About Vaginal Atrophy

Adapted from Johnston L, The Recognition and Management of Atrophic Vaginitis. Geriatrics & Aging 2002; 5(&):9-15

This diagram is an example of the lining of the vagina before menopause (left side of diagram) and after menopause (right side of diagram).

Menopause usually begins in women between the age of 45 and 55, but can occur before or after this age. In the UK the average age is 51.2  The change in oestrogen levels that takes place at menopause can cause both physical and emotional symptoms, it can also lead to a condition known as Vaginal Atrophy. 3-5 Vaginal atrophy can cause pain during sex as well as, making it uncomfortable to sit, stand, exercise, urinate or even work. Vaginal atrophy can affect everyday life, whether women are sexually active or not. This can have a detrimental effect on quality of life. 6

Before menopause, when the vagina is well supplied with oestrogen, its lining is thicker and has more folds, allowing it to stretch with intercourse and childbirth. After menopause, when levels of oestrogen are low, the vaginal lining is thinner and has fewer folds, which makes it less flexible, due to Vaginal Atrophy (VA) (also referred to as urogenital atrophy or vulvovaginal atrophy (VVA)) 1

As oestrogen receptors are present on the vagina, urethra, bladder trigone and the pelvic floor, all of these areas can be affected.1 In order to encompass all of these areas the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH) have introduced the term Genitourinary Syndrome of Menopause (GSM) 1,7


1. Primary Care Women’s Health Forum-Guidance on diagnosis and Management of Urogenital atrophy or Genitourinary Syndrome of the Menopause (GSM) 2. The menopause – Women’s Health Concern – www.womens-health-concern.org 3. Menopause – Symptoms and causes – Mayo Clinic – www.mayoclinic.org 4. Vaginal atrophy – Symptoms and causes – Mayo Clinic – www.mayoclinic.org 5. https://cks.nice.org.uk/menopause#!diagnosisSub 6. Vaginal dryness – Women’s Health Concern – www.womens-health-concern.org 7. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society http://www.menopause.org/docs/default-source/2014/gsm-paper.pdf