Vaginal Vulva Dryness Menopause

It is helpful to distinguish the vulva from the vagina because these genital areas have different tissue structure and function.  It is also helpful to note, that vaginal discomfort is felt with penetration . . . during intercourse. However, vulva, labia dryness, irritation and soreness can be felt throughout the day.

The vulva is a woman’s external genital. The vulva includes the hair covered mons pubis,  the fatty labia majora, the innermost labia minora, the clitoris, and the vestibule and vestibular glands of the vagina (by the vaginal opening). Except the mons pubis and labia majora vulva surfaces are lined by a moist tissue layer (stratified squamous epithelium tissue). This natural moisture keeps the labia, vulva area comfortable and functioning well (much like moisture keeps the eyes comfortable).

Vulvovaginal atrophy (weakened thinned tissue) is a common condition primarily in postmenopausal women. Vaginal atrophy, atrophic vaginitis, and urogenital atrophy are other terms used to describe a constellation of symptoms associated with decreased estrogenization of the vulvovaginal tissue. A moist rose petal looks and feels different than a dry rose petal.

Symptoms of vulvovaginal atrophy include vaginal dryness, irritation, and at times light bleeding and soreness after sex. These symptoms may be associated with vaginal discharge and dyspareunia (painful intercourse). Urinary symptoms associated with vulvovaginal atrophy include frequency, urgency, and urge incontinence.

Clinical findings include atrophy (thinning) of the labia and the vaginal opening (introitus). The labia minora may recede (thin). Vulvar and vaginal tissue may appear pale, shiny, and dry; if there is inflammation, the vulva and/or vagina tissue may appear reddened or pale with petechiae*. Vaginal rugae disappear, and the cervix may become flush with the vaginal wall. Vaginal shortening and narrowing also tend to occur. *Petechiae are tiny pinpoint reddish spots that appear on the skin as a result of bleeding under the skin (somewhat like little bruises).

Vulvovaginal atrophy can occur at any time in a woman’s life cycle, although it is more common in the postmenopausal years; a time of low estrogen (hypo-estrogenism). Other causes of a hypo-estrogenic state include lactation, various breast cancer treatments (Arimidex, Tamoxifen), and use of certain medications. In situations other than menopause, vulvovaginal may resolve spontaneously when estrogen levels are restored.

Vulvovaginal atrophy occurs under conditions of low estrogen (hypoestrogenism).
●  premenopausal estradiol levels fluctuate from 10 to 800 pg/mL depending on when measured during the menstrual cycle.
●  postmenopausal estradiol levels are typically less than 30 pg/mL.
After menopause, circulating estradiol derives from estrone, which is peripherally converted in fat tissue from adrenal androstenedione.

A Bit About The Vaginal Structure and Function
The vaginal epithelium is a stratified squamous epithelium, which until menopause is moist and thick with rugae. At menopause, with declining levels of estrogen, the vaginal epithelium thins. Fewer epithelial cells result in less exfoliation of cells into the vagina. As epithelial cells exfoliate and die, they release glycogen, which is hydrolyzed to glucose. Glucose, in turn, is broken down into lactic acid by the action of lactobacillus, a normal vaginal commensal organism. Without this cascade, the pH in the vagina rises, resulting in a loss of lactobacilli and an overgrowth of other bacteria, including group B streptococcus, staphylococci, coliforms, and diphtheroids. These bacteria can cause symptomatic vaginal infections and inflammation. After menopause, the elasticity of the vagina is reduced and connective tissue increases. The decline in estrogen level contributes to a decrease in vaginal blood flow and a decrease in vaginal lubrication.

The effects of endogenous estrogens on vulvovaginal tissues are mediated through estrogen receptors (ERs) α and β, found at sites throughout the urogenital area, including the vagina, vulva, labia, urethra, and bladder trigone.

Above Info Sourced from: Vulvovaginal Atrophy
Maire B. Mac Bride, MBBCh, Deborah J. Rhodes, MD, and Lynne T. Shuster, MD.  Mayo Clin Proc. 2010 January; 85(1): 87–94.

Helpful Note: Unlike hot flashes, and heart palpitations which tend to ease after the menopause transition, labia minora dryness and/or vaginal atrophy does not lessen over time. This is because the vulva and vaginal structure have changed as a direct result of diminished ovarian estrogen production due to menopause.

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DISCLAIMER: The Kátha Soma website does not provide medical advice, diagnosis or treatment. The information provided is neither intended nor implied to be a substitute for professional medical advice. Seek the advice of a physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. 2017