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Vaginal symptoms

“Genitourinary syndrome of menopause” (GSM) is the umbrella medical term for vaginal, vulvar, and urinary symptoms occurring during menopause. Increased UTIs and vaginal dryness usually begin in the later stages of peri-menopause and tend to become more pronounced during post-menopause. Of post-menopausal women, 58% report symptoms of genitourinary syndrome. Some women experience only mild discomfort, while others suffer from painful penetration during sexual intercourse, difficulty walking, and itchiness in their vaginal area. 

50% of post menopausal women experience vaginal symptoms

Women may find discussing these types of symptoms difficult and menopausal vaginal health problems are often under-diagnosed and under-treated.  A recent study (2021) found that 66% of the women do not discuss the impact of their symptoms on sexuality with their gynecologist. Menopausal symptoms involving your vagina will not resolve themselves spontaneously. It is important that you discuss what you are experiencing with a trusted healthcare professional who can provide treatment options. Once treated, you will experience relief from symptoms and will ensure that symptom compounding does not occur. 

The Lowdown on Vaginal Symptoms

Why it happens and the science behind it, how it may impact your life, how you and your doctor can diagnose it and common triggers or risk factors.

During peri-menopause, the walls of the vagina will become thinner and less moist. Vaginal secretions that normally lubricate the vaginal wall, particularly noticeable during intercourse, are reduced. The change occurring to the vaginal walls is due to lower levels of the hormone estrogen. Lowered estrogen leads to increased levels of pH and a chain-reaction involving a less acidic environment and noticeable alterations to the vaginal epithelium. This results may result in one or more of the following:

  • Vaginal dryness or discomfort through itchiness, soreness, burning in the vaginal area, often noticed during penetrative sexual intercourse
  • Pain during sex (“dyspareunia”), either persistent or recurrent before, during, or after sex
  • Deep Dyspareunia refers to pain from deep vaginal penetration 
  • Urinary Tract Infections we have covered this topic in more detail here

The various vulvar and vaginal symptoms are also referred to as VVA or “vulvar and vaginal atrophy” and may result in or contribute to a low sexual desire (lowered libido). Which makes sense, because who would want to have sex when it hurts? We have written more on the topic of lowered Libido here, but please please know that sex should NEVER be painful. If it is, or if you are experiencing any other symptom related to a change in your vaginal comfort (such as itchiness, dryness, burning feeling, soreness, stinging), please consult a medical professional.  These symptoms are very common during this phase of your life and there are effective treatments that will help return things to normal quickly. Having a positive sex life and vaginal comfort are important for a woman, regardless of her age.

The primary area of concern when considering the amplification of menopausal symptoms stemming from VVA is sexual enjoyment. A study of menopausal women suffering from VVA symptoms indicated that 59% also experienced a decrease in their enjoyment of sex. VVA symptoms interfered with quality of sleep (24% of women studied), inhibited the enjoyment of normal activities (23%), and negatively affected a woman’s mood (23%). 

Any symptoms suffered which involve our genitalia or reproductive areas can cause correlated struggles in normal sexual experiences. As these matters are often private and not discussed, there is a danger of amplifying conditions if initial symptoms are left untreated. It is important to realize the chain-reaction effect from physical symptoms which could impact your enjoyment of typical and common sexual satisfaction. Aside from our libido’s operation and the reality of sexual pleasure, sex activates positive neurotrasmitters and provides extensive physiological and psychological benefits. If any of your menopausal symptoms are interfering with your normal enjoyment of sexual activity, it is important to address your underlying symptoms with appropriate treatment so you can quickly regain your complete quality of life.

Testing and diagnosis for VVA is performed through self-reporting assessments. When you meet with your healthcare professional, make sure to mention any changes to your body, emotions, relationships, or daily activities that you have noticed recently. This information will help your doctor to accurately diagnosis symptoms of a clinical nature and will allow for treatment options potentially target multiple symptoms that are caused by your body’s lowered hormone levels.

“Vaginismus” is a medical term referring to physiological reactions a woman may experience due to fear of vaginal penetration. Specifically, the vaginal muscles tighten involuntarily and can not be controlled. Vaginismus can occur even if a woman has previous vaginal penetration without problematic muscle response.

Physical health

Painful sex

Vaginal dryness is incredibly common and as it is caused by low levels of estrogen (not just fluctuating levels) it will not resolve by itself once you enter Menopause. It may result in or contribute to a low sexual desire (lowered libido), which makes sense, because who would want to have sex when it hurts? We have written more on the topic of lowered Libido here, but please please know that sex should NEVER be painful. If it is, please consult a medical professional. There are effective OTC and Prescription based treatments available that will help return things to normal quickly. Having a positive sex life and vaginal comfort are important for a woman, regardless of her age.

Prevention and Treatment

Learn more about your options for prevention, management and treatment of vaginal and vulvar symptoms. This is not an exhaustive list of the treatment options available, but a good start.

There are several treatment options available, and the good news is that treatment of VVA symptoms is often possible through the self-application of simple and topical medication.

There are no known dietary treatments for VVA symptoms. Women experiencing recurrent UTIs have found benefit in using cranberry extract (note that cranberry juice is high in sugar and not recommended), but the scientific evidence for this is weak and inconclusive at best.

Exercise has a positive impact on physical and mental wellbeing during menopause. Specifically for VVA symptoms, regular participation in yoga activities and a focus on Kegel pelvic-floor exercises are beneficial. Kegel exercises, in combination with vaginal dilators and cognitive behavioral therapy (CBT) has been found to reduce involuntary tensing of the vaginal muscles (“vaginismus”) that sometimes accompanies VVA symptoms, particularly when dyspareunia (pain during intercourse) is present. 

A healthy lifestyle promotes optimal, overall health. Maintaining an advisable weight and participating in regular exercise are important menopausal considerations.

Participating in sexual activities as often as you feel able has health benefits and releases important neurotransmitters in a woman’s brain. Women who participate in regular sexual activity show lower blood pressure, improved immune system operations, improved cardiovascular health, higher levels of self-esteem, better quality sleep, increased feelings of intimacy and connection in valued relationships, reduction in life stress levels, and increased enjoyment of pleasurable feelings.

  • DHEA supplements contain natural hormones (dehydroepiandrosterone). Topically-applied hormones interact with your body’s estrogen and testosterone levels through ingested or cream-based products. It is important to consult with a medical professional before using DHEA supplements.
  • A study of women in post-menopause found that oral consumption of sea buckthorn oil supplements resulted in an improvement in the women’s vaginal epithelium. Sea buckthorn oil may be an effective alternative for women who are unable to use hormonal treatments.

There are several over-the-counter products available to help relieve the symptoms of VVA. As a first treatment, many women choose to use lubricants during intercourse. Alternatively, any sexual stimulant that increases a woman’s arousal will improve the secretion of natural moisture. For some women this is enough, but for many others it is not. Don’t be discouraged if this doesn’t work for you, there are plenty of other treatment options available.

  • Vaginal dilators and internal vibrators have been found to produce medically quantifiable results for women suffering from vaginismus and should not be considered a taboo treatment alternative.
  • Vaginal moisturizers are also available. Through consistent (multiple times each week) application of vaginal hyaluronic acid (for example, Vagisil Prohydrate External Hydrating Gel), women experience a reduction in vaginal dryness and its associated symptoms. Natural vaginal moisturizers also include unrefined coconut oil and Vitamin E oil.
  • Chamomile vaginal gel. Although additional research is required, recent studies have shown that consistent usage of chamomile vaginal gel can have a positive effect for post menopausal women experiencing vaginal athrophy (dryness) and dyspareunia (pain during sexual intercourse)
  • Vaginal probiotic supplements including pills and suppository capsules that are inserted into the vagina using an applicator, are quite popular amongst women in this age group. Despite manufacturers making efficacy claims, clinical research supporting these claims is virtually nonexistent. However, taking them can’t hurt and may help. Look for probiotics containing the bacteria Lactobacillus rhamnosus and Lactobacillus reuteri.

Vaginal stimulants, lubricants, and moisturizers can be used in tandem with hormonal treatment options.

Ospemifene is an estrogen receptor agonist/antagonist (selective estrogen receptor modulator, SERM) used in the treatment of vulvar and vaginal atrophy. It has a unique non-hormonal composition and may be effective for women suffering from low libido symptoms concurrent with other vaginal conditions related to menopause.

VVA symptoms are often treated with localized vaginal estrogen replacement therapy. This is a hormonal replenishment treatment (Hormone Replacement Therapy “HRT”) that provides topical application of estrogen following naturally lowered levels of hormone production during menopause.  Localized HRT involves a low-dose of estrogen and is prescribed in cream, ring, or tablet form. Effectiveness of vaginal estrogen treatments can take up to 3 months and more than one type of HRT application may be necessary simultaneously (i.e. internal application by one method and external genitalia application by another). Systemic HRT - taken orally or transdermally - is also usually effective in treating VVA.


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