Smiling elderly couple sitting and holding hands by a window

Age Changes

Vaginal atrophy is a common, age-related sex problem. The following are the symptoms, and treatment.

Symptoms of Vaginal Atrophy

  • Increased discomfort or pain during intercourse
  • 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
  • Uncomfortable pelvic/gynecological exams

What is Vaginal Atrophy?

Vaginal atrophy is characterized as 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 in a woman, which is essential for a vagina's structural and functional integrity. These changes make the vagina susceptible to irritation and inflammation.

Low estrogen levels may result from menopause, aging, treatment for cancer, surgery, and/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 vaginal atrophy and other related symptoms, while the condition is referenced as "atrophic vaginitis". 

Vaginal Atrophy may lead to Vaginismus as a Secondary Condition

When vaginal atrophy goes untreated and women continue to have sex with pain, the vaginal muscles tend to brace themselves and protect the body by tightening up. Over time, vaginal tightening becomes an automatic reaction that persists, even after the original atrophy condition is diminished or eliminated. The ongoing tightness also causes discomfort or pain and can become 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 following treatment suggestions, 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 regular sex lives.

Vaginal DilatorsVaginal dilators are very helpful in restoring elasticity in the vagina. 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 MoisturizersVaginal 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 in the vagina.

Personal Lubricants—Personal lubricants make the vagina more slippery, reducing irritation and sometimes improving sexual pleasure. There are many different types of lubricants: 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 that heighten sexual pleasure.

Kegel ExercisesKegels 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 how to do these exercises in detail.

Estrogen ReplacementIf 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 your physician.