Vulvo-vaginal atrophy in menopause is a complex condition that is part of a pathology, the genito-urinary syndrome, which includes several symptoms that are very common in menopause, in fact involving at least one in two women according to the most recent estimates
Vulvo-vaginal atrophy in menopause: the symptoms
“Symptoms ofvulvo-vaginal atrophy in menopause, which tend to increase and become chronic over time, on the one hand involve the vaginal sphere and include dryness, redness, itching, burning, irritation and discomfort, pain during sexual intercourse, and discharge,” lists Monica Costantini, gynecologist.“On the other hand, as the name suggests, they do not even spare the urinary system, as we may experience a feeling of weight in the lower abdomen, alterations in urinary frequency and urgency, hematuria (blood in the urine), frequent urinary infections, dysuria (difficulty urinating).”
Vulvo-vaginal atrophy in menopause: the causes
What happens? As stated in the new book by Rossella Nappi, gynecologist, endocrinologist and sexologist, Living Well in Menopause (2024, Fabbri Editori), “the level of hydration inside the vagina decreases, a condition that often extends to the external tissues of the vulva, which become more delicate and sensitive. The cause is the abrupt drop in estrogen, which lowers our defenses, making us more exposed to the aggression of external agents, to the assault of intestinal bacteria that then invade the reproductive system, but also to bacteria of the genital and urinary system that, no longer kept at bay by the immune defenses and the acid pH guaranteed by estrogen, become responsible for infections such as vaginitis or cystitis.
Estrogen deficiency leads to a depletion of collagen and elastic fibers: no longer nourished, the genitals become thinner, lose elasticity and struggle to congest during arousal, accomplices also being the missing or in reserve androgens. The consequence is a deficit in lubrication during the sexual act, causing pain and tension during intercourse. Recurrent cystitis, especially after intercourse, up to 48-72 hours, is closely related to dryness and pain.”
Vulvo-vaginal atrophy in menopause: the consequences
“The impact this condition has on menopausal women can be considerable,” Costantini comments. “Many fear sexual intercourse, and not infrequently give it up altogether: desire wanes, and the relationship with one’s sexuality can only suffer, because of these disorders, but also because of the consequences of dryness, particularly pain on penetration. An anxious state during intercourse can, in turn, lead to involuntary contraction of the pelvic muscles surrounding the vaginal vestibule, further worsening discomfort and pain. In some cases, the complaints are so acute that women even give up daily activities such as playing sports or riding a bicycle.”
Vulvo-vaginal atrophy in menopause: treatments
“We need to intervene at multiple levels,” Monica Costantini continues. “Fortunately, the therapeutic principals available are different and can be combined or alternated with each other, depending on the individual needs and the specific situation of the woman.” At the hormonal level, if there are no contraindications, local estrogen-based formulations can be used, in the form of ovules, creams, gels or rings, to be applied locally at the vaginal and vulvar levels. Several formulations exist: one of the most recent is dehydroepiandrosterone (DHEA) in vaginal ovules, which is effective on the dryness and pain front by acting directly on the tissues of the vagina with combined effects, both androgenic and estrogenic.
Also useful may be the use of emollient and moisturizing products for self-massage of the perineum, for example, based on hyaluronic acid and spermidine: they help to relax the muscles, nourish the tissues and regain “confidence” with one’s body, restoring lubrication and softness, with a feeling of comfort and ease. Spermidine in particular is effective in treating atrophy because it improves the thickness and elasticity of vaginal tissues with estrogen-like effect. In addition, in the presence of vulvar pain, it can modulate the inflammatory response by reducing the production of pro-inflammatory cytokines. Oral hormone therapy with ospemifene, a selective estrogen receptor modulator drug, can also be opted for. “It has an effective estrogen-like activity at the level of the vulva and vagina, with a tissue rejuvenating effect, but without stimulating endometrial growth and without effects on the breast, because it acts on different receptors,” Costantini explains.
In cases of particularly severe symptoms or in women who cannot use hormonal therapies, there are also minimally invasive regenerative and physical therapy approaches developed in the field of aesthetic medicine, such as laser or radiofrequency, which use heat to regenerate tissues, improve elasticity and vascularity, with a true anti-aging effect, or oxygen andjaluronic acid treatment
Good habits
1. Change cleansers, using a product that is nourishing to the mucous membranes (oil-based) and has an osmolarity that respects the natural 2. Get into the habit of doing regular pelvic floor rehabilitation exercises 3. Take advantage of the application of topical products to do beneficial and relaxing self-massage: just take a small amount of product and apply it by gently brushing, contracting the vaginal muscles as if you were to hold an imaginary ball inside and then drop it.