Conditions & Treatments

Vulvovaginal Atrophy

Vulvovaginal atrophy refers to a condition when a woman develops pain, dryness, itching and irritation of the vagina and vulva caused by low estrogen levels, usually as a result of menopause.

What is vulvovaginal atrophy?

Vulvovaginal atrophy describes a condition when a woman experiences a range of symptoms caused by decreased levels of the hormone estrogen, including vaginal dryness, discomfort with sexual activity, and urinary urgency or frequency. These hormone changes cause the vaginal walls and vulva (the “lips” of the vagina) to become thin, pale, dry and/or inflamed. Vulvovaginal atrophy may affect up to half of woman at some point in their lives.

What are the symptoms of vulvovaginal atrophy?

The most common symptoms of vulvovaginal atrophy are:

  • Dryness, itching and irritation of the vagina and/or vulva
  • Decreased lubrication with sexual activity
  • Pain during sexual activity
  • Bleeding after sexual activity
  • Urinary urgency or frequency
  • Burning with urination
  • Urinary tract infections

Symptoms associated with vulvovaginal atrophy during menopause can be present during the early stages of menopause or may start several years later. Symptoms generally worsen over time if untreated.

What causes vulvovaginal atrophy?

Vulvovaginal atrophy occurs in women when there is a prolonged decrease in the production of the hormone estrogen. Most often, vulvovaginal atrophy is a result of reduced estrogen levels after menopause, but it can occur in younger women from a decrease in estrogen due to other causes.

Decreased estrogen levels can be caused by:

  • Natural menopause
  • Menopause after surgical removal of both ovaries
  • Giving birth or during breast feeding
  • The use of certain medications that suppress estrogen levels
  • Severe stress or rigorous exercise that causes ovulation to stop
  • Hormonal treatments for breast cancer
  • Pelvic radiation or chemotherapy for cancer

How is vulvovaginal atrophy diagnosed?

Vulvovaginal atrophy can be diagnosed by a health care provider who will take a complete medical history and perform a pelvic examination. Your health care provider may note that the vulva and vagina are pale and dry, there may be loss of the folds of the vaginal wall, and the vagina is narrow and shortened.

How is vulvovaginal atrophy treated?

The choice of therapy for vulvovaginal atrophy depends on a woman’s health history, the severity of her symptoms and her personal preferences.

A health care provider may recommend one or a combination of the following treatments:

  • Over-the-counter vaginal moisturizers
  • Over-the-counter water- or silicone-based lubricants during sexual activity
  • Low doses of vaginal estrogen, available as a vaginal cream, ring or tablet
  • Oral estrogen therapy
  • Selective estrogen receptor modulator (SERM), a type of hormone taken orally
  • Vaginal dilators to stretch the vaginal walls
  • Regular sexual activity, which increases blood flow to the vagina to help prevent vaginal atrophy
  • Pelvic floor physical therapy to help relax the pelvic muscles

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

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Obstetrics and Gynecology

  • Midlife Women's Health Center
    The Massachusetts General Hospital Midlife Women’s Health Center brings together experts from more than 15 specialties to improve, promote and advance health care for women at menopause and beyond through research, collaboration and education.

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