peanut oil, are easily available products that may be used as a lubricant with sex. Again, natural oils are not recommended for use with latex condoms or diaphragms; the oil can damage the latex, potentially making it less effective in preventing pregnancy or sexually transmitted infections.

Vaginal moisturizes (eg, Replens, Moist Again, Vagisil, K-Y Silk-E, and Feminease) are formulated to allow water to be retained in the vaginal tissues. Moisturizers are applied into the vagina three times weekly to allow a continued moisturizing effect. These should not be used just before having sex, as they can be irritating.

Hand and body lotions should not be used to relieve vaginal dryness since they can be irritating to the vaginal tissues.

Vaginal estrogen — Vaginal estrogen is the most effective treatment option for women with vaginal dryness. Vaginal estrogen must be prescribed by a healthcare provider.

Very low doses of vaginal estrogen can be used when it is put into the vagina to treat vaginal dryness. A small amount of estrogen is absorbed into the bloodstream, but only about 100 times less than when using estrogen pills or tablets. As a result, there is a much lower risk of side effects, such as blood clots, breast cancer, and heart attack, compared with other estrogen-containing products (birth control pills, menopausal hormone therapy).

Several types of vaginal estrogen products are available

• Estrogen cream (eg, Premarin, Estrace cream) – is inserted into the vagina every day for two to three weeks, and then one or two times weekly. The cream can be difficult to measure accurately and insert into the vagina.
• The vaginal estrogen insert (Vagifem) –  looks like a small tablet but is inserted inside the vagina. The vaginal tablet is packaged in a disposable applicator. Vagifem is usually inserted every day for two weeks and then twice weekly.
• The vaginal estrogen ring, called Estring – is a flexible plastic ring that is worn inside the vagina all the time. It is replaced every three months by the woman or her healthcare provider. The ring does not need to be removed during sex or bathing. It cannot be felt by most women or their sexual partners. In women who have previously had a hysterectomy, the ring will sometimes fall out.
• Estring  – should not be confused with the estrogen replacement vaginal ring (Femring), which releases a much higher dose of estrogen and is intended to be absorbed into the body to relieve hot flashes.
• How long can I use vaginal estrogen? — Vaginal estrogen is thought to be safe and can probably be used indefinitely, although there are no long-term studies confirming its safety.
• Is vaginal estrogen – safe for women with a history of breast cancer? — The safety of vaginal estrogen in women who have a past history of breast cancer is unclear. A small amount of estrogen can be absorbed from the vagina into the bloodstream. If you have a history of breast cancer, talk to your healthcare provider or your oncologist about the potential risks and benefits of vaginal estrogen.
• Ospemifene — Ospemifene is a prescription medication that is similar to estrogen, but is not estrogen. In the vaginal tissue, it acts similarly to estrogen. In the breast tissue, it acts as an estrogen blocker. It comes in a pill, and is prescribed for women who want to use an estrogen-like medication for vaginal dryness or painful sex associated with vaginal dryness, but prefer not to use a vaginal medication. The medication may cause hot flashes as a side effect. This type of medication may increase the risk of blood clots or uterine cancer. Further study of ospemifene is needed to evaluate the risk of these complications. This medication has not been tested in women who have had breast cancer or are at a high risk of developing breast cancer.
• Prasterone (dehydroepiandrosterone) — Prasterone, also known as dehydroepiandrosterone (DHEA), is also an option for women with vaginal dryness due to menopause. It comes in the form of a suppository that is inserted into the vagina once a day. Vaginal estrogen therapy is more commonly used than prasterone, because vaginal estrogen has been studied more thoroughly and the twice-weekly dosing may be more convenient. However, prasterone is a reasonable option for women who can’t take estrogen or prefer to avoid it, but who can use other vaginal hormones.
• Sexual activity — Vaginal estrogen improves vaginal dryness quickly, usually within a few weeks. You may continue to have sex as you treat vaginal dryness because sex itself can help to keep the vaginal tissues healthy. Vaginal intercourse may help the vaginal tissues by keeping them soft and stretchable and preventing the tissues from shrinking.

Non-Hormonal Remedies

The following non-hormonal remedies may provide relief for vaginal dryness and discomfort:

• Vaginal lubricants – Reduce discomfort with sexual activity when the vagina is dry by decreasing friction during intercourse. Water-soluble products are effective, as well as olive and coconut oils.
• Vaginal moisturizers – Line the wall of the vagina and maintain vaginal moisture. Like your face or hands, your vagina should be moisturized on a regular basis — several times weekly, at bedtime.
• Regular sexual stimulation – Promotes blood flow and secretions to the vagina. Sexual stimulation can improve vaginal health.
• Pelvic floor exercises – Can both strengthen weak vaginal muscles and relax tight ones.
• Expanding your views of sexual pleasure – Options such as extended caressing, mutual masturbation and massage. Trying different options can help make painful intercourse more comfortable or allow you to remain sexually intimate without intercourse.

In addition, vaginal dilators can help stretch and enlarge the vagina, especially if sexual activity is infrequent and the vagina has become too short and narrow for intercourse. In addition to regular use of vaginal estrogens, lubricants and moisturizers, several months of daily “exercises” with lubricated vaginal dilators can help. Dilators can be purchased from pharmacies and medical supply stores and used with the guidance of a gynecologist, physical therapist or sex therapist.

Vaginal Estrogen Therapy

Low-dose topical estrogen is an effective and safe treatment available by prescription. Improvements usually occur within a few weeks; although, complete relief may take several months.

Topical estrogen is applied directly to your vagina to:

• Increase the thickness and elasticity of vaginal tissue.
• Restore a healthy pH level.
• Increase vaginal secretions.
• Relieve vaginal dryness and discomfort with sexual activity.

Low-dose vaginal estrogen products are available by prescription as vaginal creams (used two or three nights weekly), a vaginal estradiol tablet (used twice weekly) and an estradiol vaginal ring (changed every three months). All are highly effective. You may wish to try several different methods and choose the one you prefer.

Home Remedies

Vaginal dryness affects any age but it most commonly occurs after menopause .

In fact, up to 40 percent of postmenopausal women complain about this problem, but only a few get medical help .

During the stage of menopause, the body stops producing estrogen, the hormone in charge of lubricating the vagina, maintaining its elasticity, and keeping it healthy.

At first, vaginal dryness may not seem like a big deal. But over time, it can take a toll on your relationship and sex life .

Estrogen replacement therapy is the frequently used treatment for this condition but unfortunately, it can cause unpleasant side effects such as bleeding in the vagina, and tender and painful breasts, among others .

If you’d like to resolve this issue without using an estrogen product, here are some natural home remedies that you can try.

These remedies can also provide relief for other symptoms that accompany vaginal dryness such as itching, burning sensation, swelling, and pain during sexual intercourse.

Tea Tree Oil

In Australia where tea tree oil originated as well as in Europe and North America, it is added to topical formulationsdesigned to cure cutaneous infection.

This oil is loaded with many active compounds but its main component terpinen-4-ol is what’s responsible for most of its pharmacological benefits .

Vaginal atrophy is one of the many issues that it can help resolve.

This condition is characterized by changes in the vagina such as thinning, drying and swelling due to the reduced levels of estrogen hormone .

Tea tree oil belongs to the list of effective non-hormonal remedies for vaginal dryness .

Not only is it a natural oil that can lubricate the vagina, it is also an antimicrobial that can preserve the proper balance of bacteria in the genital area .

In fact, it is typically used as an “adjunct in the treatment” of vaginal infections .

What You’ll Need:

• 2 drops of tea tree oil
• 1 tablespoon of coconut oil

Recommended Directions:

• In a mixing bowl, put tea tree oil and coconut oil.
• Mix well.
• Pour mixture in a glass jar with a lid.
• Shake to make sure that the oils are blended.
• Using a cotton swab, apply oil mixture in the vagina.
• Repeat procedure twice a day.

Aloe Vera

In ancient Egypt, aloe vera became known as the “plant of immortality” .

For centuries, its various medicinal applications have been utilized not only in Egypt but also in other countries such as Japan, China, India, Greece and Mexico .

Today, it serves many purposes in health and dermatology.

For those who’d like to get rid of vaginal dryness, they can try using aloe vera, which is also recognized widely as a natural moisturizer.

It’s a good non-hormonal alternative to treating vaginal atrophy .

The gel extract from this plant can be applied topically to alleviate vaginal dryness .

Since it’s also a potent anti-inflammatory, it can also prevent swelling, which is another change in the vagina due to decreased estrogen levels .

What You’ll Need:

• 1 teaspoon of aloe vera gel
• 1 teaspoon of fresh milk
• 1 glass of aloe vera juice

Recommended Directions:

• Mix aloe vera gel and fresh milk.
• Use this mixture to wash your vagina during bath time.
• Be sure to rinse well with water after.
• Also, make it a habit to drink aloe vera juice everyday as it helps in the lubrication of the vagina.

Coconut Oil

There are many lubricant products available in the market today but if you prefer to do it the natural way, then you can make use of natural oils like coconut oil.

Coconut oil works by restoring the skin’s barrier function, which in turn can help reduce vaginal atrophy symptoms such as itchiness, burning pain, and dryness.

When applied inside the edge and outside the entrance of the vagina, it can help rejuvenate dry and irritated tissues .

However, it should be used pure, and not combined with essential oils or other additives.

Pure coconut oil can easily be purchased in pharmacies and many health food stores so you won’t have a hard time using this remedy .

Just remember not to use it with a condom, as it may break down the latex and damage the condom, putting you at risk of pregnancy or infection from your partner .

What You’ll Need:

• 1 teaspoon of virgin coconut oil
• 1 tablespoon of coconut oil

Recommended Directions:

• Consume a teaspoon of virgin coconut oil everyday.
• Pour a tablespoon of coconut oil on your genital area.
• Massage it to restore lubrication and moisture.
• Do this once a day.

Chamomile

Rich in flavonoids and terpenoids, chamomile flowers have long been used to treat many health problems including ulcer, insomnia, digestive ailments, muscle cramps, hay fever and inflammation .

Chamomile is also a viable remedy for atrophic vaginitis.

Washing with a chamomile concoction may help improve the symptoms of this condition, including vaginal itching, discharge, dryness, and even pain during urination.

Its natural moisturizing effects are useful for reducing dryness in the vagina.

Although found effective, this herbal solution is not without a few minor side effects, which you may or may not be able to tolerate.

Other clinical reviews on vaginal atrophy treatments mention the use of chamomile.

What You’ll Need:

• 1 cup of dried chamomile flowers
• 1 pot of water

Recommended Directions:

• Boil a pot of water.
• Add chamomile flowers.
• Simmer for 10 minutes.
• Remove from heat.
• Let it steep for 10 minutes more.
• Strain the mixture.
• Use this to wash your vagina throughout the day.
• This remedy is mild enough to use daily.

Flaxseeds

Herbal remedies for vaginal dryness consist not only of natural ingredients that can be applied topically but also those that can be ingested internally.

Flaxseeds, for example, are loaded with omega 3 fatty acids and vitamin E that can help keep estrogen levels up, and thereby prevent dryness in the vagina.

An oral dose of vitamin E between 100 and 600 IU has been found to improve vaginal lubrication, as well as reduce dryness and irritation.

You can choose to supplement with vitamin E or simply up your intake of vitamin E food sources such as flaxseeds. It’s also a good idea to use vitamin E oil as a natural vaginal lubricant.

What You’ll Need

• A bunch of flaxseeds

Recommended Directions:

• Snack on flaxseeds throughout the day.
• You may eat it plain, or include it in your meals.
• This will help keep the estrogen levels up, and prevent the vagina from drying.

Olive Oil

Olive oil is often included in the non-hormonal treatment options for vaginal dryness and atrophy.

As a lipid lubricant, it is packed with unsaturated fatty acids that enhance hydration as well as repair the epithelial tissues in the vagina .

The best thing about this is that it does so without causing any side effects and without disrupting the vaginal microbiota .

In a clinical trial performed by Australian researchers, 25 women who have difficulty or pain during sexual intercourse, were asked to use nonconventional treatments such as olive oil, exercise, and moisturizer to resolve this problem.

Olive oil was rated as 73 percent effective in improving the condition.

What You’ll Need:

• 1/4 cup of olive oil

Recommended Directions:

• While bathing, wash your vagina with water.
• Do not use any soap or cleanser.
• Pat it dry.
• Pour over olive oil on your vagina.
• Let it sit for 30 minutes before wiping off.
• Follow this treatment method three times a week.

Nettle

Nettle has been found to possess many pharmacological effects that are beneficial for people’s health.

It’s a strong antioxidant, antifungal, antibacterial and analgesic that can ward off many types of infections and ailments .

Although it’s not a popular remedy for vaginal dryness, some women have reported that it works. This is even though there is no sufficient scientific evidence to support its efficacy and safety.

According to Turkish researchers, daily infusion of nettle is an efficient way to rehydrate the dry tissues in the vagina.

What You’ll Need:

• 1 cup of nettle leaves
• 1 pot of water

Recommended Directions:

• In a pot, bring water to a boil.
• Lower heat to simmer.
• Add nettle leaves.
• After 15 minutes, remove from heat.
• Let it steep for 10 to 15 minutes.
• Strain the tea.
• Use this mixture to rinse the vagina each time you will use the comfort room.
• Be sure that it’s cool enough before you use it.

Comfrey Root

Comfrey root may not be as famous as other herbal roots like ginger or turmeric but it is also a powerful medicinal plant that has been used for centuries.

It originated in Europe and in some countries in Asia but it was also naturalized in North America where the Native Americans immediately took note of its amazing healing powers.

At present, many randomized controlled trials have confirmed its effectiveness as a remedy for pain and inflammation due to arthritis, strain, sprain, acute myalgia and so on.

This herbal solution is also recommended for vaginal atrophy, particularly for dryness. Infusing bath water with comfrey root or using it for massaging the vagina can strengthen and soften the vaginal tissues.

When used as a lubricant during sexual intercourse, it can improve vaginal flexibility and boost sexual performance.

What You’ll Need:

• 1 tablespoon of comfrey root
• 3 cups of water
• 1 teaspoon of olive oil

Recommended Directions:

• Boil comfrey root in three cups of water.
• Remove from heat.
• Cover and allow to steep for 20 minutes.
• Strain the mixture.
• Massage your vagina with this mixture three times a day.
• Pour olive oil on the vagina after.

Soy

A drop in estrogen level is the main factor that causes vaginal dryness.

This can be remedied by using phytoestrogens, which refer to “nonsteroidal compounds” that can be found in plants, and are “capable of binding to estrogen receptors” .

Isoflavones, in particular, have been found to improve vaginal dryness when applied topically or when used in combination with other compounds such as vitamin E.

Because they can mimic the properties of estrogen, isoflavones can also treat other menopausal symptoms such as hot flashes, night sweats, and insomnia.

One of the best sources for isoflavones is soybean.

Take note, however, that soy products cannot be used for long term as they may have an adverse effect on the uterus.

What You’ll Need:

• 3 glasses of soy milk

Recommended Directions:

• Drink a glass of soy milk once in the morning, once during lunch time and once before going to bed.
• Do this remedy for only one to two months.

Exercise

Unlike in the previously mentioned remedies that require the use of natural ingredients, this one only entails patience and consistency on your part.

Regular exercise has been found to be beneficial for those suffering from vaginal dryness.

Not only does it boost blood circulation and maintain hormonal balance, but it also stimulates activity in the adrenal glands to promote the production of estrogen.

Experts recommend regular aerobic workouts such as swimming and running or low-intensity activities like yoga.

On the other hand, irregular high-impact exercises should be avoided as these may only worsen your condition.

A 2013 study reports that pelvic floor muscle (PFM) relaxation exercises performed twice daily had an efficiency rating of 92 percent.

What You’ll Need:

• Patience and consistency

Recommended Directions:

• Go brisk walking 30 minutes a day in the morning before going to work.
• In the afternoon, when you come home, engage in a 30-minute aerobic workout such as jogging and jumping jacks.
• Be sure to do warm-up and cool-down exercises before and after each workout.

Milk

There are plenty of good reasons milk is used for skin care.

Many believe that it has soothing properties that can moisturize skin and prevent dryness.

It is also said to exfoliate dead skin cells, brighten the complexion, and improve skin’s ability to draw in and lock in moisture.

These claims are not unfounded.

Japanese researchers investigated in 2015 the effects of milk on dry skin, and they conclude that it works by preventing moisture loss and increasing hydration.

For those who complain of vaginal dryness, bathing in milk or applying milk on the affected area can be a quick and effective solution.

As an added bonus, you get to have smooth and soft skin after using this remedy.

What You’ll Need:

• 1 cup of cold milk
• 10 drops of rose water

Recommended Directions:

• Add rose water to cold milk.
• Soak a cloth in the milk mixture.
• Apply on the vaginal area for five to seven minutes.
• Wash off the milk with water.
• Repeat procedure everyday.

Honey

Like milk, honey has also been used since the ancient times as part of skin care regimen.

Honey is said to be one of the most effective natural moisturizers that can also nourish the skin with its overload of antioxidants.

It works to relieve skin dryness by attracting moisture from the atmosphere, and sealing it in the skin.

Several studies mention honey’s properties as a humectant, emollient and moisturizer

It’s not a surprise that it can also help curb the problem of vaginal dryness.

Just make sure that you don’t use honey in pure form. You must dilute it in water as it can be very sticky and difficult to remove.

What You’ll Need:

• 1 cup of water
• 1 teaspoon of honey

Recommended Directions:

• Dissolve honey in water.
• Use this solution to wash your vagina every morning.
• Wash off with warm water.
• Repeat every day for several weeks.

Vaginal dryness may not seem as terrible as other menopausal symptoms such as hot flashes or depression. But just the same, it can also have adverse effects in your life.

Because of this, it’s imperative to resolve this issue right away using home remedies that are not only simple and cost-effective but also safe.

References