Vaginal Symptoms
“Vaginal pain should be investigated and cure by its cause, not only from menopause”
During their life, at least one-third of all women will experience some troubling symptoms in the vulvovaginal area (external female genitals and vagina).
These symptoms range in severity from mildly annoying to debilitating—and include vaginal discharge, irritation, burning, dryness, itchiness, and pain (both with and outside of sexual activity).
There are many other possible causes of vulvovaginal symptoms, including the following:
- Vaginal infections, such as those caused by a yeast fungus
- Bacterial vaginosis, an overgrowth of certain vaginal bacteria that causes a fishy odor and discharge
- Sexually transmitted infections (STIs), including gonorrhea, Chlamydia, or Herpes, which may cause vaginal inflammation, discharge, pain, or itching
- Skin conditions, such as vulvar eczema or lichen sclerosus (crusty, scaly skin on external genitals), that are associated with itching and irritation
- Certain diseases, such as Crohn’s disease, an inflammatory bowel disorder
- Injury to pelvic nerve fibers, leading to vulvar burning or pain (sometimes called vulvodynia)
- Allergic reactions to chemicals in soaps, bubble baths, spermicides, condoms, feminine hygiene sprays, or deodorant tampons and pads
- Irritation from tampons or birth control devices, such as a diaphragm or cervical cap, left inside the vagina too long.
In addition, menopause can cause vulvovaginal symptoms. However, not all women develop symptoms, or the symptoms may not be troublesome until several years after menopause. 
Decreases in estrogen levels may cause tissues of the vulva and the lining of the vagina to become thin, dry, and less elastic—a condition known as atrophy. Vaginal secretions diminish, resulting in decreased lubrication.
Loss of estrogen also results in an increase in vaginal pH, changing the healthy acidic environment to an alkaline one that is more susceptible to vaginal infection.
Without treatment, the problem may worsen, and the vaginal tissues can become inflamed— a condition called Atrophic Vaginitis. Fragile vaginal tissues are prone to injury, tearing, and bleeding during sexual intercourse or even a pelvic examination. The resulting pain can intensify to the point where sexual intercourse is no longer pleasurable or possible. Women who are not sexually active may be bothered by vaginal dryness and itching, and these symptoms can become more severe with the passing years.
Perimenopausal women should not assume that vulvovaginal problems are due to reduced estrogen levels. Symptoms should be investigated by a clinician to identify the cause. All women at menopause and beyond should have a thorough, regular evaluation of vulvovaginal health, regardless of whether or not they have symptoms or are sexually active.
Vaginal Symptoms & Surgical-Induced Menopause
Surgical procedures (for cancer or benign conditions) that cause early menopause vary greatly in effects on the vagina. Some have no direct effect, while others include removal of a part of the vaginal walls or involve vaginal reconstruction. Prior to surgery, a woman should talk to her healthcare professional to learn how the surgery will affect her vagina and what can be done to alleviate vaginal effects after the surgery.
Vaginal Symptoms & Chemotherapy-Induced Menopause
Some chemotherapy drugs can irritate the vagina, leaving it dry and inflamed, and vaginal yeast infections are common during chemotherapy, especially in women taking steroids or strong antibiotics. However, effective treatments are available for these problems. Pelvic radiation therapy can cause vaginal itching, burning, and dryness. The vagina may feel tender during treatment and for a few weeks afterwards. The walls of the vagina may lose flexibility and become tough and fibrous. Pelvic radiation can cause the vaginal lining to become thin, fragile, and prone to vaginal sores or ulcers, while vaginal scarring from radiation therapy can shorten the vagina, making intercourse painful and difficult.
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