Vulvo-vaginal Atrophy

What is vulvo-vaginal atrophy or VVA?

Vulvo-vaginal atrophy or VVA is a consequence of the loss of estrogen to the vaginal tissues during menopause.  This is a progressive, chronic condition which can cause symptoms of vaginal dryness, itching, burning, irritation, dysuria (pain with urination), and dyspareunia (pain with sex).  The weakened tissues are also more prone to trauma with tears, bleeding and recurrent infections.  VVA can worsen over the years after menopause.  Approximately 40% of postmenopausal women experience symptoms of VVA.  Several therapeutic options are available to alleviate VVA symptoms, including non-hormonal moisturizers & lubricants, vaginal hormone therapies, systemic hormone therapies, and new office based procedures.

Is there symptom relief?

Non-hormonal moisturizers are available for vulvar and vaginal usage.  These need to be applied regularly (daily-twice weekly).  Although mild cases of vulvo-vaginal atrophy may respond, these are usually not adequate for severe symptoms.  Lubricants are available for use during sexual activity, but again are usually not adequate for severe dyspareunia.

There are several vaginal estrogen products that are available; creams, vaginal pills, and a ring are all FDA approved.  It is possible that a small amount of estrogen can be absorbed into the bloodstream & all but the ring need to be applied regularly (daily initially, then two-three times weekly).  There have not been any scientific studies that associate the use of vaginal estrogen with breast or uterine cancer, but women with breast cancer are generally advised not to use these products.  A SERM (selective estrogen receptor modulator) has been shown to help with dyspareunia.  It is a daily oral tablet.  Although theoretically it should not cause breast cancer, it can be associated with blood clots in the legs and should not be taken by older women.  It also can cause hot flashes in younger menopausal women.  A vaginal DHEA (pro-hormone) product is under development, but will probably not be recommended for breast cancer patients.

Systemic hormones (estrogen/progesterone) work very well for VVA, but there are risks associated with their use.  It is generally recommended that women use systemic hormones only if they have other symptoms of menopause like hot flashes, night sweats, or mood swings.  It is also recommended that we use only the smallest doses for the shortest length of time.

Procedures for Vulvo-vaginal atrophy

There are several new office based procedures that have adapted the use of thermal energy to the vagina.  These products were initially developed for “anti-aging” skin treatments.  They work by heating the tissues of the vagina and stimulating the development of collagen and elastic fibers.  This is a superficial treatment and does not damage surrounding tissues.  A series of 3 treatments about 4-6 weeks apart is needed to obtain 92% success.  It is suggested that most women will need a “booster” treatment yearly.  The procedure with the most & best scientific studies is the Mona Lisa Touch Laser.  This holds great promise for women who are not candidates for hormonal therapy or for women who do not get good results from hormonal therapy.  Unfortunately, at this point in time, insurance companies are not reimbursing for this procedure because it is considered “cosmetic”.



  1. Dear Dr. Gunter
    I am 80 years old. I have VVA. Do you practice with ADC North? I would like to meet with you. Is this possible?

    • Avatar Patricia Gunter MD says

      Dear Anonymous,

      Yes, I see patients in the Menopause & Osteoporosis Center on the first floor of ADC North. You may schedule an appointment on-line or call 512-901-4072. I look forward to helping you.

      Patricia A. Gunter MD