My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
Not much scares me more than the feeling of something interfering with my sex life. Not even spiders, and if you know me you know I am terrified of those little buggers.
Anyway, pain during sex can immediately kill the vibe and cause major problems down the line if the cause is left untreated. One condition that can cause pain during sex is vaginal atrophy.
Vaginal atrophy, also known as atrophic vaginitis, is the thinning, drying, and inflammation of the skin in and around the vagina. It happens when the body begins losing (o)estrogen.
The primary cause of atrophy in the vagina is a loss of estrogen. Estrogen is responsible for helping to keep the vagina healthy and renewed.
“Estrogen typically stimulates exfoliation of vaginal epithelial cells, causing increased levels of glycogen in which vaginal flora lactobacilli convert into lactic acid. This process allows for the replacement of older vaginal epithelium, keeping the typical acidic pH of the vaginal canal.
“As estrogen levels decrease, this process is hindered, and the vaginal epithelium becomes atrophic with diminished secretions and a less acidic environment. This, in turn, increases the risk of vaginal and urinary tract infections.” (Bleibel; Nguyen, 2022)
As we see from the above excerpt, the reduction of estrogen can be a catalyst for other problems as well.
Though vaginal atrophy is most commonly experienced during and after menopause, postmenopausal atrophic vaginitis is not the only kind. There are people who have not gone into menopause who may suffer from the condition.
People on certain medications such as certain birth control pills or some cancer treatments may experience atrophy. Certain surgeries, such as the removal of the ovaries can cause atrophy as well.
Transgender people may also experience vaginal atrophy while undergoing gender affirming care. In a study titled, The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People, we learn: “Transmasculine individuals on testosterone therapy frequently experience symptoms of vaginal atrophy similar to those of the post-menopausal state, including dryness, irritation, bleeding with vaginal penetration (sex or medical examination), and dyspareunia.”
The symptoms of this condition can be overwhelming and many are left undiagnosed, and left to deal with it on their own. Let’s find out what to look for.
The symptoms of atrophy in the vagina can vary from person to person and can include:
There are other types of atrophy that can be present as well. Each has their own symptoms that can compound the ones from vaginal atrophy.
Vulvar atrophy occurs in the vulva and can affect the surrounding areas. This can include cervix atrophy, labial atrophy, genital atrophy, and an atrophic uterus. A study called, Vulvovaginal Atrophy, provides us with the following information:
”Vulvovaginal atrophy (VVA) is a common and underreported condition associated with decreased estrogenization of the vaginal tissue. Symptoms include dryness, irritation, soreness, and dyspareunia with urinary frequency, urgency, and urge incontinence.”
This can affect a woman at any age, but is most often associated with perimenopause and post menopause.
Atrophy that also occurs in the urinary tract called urogenital atrophy, this can include urethral atrophy which affects the urethra.
“Urogenital atrophy resulting from postmenopausal estrogen deficiency has numerous clinical effects, including vaginal dryness, sexual dysfunction, urinary incontinence, and recurrent urinary tract infections (UTIs), all of which can cause significant distress and reduction in quality of life. Although nearly one third to one half of postmenopausal women experience these symptoms, they are often overlooked because patients may be reluctant to discuss them and clinicians fail to screen for them.
“As these symptoms are unlikely to resolve without treatment, the prompt diagnosis and treatment of urogenital atrophy is essential. Estrogen therapy, administered either locally or systemically, provides significant relief from symptoms related to urogenital atrophy.” (Goldstein 2010)
As one might imagine, these things can take a toll on the sufferer’s life. It can cause fear, pain, relationship difficulty, and embarrassment. Especially if the person doesn’t realize their condition has a name, cause, and doesn’t have to be permanent.
Awareness is key, as some of the above symptoms can also be attributed to other conditions. Unfortunately, lack of knowledge and shame can prevent a visit to the doctor leading to an increase and worsening of the condition. With knowledge comes power, and doctors have the power to treat atrophic vaginitis.
Diagnosing atrophy in the vagina requires simple tests such as a pelvic exam, urine testing, and an acid balance test. These tests are normally painless.
A pelvic exam, though uncomfortable, usually isn’t painful. Urine testing is relatively easy and consists of collecting urine in a cup and testing it. The acid balance test consists of placing a strip in the vagina, or collecting vaginal fluid to be placed on the strip to test the acid levels.
The list of treatments available, and the combinations that can be put together to help patients is long. Though it could take some trial and error to know which one is the best for each patient.
Doctors take into account the reasons someone is suffering, their age, other treatments they are using for other conditions, and the results gathered in the diagnosing phase.
Treatments available include creams, vaginal moisturizers (such as Gynatrof), and water based lubricants to treat the symptoms of dryness. Topical estrogen options to treat the cause can also be prescribed such as:
Laser treatment is an option that many don’t know is available. In a study called, Current Treatment Options for Postmenopausal Vaginal Atrophy, we learn:
“Recently introduced in the treatment of VVA, laser vaginal therapy has demonstrated effectiveness as well as high satisfaction among patients and health care providers. Data on the procedure were first published in 2014 and use of fractional microablative carbon dioxide laser therapy for genitourinary surgery was approved by the FDA.
“Laser therapy improves the vascularization of the vaginal mucosa, stimulates the synthesis of new collagen and matrix basic substance in the connective tissue, thickens the vaginal epithelium with the formation of new papillae, replenishes glycogen in the vaginal epithelium, allows restoring the balance of the mucosa and therefore improves the symptoms of atrophy caused by a lack of estrogen.” (Branco; Naumova, 2018)
Depending on the circumstances, laser treatment could be a great option for many.
Prasterone is used to deliver the hormone DHEA directly into the vagina and relieves the symptoms that make sex painful. This can really help and also prevent vaginismus. DHEA helps the body produce things like estrogen naturally.
There are medications you can take that can help with symptoms as well. These can be taken daily in accordance with your doctor’s orders, and be used alongside other forms of treatment.
There are natural treatments that don’t require medications or synthetic hormones. Here is a look at some of them.
Herbs and other natural supplements have been used for centuries to help heal and support the body. Oils such as coconut and olive oil can be used to lubricate the skin. Cranberry and other foods have helped with the urinary tract as well.
Gut health and diet can play a part in managing the symptoms of atrophy as well. Foods rich in plant estrogens, such as soy and flaxseed, could help.
Vitamins may help support and nourish the body which could lessen symptoms. Vitamins such as:
It is important to consult your doctor as these things may help, but especially for severe vaginal atrophy, it is important that they be used with the advice of a professional.
Moving our bodies can increase endorphins, help all the systems of the body get stronger and healthier, and make us feel great. When we feel great, dealing with symptoms is less stressful. Over all, especially with the other supports in place, exercise can be a huge asset.
Vaginal dilators stretch and stimulate the vagina. They can be used with other forms of estrogen therapy. These devices are available without a prescription, and are normally recommended to be used in addition to pelvic floor therapy.
Dilators are cylinder shaped and range in size from small finger to a larger dildo or penis. They usually have a wider base to make them easy to handle. Their graduating size can help relieve the stress and fear of things being in the vagina, and be used privately.
A relaxing environment, water based lube, and some time set aside are all good things to start. One should begin with the smallest dilator, or most comfortable, allowing it to gently stimulate and stretch the vagina in a painless way. Progression to the next size should be done when the person is ready, and with the advice of their therapist or doctor.
Vaginal atrophy treatment is usually extremely effective. “Studies have shown that systemic HRT eliminates the symptoms of vaginal atrophy in 75% of cases, while local therapy does so in 80%–90% of cases.” (Branco; Naumova, 2018) There is hope for those who are suffering with atrophic vaginitis. Odds are, getting treatment will help tremendously.
A happy, healthy vagina is something all vagina owners can benefit from. New or worsening symptoms can be scary and intimidating.
For those suffering with atrophy, the options are many. The information above was just a sample of what could be available.
If you have any questions or are experiencing symptoms that are consistent with vaginal atrophy, please, call your doctor. Treatment can make a tremendous difference and put you back in control of your life.
References:
Bleibel, B., & Nguyen, H. (2022). Vaginal Atrophy. In StatPearls. StatPearls Publishing.
Krakowsky, Y., Potter, E., Hallarn, J., Monari, B., Wilcox, H., Bauer, G., Ravel, J., & Prodger, J. L. (2022). The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People. Frontiers in cellular and infection microbiology, 11, 769950. doi.org/10.3389/fcimb.2021.769950
Mac Bride, M. B., Rhodes, D. J., & Shuster, L. T. (2010). Vulvovaginal atrophy. Mayo Clinic proceedings, 85(1), 87–94. doi.org/10.4065/mcp.2009.0413
Goldstein I. (2010). Recognizing and treating urogenital atrophy in postmenopausal women. Journal of women’s health (2002), 19(3), 425–432. doi.org/10.1089/jwh.2009.1384
Naumova, I., & Castelo-Branco, C. (2018). Current treatment options for postmenopausal vaginal atrophy. International journal of women’s health, 10, 387–395. doi.org/10.2147/IJWH.S158913
We hope you enjoyed this article. To help us to create more content like this, please consider visiting our Shop.
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
If you’ve had more than one loss, you may already have had chromosome testing, a karyotype or carrier screening, and still no answer. Here is
I am 36 years old, and I have spent a large part of my life trying to understand my own body and trying to become
