One of the most under- treated and least discussed condition is that of vaginal atrophy. This condition is better prevented than treated after the fact. Unfortunately, until the diagnosis is made one would not even consider discussing the treatment.

I routinely ask my patients if they experience signs and symptoms of vaginal atrophy. I have it on my questionnaire that I give all women of menopausal age. Many times the answer is no, and I know good and well the problem is there. Often, they are too embarrassed or shy to discuss the problem of vaginal dryness.

What does the term vaginal atrophy actually mean? Atrophy is a condition of cellular death, which leads to shrinkage of tissue as well as thinning of tissue. Once the blood flow is diminished the condition starts to develop. It may take years to produce symptoms, which are bothersome to the patient. The natural progression occurs with estrogen deficiency as seen in prior to and during menopause. The decline in estrogen can occur much sooner as early as the mid 40’s. This decline in estrogen is most abrupt with surgical menopause.

The symptoms of vaginal atrophy are: vaginal dryness, painful intercourse, bladder spasm, vaginal bleeding, and vaginal discharge. The signs are thinning of the labia and loss of vaginal rugae, (the folds in the vagina), erosion of the urethra, and incontinence of the bladder. The lack of intercourse will accelerate the signs and symptoms of vaginal atrophy.

The condition most commonly will present to women as dryness with intercourse. They will go out and buy vaginal lubricants to treat a condition that they accept as part of getting older. The mind set is a strong one and hard to change in some people. With education and acknowledging that this is a condition that is readily treatable, only then can we start to erode that old mindset.

Just to give you a little anatomy lesson, the urethra, bladder, and vagina all where embryological derived from the urogential  sinus, which is stimulated by estrogen.  So the lack of estrogen will lead to atrophy as quickly as it will stimulate the tissue.

Well what is the treatment of this condition? I hope you didn’t say KY jelly. The treatment is estrogen and how it is to be applied is very important to the success of the treatment. What I mean is there are many forms of treatment from vaginal pills, lotions, gel, creams, and inserts. All have the same goal of placing estrogen in the vaginal area for treatment. What varies is cost and effectiveness of treatment. The vaginal insert such, as Femring is very expensive and sometimes don’t always stay in place. If your vaginal atrophy is significant the ring may not even fit in the vagina. A pill insert called Vagistat is less painful to apply but is the most expensive method discussed. The vaginal creams such as Premarin and Estrace are meant to be applied through an applicator that applies estrogen deep into the vagina. The problem with this method is cost and the fact you applying hormone so deep into the vagina you are not getting to the areas that need it the most, i.e. urethra, lubricating glands at the opening of the vagina, and the labial tissue.

I find that the bio identical hormone estrogen lotion works extremely well. It is applied topically to the open of the vagina and therefore comes in contact with the areas that need the hormone the most. The lotion is bio identical so there is little concern about reaction to the application. The cost is around 4 dollars a month. Where some may be as high as 80 dollars a month, I see now why some women would use KY jelly as their first line treatment. I guess most women would like better sex, but it comes at a price point when it cuts into their hair salon budget.

The take home message is that with the age of Viagra and the liberation of men from erectile dysfunction, women you should empower yourself to be able to enjoy this time in your life without the problems that occur with vaginal atrophy. Think of it this way, if I cut off the blood supply to your arm and the tissue started to die you would do something about it, I am sure. Well, the same is seen with the vagina, you just can’t readily see it like you can an extremity. So don’t ignore what you can’t see for one day, it can cause you a lot of problems.