So, what is vaginal atrophy? Symptoms, causes and what helps

Of all the things that could change with your body as a woman, vaginal atrophy has to be up there with some of the worst-sounding. Just the term itself is enough to make one shrivel up a little inside (or down there).

Referring to the thinning of the tissue and skin around the vulva and inside the vagina due to hormonal changes, vaginal atrophy is when the skin becomes drier, thinner, less supple and more fragile.

What is vaginal atrophy?

Dr Jean-Jasmin Lee Mi-Li, consultant at KK Menopause Centre and KKH Sexual Health Clinic, highlights the difference between vaginal dryness and vaginal atrophy. “Vaginal dryness and vaginal atrophy are different. Dryness refers to reduced lubrication, while atrophy involves broader changes like thinning and inflammation. These issues can affect women at any age due to breastfeeding, stress, diabetes, certain medications, or cancer treatments. However, hormonal changes during perimenopause and menopause significantly worsen symptoms.”

The latest research from KKH involving 1,461 women aged 45 to 65 revealed that vaginal dryness affects four in 10 Singapore women, and is the fourth most prevalent moderate to severe symptom in this age group. The study also found that vaginal dryness actually ranked higher than many well-known menopausal symptoms like hot flushes and night sweats.

“This highlights how widespread and bothersome – yet often unspoken – intimate health concerns are during menopause,” says Dr Lee. “The research also showed that related issues significantly impact women’s lives,”

Dr Ng Kai Lyn of Aster Gynaecology, whose subspeciality is uro-gynaecology says the majority of Singapore women only come in when they start suffering the consequences of vaginal atrophy. These include recurrent urinary tract infections, microscopic haematuria (blood in the urine), as well as issues related to the frequency and urgency of peeing.

“Towards the end of our reproductive lifespan, the distance between the urinary pipe and the vagina actually get really close,” Dr Ng explains. “As your oestrogen levels dwindle, the skin around the vagina and vulva become really thin. Micro-cracks start forming in the skin epithelium, and these compromise the skin barrier, so bacteria ends up passing through into the urine pipe and bladder, causing the infections.”

What makes it worse is that many women might not realise these issues are related to vaginal atrophy and perimenopause. “I’m seeing a lot of women who have already bounced around a lot between GPs and urologists, and end up here realising that the issue is atrophy related to menopause,” say Dr Ng. “A lot of people are not making that link at this point of time, mainly because there’s not a lot of awareness.”

Treatment options

The good news is that vaginal atrophy can be effectively treated with both hormonal and non-hormonal options. KKH recently launched Singapore’s first guideline on managing menopause transitions. It recognised that bladder and intimate health symptoms are very common, but often go unreported due to embarrassment.

“[It] recommends that healthcare professionals actively ask about these symptoms during consultations,” says Dr Lee. “Treatment options are also clear – start with vaginal moisturisers and lubricants, then consider vaginal oestrogen for persistent symptoms.”

This differs from the lubricants used for sexual activity. They come in the form of either a gel or a pill that is inserted into the vagina and then dissolves.

“I always tell my patients it’s like an overnight sleep mask,” says Dr Ng. A vaginal moisturiser improves the overall condition of the vaginal skin, whereas a lubricant for sex is focused more on the friction it can cause. If these don’t work, it’s time to try vaginal oestrogen – localised oestrogen therapy in the form of creams or pills.

“Typically, this is administered twice a week at night before you sleep,” says Dr Ng. “It’s safe to use long term, because whatever is emitted locally stays local, so the systemic absorption is very negligible.”

Hormone replacement therapy (HRT) is a more long-term solution for menopausal symptoms. “[This is for] women who have hot flushes with mood disturbances, sleep disturbances, brain fog, or difficulty concentrating,” says Dr Ng.

Dr Lee also makes a point to clarify misconceptions around the use of HRT. “Many still have concerns based on outdated research from decades ago. A flawed study from the early 2000s led to strong safety warnings that may have unnecessarily worried women. This means many women who could benefit from treatment may have been avoiding it due to fears that are no longer justified by current medical evidence.”

Another treatment option that has hydrating results is the Morpheus8V, a vaginal-specific applicator for the Morpheus8 machine that is more commonly used in aesthetic facial treatments. This non-surgical FDA-approved treatment addresses symptoms of vaginal atrophy, laxity, and dryness-related sexual or urinary dysfunction. It uses bipolar radio frequency (RF) energy combined with microneedling to stimulate collagen and elastin production in the vaginal (and vulva) tissues.

Dermatologist Coni Liu, who offers the treatment at her clinic Dermally, says: “There are several scientific studies to demonstrate the efficacy of using Morpheus8V to improve the symptoms caused by vaginal atrophy.”

As a dermatologist, she considers the issue from a skin-focused point of view. “I think gynaecologists probably view it with a hormonal approach, with treatment options like topical oestrogen or systemic hormone replacement therapy. As dermatologists, we focus on improving the structural integrity of the skin.”

Don’t shy away from talking to a doctor about vaginal atrophy

All doctors interviewed were very clear that vaginal atrophy is something that more women should talk to their doctors about. “One should not shy away from discussing it,” says Dr Ng. “Women typically work hard to maintain their face and skin health as they get older, yet we frequently see that ball gets dropped when it comes to the vulval and vaginal skin health. Most tend to only come in when they become symptomatic, by which time it does take a while to get things better.”