Coping with… Vulvo-vaginal atrophy
Thinning and drying of the vaginal walls and vulvae can be effectively treated
Vaginal and vulvar atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls and vulvae (genital lips) that may occur with a decrease in oestrogen, most often after the menopause.
Symptoms include genital itching, burning and discharge; pain, frequency and urgency when peeing; discomfort or light bleeding on intercourse, and recurrent urinary infections.
Atrophy is caused by decreasing oestrogen production, leading to thinner, dryer, less elastic and fragile vaginal and vulvar tissues. This occurs in the years leading up to and through the menopause, or after surgical removal of the ovaries. Women sometimes experience it during breastfeeding or when taking medications that affect oestrogen levels, such as some birth control pills, or after pelvic radiation therapy, chemotherapy or breast cancer hormonal therapy.
Other risk factors include smoking, which affects blood circulation, lessening the flow of blood and oxygen to the genital area as well as reducing the effects of naturally occurring oestrogens. Researchers have observed that women who have never given birth vaginally are more likely to develop symptoms, and that sexual activity, with or without a partner, increases blood flow, making vaginal tissues more elastic.
Atrophy increases your risk of vaginal infections due to changes in the acid balance of your vagina, and urinary infections, as well as burning, frequency, urgency and leakage.
Many postmenopausal women experience vulvo-vaginal atrophy but are embarrassed to discuss their symptoms. But you don’t need to put up with it, as there are simple, effective treatments.
It’s also very important to see your doctor if you have any unexplained vaginal spotting or bleeding, unusual discharge,
burning or soreness, or if you experience painful intercourse that’s not resolved by using a vaginal moisturiser.
Diagnosis is made by the symptom history and an examination, a urine test, and possibly blood hormone level checks and vaginal swabs to exclude infection.
Treatments include vaginal moisturisers applied every few days, or water-based lubricants applied just before sexual activity – the effects of a moisturiser generally last a bit longer than those of a lubricant. If this doesn’t help, you need to discuss oestrogen replacement, either as local creams, gels, pessaries or a vaginal ring, or by taking daily oral HRT.
QHow can I arrange travel vaccinations for when we start to travel again?
AThe website fitfortravel.nhs.uk gives disease risks and required vaccinations for individual countries, as well as any news affecting the Home Office’s advice on where to travel. Then discuss it at least eight weeks before you go with your NHS practice nurses, who usually run travel clinics, and can arrange vaccinations and malaria protection tablets. The NHS routine vaccination schedule doesn’t cover all the infectious diseases found overseas and you may need to pay privately for some. You can also get travel vaccinations from non-NHS travel clinics and some pharmacies. Some countries require proof of vaccination on an International Certificate of Vaccination or Prophylaxis (ICVP). In any case, it’s a good idea to take a record of the all vaccinations you’ve had.