Between 10 and 40 percent of women experience symptoms of atrophic vaginitis after menopause, but only 20 to 25 percent will seek medical help.
Others may not do so because they use home treatment or because they feel embarrassed due to the sensitive nature of the condition.
Left untreated, it can affect quality of life.
- Atrophic vaginitis refers to dryness of the vagina.
- Around 40 percent of postmenopausal women experience symptoms, but many do not seek treatment.
- Symptoms include painful intercourse and an increase in urinary tract infections (UTIs).
- It is caused by a reduction in estrogen, normally following menopause or treatment with anti-estrogen drugs.
- Topical treatments and hormone replacement therapy (HRT) may held relieve symptoms.
Atrophic vaginitis can lead to vaginal dryness and discharge.
Here are the main indicators of atrophic vaginitis:
- vaginal dryness
- pain during sexual intercourse, or dyspareunia
- thin, watery, yellow or gray discharge
- paleness and thinning of the labia and vagina
- irritation when wearing certain clothes, such as tight jeans, or when on a bike seat
- more frequent urinary tract infections (UTIs)
Symptoms also present in the urination process. These include:
- painful urination
- blood in the urine
- increased frequency of urination
- increased likelihood and occurrence of infections
There may also be a reduction in public hair, and the vagina may become narrower and less elastic.
The most common cause of atrophic vaginitis is the decrease in estrogen after menopause. It can also occur after childbirth, and it can happen when anti-estrogen drugs are used to treat other conditions.
The ovaries make estrogen until a woman experiences menopause. In the United States, 51 years is the average age at which menopause occurs. Before menopause, the estrogen in a woman's bloodstream helps protect the skin of the vagina and stimulates vaginal secretions.
When the ovaries stop making estrogen after menopause, the walls of the vagina become thin, and vaginal secretions are reduced. Similar changes can happen to women after childbirth, but these changes are temporary and less severe.
Medications or hormones can be used as part of the treatment for breast cancer, endometriosis, fibroids, or infertility to reduce estrogen levels. This decrease can lead to atrophic vaginitis.
Other causes include:
Atrophic vaginitis may occur in younger women who have had surgery to remove their ovaries. Some women develop the condition at times when estrogen levels are naturally lower, such as during breastfeeding.
Other substances that can cause further irritation to the vagina are soaps, laundry detergents, lotions, perfumes, or douches.
Smoking, tampons, yeast infections, and condoms may also trigger or worsen vaginal dryness.
The doctor will carry out an examination and ask about medical history. They may ask about the use of agents that can irritate the area and cause or aggravate symptoms, such as soaps or perfumes.
The pH, or acidity, of the vaginal area is also taken. A pH of 4.6 or higher indicates atrophic vaginitis. The normal pH of this area is 4.5 or less.
The doctor may also request an infection screening, especially in cases of discharge or bleeding. A diabetes test may be performed to rule out diabetes.
Examples of infections that may also be presenting include candidiasis, endometritis, and bacterial vaginosis. Atrophic vaginitis can make the area more susceptible to becoming infected. It can occur alongside an infection.
<!--[:LINK|151172|Candidiasis, or vaginal yeast infection, can occur alongside atrophic vaginitis. Click here to learn more.:]-->
If the diagnosis is unclear, or malignancy is suspected, a biopsy may be taken to rule out cancer.
A vaginal examination is likely to cause discomfort or pain in a patient with atrophic vaginitis.
Topical treatments can help.
A water-soluble vaginal lubricant may help to provide relief during intercourse, for mild cases.
Hormone replacement therapy is one of the treatment options for atrophic vaginitis.
Petroleum jelly, mineral oil, or other oils are not suitable. These may increase the chance of infection and may damage latex condoms or diaphragms.
Hormone replacement therapy (HRT), as a tablet, gel, patch, or implant can supply estrogen to the whole body. It is effective, but there may be side effects. Patients should discuss the risks of long-term HRT with their doctor.
Localized HRT is applied topically and focuses treatment on the affected area. A low-dose estriol cream can be used to stimulate rapid reproduction and repair of the vaginal epithelium cells.
Vaginal tablets, creams, rings, and pessaries can be applied internally to focus the supply of estrogen to the vaginal area.
Regular exercise is important as it keeps blood flow and genital circulation high. Experimenting with the diet can also prove effective. Plant estrogens, linseeds, fish oils, and black cohosh can help relieve atrophic vaginitis.
Using vaginal estrogen before the condition becomes severe can be a way to protect the vagina.
Regular sexual activity may help prevent atrophic vaginitis. Using a water-soluble vaginal lubricant can soothe mild cases during sexual intercourse.
As long as the vagina has sufficient levels of estrogen, sexual activity can also show benefits for both the elasticity and flexibility of the region. Women who are sexually active report fewer symptoms of atrophic vaginitis when compared to women who do not regularly have sexual intercourse.
Written by Sy Kraft
What is labial hypertrophy?
We all have different facial features, body types, and coloring. There are also considerable differences in female external genitalia, known as the vulva.
The vulva contains two sets of skin folds, or lips. The large outer folds are called the labia majora. The smaller, inner folds are the labia minora.
In most women, the labia aren’t symmetrical. It’s not at all unusual for one side to be larger, thicker, or longer than the other. There’s a wide spectrum of shapes and sizes that fall under the category of “normal.”
When the labia majora are enlarged, it’s called labial majora hypertrophy. When the labia minora are larger than, or stick out more than the labia majora, it’s called labial minora hypertrophy.
Either way, it doesn’t mean that you have a medical issue. Most women will never have a problem due to the size or shape of their labia.
What are the symptoms of labial hypertrophy?
If you have mild labial hypertrophy, chances are you’ll barely notice it. Labia minora, however, are much more sensitive than the protective labia majora. That’s why enlarged labia minora can cause a few difficulties. Labial hypertrophy can cause a noticeable bulge in your clothing, especially when you’re wearing a bathing suit.
Other symptoms of labial minora hypertrophy include:
If the area is overly sensitive, you may be inclined to avoid touching it. It can also be trickier to clean between the folds of skin, particularly during your period. This may lead to chronic infections.
Long labia can rub on your underwear. Prolonged friction can lead to rough, irritated skin that’s super sensitive.
Pain and discomfort
Enlarged labia can hurt during physical activities, especially those that put pressure on the genital area. A few examples are horseback riding and bike riding.
Pain and discomfort can also occur during sexual foreplay or intercourse.
Causes and risk factors
What causes labial hypertrophy?
Just as one of your legs may be slightly longer than the other, your labia probably don’t match exactly. There’s really no such thing as the correct size or shape for labia.
Exactly what causes the labia to grow bigger isn’t always clear. Causes may include the following:
- Due to genetics, you may have been that way since birth.
- As estrogen and other female hormones increase during puberty, many changes take place, including growth of the labia minora.
- During pregnancy, increased blood flow to the genital area can increase pressure and lead to a feeling of heaviness.
- In some cases, labial hypertrophy may occur due to infection or trauma to the area.
How is it diagnosed?
There’s no special test or exact measurements to determine if you have labial hypertrophy. If your labia minora extend beyond your labia majora, your doctor may diagnose it as labial hypertrophy upon physical examination.
Is there any treatment?
When labial hypertrophy isn’t causing a problem, you don’t need any treatment. It’s not harmful to your overall health.
It’s another story if labial hypertrophy interferes with your life and your ability to enjoy physical activities or sexual relations. If that’s the case, see your gynecologist. It’s worth getting a professional opinion.
For severe labial hypertrophy, having a surgery called a labioplasty can help. During the surgery, the surgeon removes excess tissue. They can reduce the size of the labia and reshape it. Surgeons usually perform the surgery under general anesthesia, although it can sometimes be done with sedation and local anesthetic.
As with any major surgery, there are a few risks, including:
- a reaction to the anesthesia
After the surgery, you may have swelling, bruising, and tenderness for a few weeks. During that time, you’ll need to keep the area clean and dry. You should also wear loose clothing and avoid activities that cause friction in the genital area.
The surgery can provide genuine relief for women who experience pain and discomfort from labial hypertrophy.
The number of labioplasties performed in the United States is growing. In 2013, over 5,000 were performed, a 44 percent increase over the year before.
Some women choose the surgery for purely cosmetic reasons. When considering labioplasty as a cosmetic procedure, discuss your expectations with your doctor.
The surgery can be performed on teenagers, but doctors generally advise waiting until you’re through puberty. This is to ensure the labia are no longer growing.
Most teenagers worry about the changes to their bodies and wonder if those changes are normal.
The American College of Obstetricians and Gynecologists recommends that doctors educate and reassure teens about normal variation in anatomy. Those wishing to have labioplasty should be assessed for maturity and emotional readiness.
What can you expect after surgery?
You should be fully healed within a month or two following labioplasty. Your doctor will give you specific instructions about when you can resume normal activities, such as intercourse and vigorous exercise.
The scars usually fade over time and results are generally positive. In some cases, the surgery can leave permanent scarring or cause chronic vulvar pain or painful intercourse.
Cosmetic results vary. It’s a matter of personal perspective.
Tips for condition management
Surgery is a big step and not always necessary for labial hypertrophy. Follow these tips to minimize irritation:
- When bathing or showering, use only mild soap that contains no coloring, scents, or chemicals.
- Avoid wearing underwear that rubs your labia or is too tight. Choose loose-fitting, breathable materials, such as cotton.
- Avoid wearing tight pants, leggings, and hosiery.
- Wear loose-fitting pants or shorts. Dresses and skirts may be more comfortable on some days.
- Choose sanitary pads and tampons that are unscented and contain no chemicals or additives.
- Before exercising, carefully position the labia where it will be most comfortable. This may also be helpful when wearing certain clothing, such as a bathing suit.
- Ask your doctor if there are any over-the-counter or prescription-strength topical ointments you can use to soothe irritation.
Talk to your doctor about other ways to manage symptoms of labial hypertrophy.