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Age Changes

Age, Atrophy & Vaginismus

Vaginal atrophy is a common, age-related sex problem. Here we explain the symptoms, treatment, and complications.

Symptoms of vaginal atrophy

  • Sex is increasingly uncomfortable and/or painful
  • Vaginal dryness, itchiness, and/or burning
  • Less natural lubrication
  • Vagina might feel like 'sandpaper' 
  • Slight spotting/bleeding during intercourse
  • Increased UTIs or vaginal infections
  • More frequent urination
  • Vagina may shrink, becoming shorter and narrower
  • Feelings of pressure
  • Vaginal discharge (usually yellowish in color)
  • Changes in the outer appearance of the vagina - shrinking folds of skin, less pubic hair
  • Pelvic/gynecological exams are uncomfortable

What is vaginal atrophy?

Vaginal atrophy is characterized by an inflammation of the vagina due to the thinning and shrinking of the vaginal walls and reduced lubrication.

The collagen, elastic fibers, vasculature, PH and moisture levels of the vagina and urinary tract are impacted by the loss of estrogen, which is essential for its structural and functional integrity. These changes make the vagina susceptible to irritation and inflammation.

Low estrogen levels may result from menopause, aging, cancer treatment, surgery, or childbirth. Over 50% of middle-aged or older women experience estrogen losses. Sometimes younger women do as well.

Doctors use the term genitourinary syndrome of menopause (GSM) to describe both atrophy and other related symptoms, and vaginal atrophy is alternately called atrophic vaginitis. 

Vaginal atrophy may lead to vaginismus, a secondary condition

When vaginal atrophy goes untreated and women continue to have intercourse with pain, the vaginal muscles tend to brace themselves to protect the body by tightening up. 

Over time, tightening becomes an automatic reaction that persists even after the original atrophy pain condition is diminished or eliminated. The ongoing tightness also causes discomfort or pain and is known as vaginismus.

Fortunately, both conditions are treatable. In fact, vaginal atrophy and vaginismus may need to be addressed simultaneously, as it is difficult to resolve one without managing the other. Atrophy can usually be resolved with the treatment suggestions following below, while vaginismus requires a more complex process as outlined in our book 'Completely Overcome Vaginismus'. 

Vaginal atrophy treatment options

Treatment options for vaginal atrophy include using vaginal dilators, personal lubricants and moisturizers, pelvic floor exercises, and sometimes estrogen replacement. With care, most women can return to a happy, healthy sex life.

Vaginal Dilators.  Vaginal dilators are very helpful in restoring elasticity. Starting with a small-sized lubricated dilator and slowly adjusting up in size, the vagina is gently stretched, making penetration comfortable again. 

Vaginal dilators are also effective within a program for the treatment of vaginismus.

Personal Lubricants. Personal lubricants make the vagina more slippery, reducing irritation and sometimes improving sexual pleasure. There are many different types: water-, oil-, or silicone-based, and even organic/plant-based formulas. Some women prefer to use coconut oil or other natural food-grade-edible oils.

Personal Moisturizers. Vaginal moisturizers help alleviate ongoing vaginal dryness. Moisturizers, such as Replens, Sylk, Yes, and others are available over-the-counter and can be used for comfort throughout the day, not just during sex. Be sure to read the labels when selecting a personal moisturizer, because some chemical ingredients – parabens and propylene glycol, for example – may irritate delicate tissues.

Kegel Exercises. Kegels are pelvic floor exercises that help stimulate blood flow to the vagina, increase elasticity, and strengthen the pelvic floor muscles. They also help to improve control over the vaginal muscles. There are various videos and sites on the internet that describe these exercises in detail.

Estrogen Replacement. If the treatment options listed above have not provided sufficient relief, estrogen replacement might be an option. It may help rebuild the lining of the vagina and increase natural lubrication.

Topical and oral forms of estrogen are available as creams, gels, sprays, suppositories, rings, patches, and tablets. Due to the risks associated with hormone replacement therapy, any type of hormonal treatment should be considered carefully in consultation with a physician.