Vaginal dryness, pain & irritation

Vaginal dryness & irritation is commonly seen around & after the time of menopause.

Causes

There are several causes, but the commonest by far is thinning of the skin, or vaginal atrophy, associated with reduced hormones. Another name for this menopausal condition is atrophic vaginitis.

Vaginal atrophy / atrophic vaginitis

Symptoms occur because drops in natural hormone levels during the menopause cause thinning of the skin of the vulva & vagina. This makes the skin more fragile generally. It can easily damaged during sexual intercourse. Lubrication levels decrease over time and the pH of the vagina changes. This encourages a change in the natural bacteria within the vagina (the microbiome) leading to fewer “friendly” lactobacilli, with an overload of “unfriendly” bacteria. This can cause infection making pain & discharge symptoms worse.

There are other causes of irritating vaginal symptoms

Any skin condition

Any skin condition seen elsewhere can be seen on the vulva too. For instance dermatitis (eczema) is common on the vulva, and can be caused by chemicals or can arise by itself.

Infection

Thrush is the commonest culprit, but other organisms like ureaplasma, anarobes or sexually transmitted infections can be the cause.

Lichen sclerosis

A poorly understood inflammatory condition which cause itching, pain, dryness & fusing. Chronic inflammation from LS can cause cancer after some time. Aggressive anti-inflammatory treatment with potent steroid cream is needed to reduce the cancer risk.

Vin & Vain

These are pre-cancerous conditions of the skin of the vulva and vagina that can lead to cancer. They are much less common than, for instance, cancer of the cervix. There is a relationship with HPV in younger women, and LS in older women.

Assessment

Assessment involves taking a history including checking whether there could be an allergic component. Then a detailed examination is performed. Swabs are usually needed. Biopsies may be needed. Atrophy can also affect the cervix and womb lining, causing bleeding. If there is bleeding this will need to be checked out.

Treatment

Hormone cream

Vaginal atrophy is then usually treated after diagnosis using a regular, very low dose local oestrogen hormone cream. The amount of hormone is much less than in HRT, has few risks. It can be used long-term. The normal dose is once nightly for 3 weeks, then 2-3 times weekly long-term. It takes a few months to work, so patience is needed.

Laser therapy

A new technique for vaginal atrophy is to use specially designed laser therapy directly applied to the vulval & vaginal skin. Three sessions are generally needed. The manufacturers describe it as mostly painless, which is not quite true! Vulval treatments are definitely painful, just like laser therapy to any other part of the skin. Vaginal treatments are better tolerated. A once-yearly treatment is recommended to maintain benefit. Overall, it’s about 60-70% effective. It is expensive – $2500-3000 for 3 sessions.