Atrophic vaginitis is the drying, thinning, and inflammation of the vaginal walls. It results from falling estrogen levels and usually happens after menopause.

Atrophic vaginitis is a type of genitourinary syndrome of menopause (GSM). GSM refers to atrophy due to loss of hormones in the perineal area, including the vagina.

The condition can cause painful intercourse and increased urinary tract infections (UTIs). A doctor may recommend topical treatments and hormone replacement therapy (HRT) to treat the condition.

Read on to learn more about atrophic vaginitis. This article discusses symptoms, causes, treatment options, and more.

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Possible symptoms of atrophic vaginitis include:

  • vaginal dryness
  • pain during sexual intercourse (dyspareunia)
  • changes in vaginal discharge
  • paleness and thinning of the labia and vagina
  • more frequent UTIs

Symptoms can also affect urination. These can include:

  • painful urination
  • blood in urine
  • increased frequency of urination
  • incontinence

There may also be a reduction in pubic hair, and the vagina may become narrower and less elastic.

The most common cause of atrophic vaginitis is the decrease in estrogen after menopause.

The ovaries make estrogen until a female experiences menopause. In the United States, the average age at which menopause occurs is 45–55 years, though some people may experience menopause earlier or later. Before menopause, the estrogen in a person’s bloodstream helps protect the skin of the vagina and stimulates vaginal secretions.

When the ovaries stop making estrogen after menopause, the walls of the vagina become thin, and vaginal secretions reduce. Similar changes can happen after childbirth, but these are temporary and less severe.

Other causes include:

To assist with reaching an accurate diagnosis, the doctor will carry out an examination and discuss medical history. They may ask about the use of products that can irritate the area and cause or aggravate symptoms, such as soaps or perfumes.

Diagnosis typically relies on a person’s symptoms. The doctor may also order tests to confirm the diagnosis and rule out other possible causes.

They may take the pH, or acidity, of the vaginal area. A pH of 4.6 or higher indicates atrophic vaginitis.

The doctor may also request an infection screening. Atrophic vaginitis can make the area more susceptible to infections and it also may occur alongside an infection.

If the diagnosis is unclear, or if the doctor suspects malignancy, they may order a biopsy to rule out cancer.

Various treatments may help a person to manage atrophic vaginitis.


A water-soluble vaginal lubricant may help provide relief during intercourse in mild cases.

However, it is important to note that petroleum jelly, mineral oil, or other oils are not suitable. These may increase the chance of infection and may damage latex condoms or diaphragms.


HRT can supply estrogen to the whole body. It is available in various forms:

  • creams
  • gels
  • tablets
  • patches
  • implants

It is generally effective, but there may be side effects. A person should discuss the risks of long-term HRT with their doctor.

A person applies localized HRT topically, focusing treatment on the affected area. A person can apply vaginal tablets, creams, rings, and pessaries internally to focus the supply of estrogen to the vaginal area.

A low dose estriol cream can stimulate rapid reproduction and repair of the vaginal epithelium cells.

A person’s doctor can advise on more treatments that may help a person manage symptoms of atrophic vaginitis.

While it may not be possible to completely prevent atrophic vaginitis, using vaginal estrogen before the condition becomes severe can be a way to protect the vagina.

Using a water-soluble vaginal lubricant can soothe mild cases during sexual intercourse.

Atrophic vaginitis typically occurs after menopause, when estrogen levels are low. It can cause vaginal dryness, pain during sex, and changes in discharge and urination. It can also increase a person’s risk of UTIs and other infections.

It is best to contact a doctor if a person has concerns about atrophic vaginitis. The doctor can confirm the diagnosis and advise on treatments to help a person manage atrophic vaginitis. These may include lubricants and HRT.