You may have heard about vaginitis. This condition, also known as vulvovaginitis, consists of the inflammation of the vagina. Its symptoms are bothersome. The most likely ones are pain, itching and vaginal flow mutations (1). Menopause and perimenopause are two of the most common periods in which this condition may appear. In those specific stages, this medical condition is called atrophic vaginitis, atrophic vulvovaginitis or genitourinary menopause syndrome (2).  

While many women, almost 50% of them, may experience the condition after the menopause, only 15% of them suffer it before this period (3). Today we will help you understand everything about vaginitis: the causes, the symptoms to look out for, risk factors and more. Get yourself comfortable and keep reading to find out all about it! 

Why does vaginitis appear in menopause?

Before getting to know how it relates to menopause, we need to know what happens to the female body during this time. Among many other changes, there is a dramatic reduction in the production of hormones, such as oestrogen. Because of that loss, cells in the vagina change and the vagina walls become thinner and weaker. Mucus production changes its pH (acidity) and reduces in amount. So, the vaginal flora mutates. Currently, the vagina gets dryer (4). 

Signs and symptoms of the atrophic vaginitis

Atrophic vulvovaginitis does not cause any symptoms for most menopausal women. Therefore, it is usually diagnosed within a routine gynaecological check. For women who do develop symptoms (2), they often notice these during sexual intercourse: vaginal dryness, which may result in painful coitus, skin soreness; slight vaginal bleeding afterwards, genital itching or irritated labia. In addition, there can be problems urinating such as an aching feeling or urinating more frequently. Finally, there can be a change in the flow or urine such as more or less watery, thick or yellowish (5). 

If you visit your doctor, they will assess for anatomy and morphological changes that cannot be observed from outside the body. Those changes may include changes in the aspect of the vagina (pale, bright, dry or smooth walls), pubic hair (the quantity may diminish), rounded and small stains, the narrowness of the vaginal opening, pH disorder and loss of vaginal flexibility (6). 

Risk Factors

The intensity of atrophic vaginitis symptoms may be stronger if they are related to any of the following risk factors (2): 

• Smoking: Being a regular smoker may cause the reduction of the amount of blood that gets to the vagina, resulting in weaker vaginal walls. In addition, it may reduce the function that oestrogen has in the body. 

• Low sexual activity: Sexual intercourse supports vaginal elasticity and lubrication. 

Alarm signs. When should you ask your doctor?

Although vaginitis symptoms are mostly only annoying, it is strongly recommended to ask your doctor as soon as possible if any of these disorders appear (2, 7): 

• Any kind of changes in discharge, such as odour, colour, etc.  

• Painful sexual intercourse that does not improve with lubricant gels. 

• Persistent itching and burning sensation. 

• Pain and discomfort whilst urinating. 

• The appearance of crusts, bumps or injury in the vaginal lips. 

• Ulcers or other injures may suggest sexually transmitted infection. 

Complications

Vaginitis can lead to additional complications if not treated (7): 

• Vaginal infections: predisposed by acidity and vaginal wall changes. 

• Problems urinating: can be linked to a urinary tract infection. 

Can we prevent vaginitis in menopause?

The good news is that vaginitis in menopause can be treated and even prevented. To treat it, one of the options is the use of creams with oestrogen (8). However, by taking some simple measures you can avoid symptoms or complications (9). Let's see some of them: 

• Proper Hygiene: Use a neutral soap to wash your vulva in your daily bath (preferably made of glycerine or with aloe vera or chamomile) to keep your pH level balanced. Try to avoid vaginal douches and any kind of chemicals which are contained in commercial vaginal sprays. Whenever you take a bath, be sure to wipe backward and not forward, to avoid contamination. 

• Have an active life: Try to do different type of aerobic exercises like walking or cycling. 

• Dressing: Try to avoid wearing tight trousers. Choose comfortable cotton-made underwear and try to be careful with wet or humid clothes. 

• Respect your sleep: having adequate sleep will enable your body to rest and strengthen your immune system. 

Now that you know everything about vaginitis in menopause: its causes, its, symptoms, its alarm signs, it's possible complications and how to prevent it, you can keep on enjoying and learning everything about this new stage of your life, which should be one of your best periods. Menopause can be lived freely and does not mean suffering at all. 

References

1. Vaginitis. Female Reproductive System [Internet]. Medline Plus. 2024 [cited 2024 Oct 17]; Available from: https://medlineplus.gov/vaginitis.html 
2. Vaginal atrophy [Internet]. Mayo Clinic. 2021 [cited 2024 Oct 17]. Available from: https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 
3. Flores SA, Hall CA. Atrophic vaginitis. StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564341/  
4. Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol [Internet]. 2016;215(6):704–11. Available from: http://dx.doi.org/10.1016/j.ajog.2016.07.045 
5. Kesavan S. Vulvovaginal Pruritus or Vaginal Discharge [Internet]. MSD Manual Professional Edition. [cited 2024 Oct 17]. Available from: https://www.msdmanuals.com/professional/gynecology-and-obstetrics/symptoms-of-gynecologic-disorders/vulvovaginal-pruritus-or-vaginal-discharge 
6. Lev-Sagie A. Vulvar and vaginal atrophy: Physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol [Internet]. 2015;58(3):476–91. Available from: http://dx.doi.org/10.1097/GRF.0000000000000126 
7. Sobel JD. Vaginitis in adults: Initial evaluation [Internet]. UpToDate. 2023 [cited 2024 Oct 17]. Available from: https://www.uptodate.com/contents/vaginitis-in-adults-initial-evaluation 
8. Lee A, Kim TH, Lee HH, Kim YS, Enkhbold T, Lee B, et al. Therapeutic approaches to atrophic vaginitis in postmenopausal women: A systematic review with a network meta-analysis of randomized controlled trials. J Menopausal Med [Internet]. 2018;24(1):1. Available from: http://dx.doi.org/10.6118/jmm.2018.24.1.1 
9. Vaginitis [Internet]. UC San Diego Health. 2023. [cited 2024 Oct 17]. Available from: https://myhealth.ucsd.edu/Search/85,P00595