Vulvovaginal Atrophy (VVA)

When vaginal tissue changes impact intimate well-being

Vulvovaginal atrophy is common among menopausal women1. It affects vaginal health and can significantly impact quality of life4.

The condition and its symptoms

What is Vulvovaginal Atrophy?

Vulvovaginal Atrophy is a condition that affects the female genital area. It is primarily associated with reduced estrogen levels, most commonly during menopause, but may also occur in other hypo-estrogenic states1.
Estrogens are hormones that play several roles in the female body. They help maintain proper vaginal pH1, regulate vaginal blood flow1, support lubrication3, and keep vaginal tissue healthy and flexible3.
When estrogen levels drop, symptoms like vaginal dryness and discomfort can develop1. Without appropriate management, symptoms may persist and can impact quality of life4.

Vaginal discomfort and pain2

Less elastic vaginal tissue4

Vaginal dryness3

Redness of the vaginal lining4

A consequence of menopause

Vulvovaginal atrophy, now commonly recognised as part of Genitourinary Syndrome of Menopause (GSM), is associated with reduced estrogen levels, most often during menopause. Lower estrogen can lead to changes in vaginal tissue, causing symptoms such as dryness, irritation, discomfort, and reduced elasticity, which may affect quality of life. Women experiencing symptoms should seek advice from a healthcare professional4.

Urinary symptoms3

  • Needing to urinate often
  • Leaking urine
  • Burning when urinating
  • Recurrent urinary tract infections

Sexual symptoms3

  • Pain or discomfort during sexual intercourse
  • Difficulties with sexual function or satisfaction

Who is affected by Vulvovaginal Atrophy

Vulvovaginal atrophy can affect women in low-estrogen states and is most common during menopause1.

 

Studies show that symptoms of vulvovaginal atrophy are common among postmenopausal women6.

 

Symptoms may also occur temporarily during periods of reduced estrogen levels.

Situations where estrogen levels decrease temporarily:

After childbirth

During breastfeeding

While undergoing certain breast cancer treatments

When taking specific medications that affect hormone levels

How Vulvovaginal Atrophy develops

The decrease in estrogen levels during menopause leads to both structural and functional changes in vaginal tissues.

Cause

Changes in tissue structure and pH

Reduced estrogen levels are associated with changes in tissue structure, including alterations in vaginal pH. Changes in vaginal pH may alter the vaginal microbiota and increase susceptibility to irritation or infection1.

Cause

Physical changes to the vagina

The vagina undergoes physical changes as well. The vaginal canal may become narrower and shorter, and the vaginal opening may reduce in size. These changes can make intercourse difficult or painful3.

Data about Vulvovaginal Atrophy

Vulvovaginal atrophy can have a significant impact on women’s intimate lives and overall well-being.

Close-up of a pensive woman with hands on her chin, representing deep reflection and emotional concern about health

65%

Report less sexual satisfaction2

62%

Say it affects their ability to be intimate2

55%

Say their relationship has suffered2

Diagnosing the disease

Professional medical evaluation is essential for diagnosing vaginal atrophy.

To diagnose the condition, the doctor will ask about your symptoms, their duration, and any related factors. Additional tests may be requested to rule out other conditions with similar manifestations.

 

A pelvic examination may also be performed to look for signs of atrophy, such as thinning of the vaginal epithelium, loss of rugal folds, and changes in mucosal colouration.

emale doctor in a white coat with a stethoscope consulting with a patient in a medical office

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References

  • 1 / Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010 Jan;85(1):87-94. doi: 10.4065/mcp.2009.0413.
  • 2 / Nasreen SZA, et al. American Journal of Internal Medicine. 2019;7(6):154-62.
  • 3 / Benini V, et al. Medicina (Kaunas). 2022;58(6):770
  • 4 / Christmas M, et al. Clin Obstet Gynecol. 2024;67(1):101-14.
  • 5 / Palacios S, Nappi RE, Bruyniks N, Particco M, Panay N; EVES Study Investigators. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric. 2018 Jun;21(3):286-291. doi: 10.1080/13697137.2018.1446930. Epub 2018 Mar 19.

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