Vulvovaginal atrophy is a change in the surface of the vagina as well as the vulva. These changes can cause the vagina and vulva to be thin, pale, and dry.
The vagina and its opening can become very narrow. It can shorten when a person does not have sex. The lining can be thin and less stretchy.
Vulvovaginal atrophy can change the amount of blood flow, vaginal secretions, and lubrication. It can also cause more swelling.
Vulvovaginal atrophy affects as many as 45 out of 100 people who are midlife and older. Not many people try to get help for this problem. If you do not treat vulvovaginal atrophy, it can get worse.
Your treatment plan will be based on your symptoms, your level of pain, and your goals. The main goal of treating vulvovaginal atrophy is to make the symptoms go away.
You may only need to use a short course of therapy to be symptom-free. If you stop treating vulvovaginal atrophy, the symptoms may come back.
For people with vulvovaginal atrophy, therapy can be:
- Vaginal moisturizers that are free of hormones
- Low-dose vaginal estrogen
When you use vaginal moisturizers on a routine basis, they can help hydrate dry tissue. They are also able to help the tissue to become thicker and to stretch more. This will make the tissue less likely to tear and to be irritated. You may use these daily or up to many times each week.
- Sesame oil (Aura Cacia)
- Coconut oil
- K-Y Silk-E
- Hyaluronic acid with moisturizers (Hyalofemme)
Lubrication is good for any act that will penetrate the vagina. This can be sex as well as the use of dilators. For these acts, you will need to use silicone-based lubricant. It can help to lower friction, add moisture, and reduce tearing and irritation. Silicone-based lubricant products include:
- Jo Premium
- Uber Lube
- KY Silk or Intrigue
- ID Millennium
- Astroglide X
- Sesame or coconut oil (not to be used with latex condoms)
- Good Clean Love
Vaginal estrogen is not the same as a hormone replacement therapy (HRT). It is not used to treat general symptoms like hot flashes or night sweats. You should only use it to treat local symptoms. You may use it each night for one to two weeks. After that, you will use it two to three times each week.
- Vagifem (estradiol hemihydrate)
- Estrace (17 beta-estradiol/plant-based)
- Premarin (conjugated equine estrogens)
- Intrarosa: This is a daily vaginal suppository. It is used as a choice before you start to use estrogen and testosterone. The medication does not work until it is in the cells of the vaginal wall. It will help to lessen hormones that move in the whole-body system.
- Vaginal laser therapy: This can be used to help with vulvovaginal atrophy, painful sex, and dryness. It can also lower urinary incontinence, frequent peeing, and vaginal infections.
These are good for people if vaginal treatments do not work. They can be good for people who have systemic issues as well as vulvovaginal atrophy.
- Osphena is a selective estrogen receptor modulator, also known as a SERM. SERMs mimic what estrogen does in the body. In the vagina, it will act like estrogen. In the breast, it will act like an estrogen blocker. This may cause hot flashes. It can also increase the risk of blood clots and uterine cancer. This has not been tested in people who have had breast cancer. It has not been tested in people who are at a high risk of getting breast cancer.
- HRT will often use an estrogen gel or patch that is put on the skin. This is known as transdermal estrogen. This is preferred to taking estrogen by mouth due to its side effects. If a person has not had a hysterectomy, they may need progesterone by mouth. Doing this can help to stop the uterine lining from getting thick.
You can do physical therapy to help your vulvovaginal atrophy as well as taking medicine. A pelvic floor physical therapist can work with you. They will try to help lengthen, retrain, and stretch any muscle and tissue that may limit sex acts.
- A few people may have vaginal narrowing or vaginismus that can limit vaginal penetration.
- You can stretch the vagina with lubricated vaginal dilators of varying sizes. This can help to bring back as well as maintain vaginal function.
- You can start normal sex acts as soon as penetration is comfortable for you. Doing this will also help with your vaginal health.
- You can use vaginal estrogen before you start vaginal stretching or pelvic floor therapy. This may help your progress.
Pain with sex or not being able to have sex can put stress on you or your partner. This can be a strain on your relationship. Even the most supportive and understanding partner may be upset or feel helpless. Many people will have fears about hurting their partner. If vulvovaginal atrophy is making it hard for you to have sex, a sex therapist may be able to help.