Vulvovaginal atrophy

Vulvovaginal atrophy (Atrophic Vaginitis) is thinning, drying and inflammation of the vaginal walls due to decreased estrogen levels brought on by menopause.

Vulvovaginal Atrophy symptoms can vary, but patients typically experience:

• Vaginal dryness, burning, or discharge
• Genital itching
• Burning and/or urgency with urination
• Urinary incontinence
• Decreased vaginal lubrication during sexual activity
• Shortening and tightening of the vaginal canal
• And more.

Diagnosing and Treating Vulvovaginal Atrophy Online

Vulvovaginal Atrophy is a common, though underreported condition in which the vagina and the outer urinary tract become inflamed. The condition is caused by the thinning and shrinking of the tissues, as well as decreased lubrication, which occur during perimenopause and menopause. The condition can lead to pain during intercourse as well as urinary issues. Because the symptoms of vulvovaginal atrophy develop slowly, many women do not notice symptoms until many years after menopause begins. Vulvovaginal atrophy can occur prior to menopause in women who have had their ovaries removed or have undergone treatments for certain forms of cancer.

During a video consult on Amwell, one of our board-certified doctors will ask you a series of targeted questions to determine the severity of your vulvovaginal atrophy. Your diagnosis will be based on the duration and severity of symptoms, as well as your medical history.

Once a diagnosis has been made, your doctor will go over the risks and benefits of the various treatment plans. Treatment for vulvovaginal atrophy varies patient-to-patient depending on the severity and cause of the pain, but a consistent treatment routine can help minimize or eliminate the pain. Your doctor will likely have you try some simple, over-the-counter remedies first, including:

• Vaginal Moisturizer, such as Replens or Vagisil, to restore moisture to the vaginal area
• Water-based lubricants, such as Astroglide or K-Y Touch, which reduce discomfort during intercourse

If over-the-counter treatments are ineffective, your doctor may prescribe one or a combination of treatments including:

• Oral Estrogen: pills taken orally that increase the estrogen levels in your body and reverse some of the symptoms of menopause
• Topical vaginal estrogen: treatments come in cream, ring, or tablet form, and are applied topically, which gives them the advantage being effective at lower doses and limits your overall exposure to estrogen
• Systemic estrogen therapy: when Vulvovaginal Atrophy accompanies other symptoms of menopause, such as hot flashes, your doctor may prescribe estrogen pills, patches or gel, or a higher dose estrogen ring, in combination with progestin or oral progesterone
• Fractional Laser Treatment: small, independent studies have shown laser treatments for Vulvovaginal Atrophy to be effective, however, this treatment is still in the investigative stage

Even with treatment, vulvovaginal atrophy may result in a negative emotional response to sexual stimulation. If you and your partner are avoiding intimacy due to the pain from your vulvovaginal atrophy, your doctor may also recommend counseling or sex therapy to help resolve these issues. This may be with one of Amwell's online therapists or a local therapist in your area.

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