Vaginitis is inflammation of the lining of the vagina (vaginal mucosa), which can have many causes. Atrophic vaginitis occurs when the levels of the hormone estrogen drop, altering the normal environment of the vagina and causing dryness, itching, burning, painful sex and abnormal vaginal discharge. Estrogen levels decline with age and they fall sharply with menopause, so atrophic vaginitis is fairly common in older women. Surgery to remove an ovary, radiation treatments in the pelvic area and some chemotherapy drugs can also cause estrogen levels to fall, resulting in atrophic vaginitis. Estrogen creams applied to the vagina or estrogen replacement therapy (estrogen containing pills) can treat the symptoms of atrophic vaginitis.
Dryness
Estrogen helps the vagina maintain a thick layer of epithelial cells. When your estrogen levels decline, the lining of the vagina thins and the cells secrete less fluid. Vaginal dryness can make sex painful, a condition called dyspareunia. If you have vaginal dryness due to atrophic vaginitis, you might consider using a personal lubricant for sex, or using a topical estrogen to reverse the thinning of the vaginal lining.
Itching or Burning
A type of bacteria called Lactobacillus lives in normal, healthy vaginas and helps to maintain the low, slightly acidic pH of the vagina. When estrogen levels fall, as in menopause, the balance of bacteria in the vagina changes and the pH of the vagina rises. In atrophic vaginitis, the loss of lactobacilli and increased (alkaline) pH can cause vaginal itching or a burning sensation. The medical term for itchiness is pruritis.
The itching might be so severe that you have trouble sleeping. External itching can be treated with hydrocortisone cream, but that is not safe to use in the vagina. Antihistamines can also reduce itching, and they can help you sleep, but again, a topical estrogen is the best long-term treatment for vaginal itching due to atrophic vaginitis.
Discharge
A normal, healthy vagina secretes discharge that is milky white or clear, odorless, and abundant enough to dampen your underwear slightly. In atrophic vaginitis, your vagina thins, so there are fewer epithelial cells and you produce much less discharge. A dry vagina can harm the normal vaginal bacteria, which prefer a moist environment. Your doctor might ask you about your vaginal discharge to help to rule out other causes of vaginitis, which are usually characterized by copious discharge.
References
- Merck Manual: Vaginitis
- "Primary Care for Women" Phyllis C. Leppert and Jeffrey F. Peipert, 2004
