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Vulvar and Vaginal Atrophy

Menopause is often called “the change of life” and with good reason. Women at midlife can experience a number of changes, both physical and emotional. It’s all a part of aging, but some changes are tougher than others.

One physical change common in postmenopausal women is vulvar and vaginal atrophy (VVA). The decline in estrogen at menopause leads to cellular changes in the vagina and vulva (the genital area outside of the vagina). Tissues become thinner and drier and lose their flexibility. There is also a decrease in vaginal pH. VVA is chronic and progressive. It doesn’t get better on its own.

What does this mean for women?

For many, VVA makes sex uncomfortable, even painful. Vaginal walls don’t secrete fluid the way they used to and poor lubrication can lead to irritation, tearing, and bleeding during penetrative sex. The vagina may also become narrower and shorter, especially if a woman doesn’t have intercourse on a regular basis.

Discomfort from VVA is not limited to sexual activity. Many women have itching, burning sensations, pain, and vaginal discharges throughout the day.

VVA can make life a challenge. Sexual difficulties and loss of intimacy can test relationships. Some women avoid intercourse altogether or avoid starting new relationships. Others may have trouble sleeping, working, playing sports, or enjoying time with friends.

It’s estimated that up to half of postmenopausal women have symptoms of vulvar and vaginal atrophy.  VVA affects an estimated 32 million women in the United States alone. Unfortunately, many women aren’t aware of VVA and don’t discuss it with their doctor. And many doctors don’t bring up the subject either.

What can be done? Today we’ll look at some ways to cope with VVA.

Over-the-Counter Treatments

Some symptoms of VVA can be treated with over-the-counter products like lubricants and moisturizers.

  • Vaginal lubricants can reduce friction during intercourse and are not absorbed into the skin. They are short-term solutions, applied before sex, and come in several varieties:

Water-based lubricants are a popular choice, as they are usually inexpensive and easy to wash off. However, they may need to be reapplied during sex.

Silicone-based lubricants tend to last longer than the water-based kind, but aren’t as easy to wash off.

Oil-based lubricants are usually not recommended. This type can weaken latex condoms, increasing the risk of breakage. While postmenopausal women don’t need to worry about pregnancy, sexually-transmitted infections are still a concern.

Some over-the-counter lubricants contain warming ingredients, dyes, perfumes, or glycerin that can irritate vaginal and vulvar tissue. If you experience this type of irritation, stop using the product and see your doctor.

  • Vaginal moisturizers are similar to lubricants, but they are applied regularly, usually every three to four days. Moisturizers are absorbed by the skin and stick to the vaginal lining, keeping it moist. These products are a good option for women who have ongoing problems with vaginal dryness.

Prescription Treatments

  • Low-dose vaginal estrogen may be dispensed as a cream, tablet, ring, or suppository that is applied directly to the vagina. Unlike vaginal lubricants and moisturizers, this therapy isn’t temporary. The medicine helps improve blood flow to the vagina and makes vaginal tissue thicker and more flexible. Vaginal estrogen should be prescribed at the lowest effective dose to limit the hormone’s effects on other parts of the body. Women who have had breast cancer should discuss their situation with their healthcare provider before considering this type of treatment.
  • Osphena (ospemifene) is an oral medication that was approved for postmenopausal women by the U.S. Food and Drug Administration (FDA) in February 2013. This drug acts like estrogen to thicken and strengthen vaginal tissues. It is prescribed for women who have moderate to severe pain during sex.
  • The FDA cautions that Osphena can cause the endometrium (lining of the uterus) to thicken. Women who experience any unusual bleeding should see their doctor as soon as possible.

Keep Having Sex

Having sex regularly can help keep the vagina moist, flexible, and healthy. It also helps prevent vaginal narrowing and shortening.

Speak Up!

Some women don’t feel comfortable discussing sexual issues or genital problems with the doctor. Likewise, some doctors feel awkward bringing up these topics with their patients. However, having the discussion is the first step in finding relief from VVA.

Even if you’ve talked to your doctor about VVA, don’t hesitate to speak up if a certain treatment isn’t working for you. It may take time to find the best solution, so don’t be discouraged if the first option isn’t the best. Another treatment may be more effective.


International Society for Sexual Medicine

“What is a lubricant?”

The Journal of Sexual Medicine

Kingsberg, Sheryl A., PhD, et al.

“Vulvar and Vaginal Atrophy in Postmenopausal Women: Findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) Survey”

(Full-text. First published online: May 16, 2013)

Medscape Education

Krychman, Michael L., MD

“Vaginal Atrophy: The 21st Century Health Issue Affecting Quality of Life”


The North American Menopause Society

“Changes in the Vagina and Vulva”

“Vaginal and Vulvar Comfort: Lubricants, Moisturizers, and Low-dose Vaginal Estrogen”

U.S. Food and Drug Administration

“FDA approves Osphena for postmenopausal women experiencing pain during sex”

(Press announcement. February 26, 2013)