Why Does Genital Pain Occur During Menopause?

A woman’s body undergoes several major stages throughout life: adolescence, sexual maturity, menopause, and later years. While these stages vary slightly for individuals, menopause typically occurs between the ages of 45 and 55. This phase marks the cessation of menstruation and is characterized by a decline in the secretion of estrogen and other ovarian hormones, which can disrupt the body’s hormonal balance.

This hormonal shift leads to various physical and emotional changes collectively known as "menopausal symptoms." When these symptoms interfere significantly with daily life, they are classified as "menopausal syndrome." Genital pain is one of the potential symptoms experienced by menopausal women, often linked to vaginal dryness and a condition called atrophic vaginitis.

Vaginal Dryness and Its Role in Genital Pain

As estrogen levels decrease, the vaginal walls and lining lose moisture, becoming thinner and more prone to irritation. This dryness reduces vaginal secretions, causing discomfort, itching, and inflammation, which can lead to genital pain.

What is Atrophic Vaginitis? Symptoms and Characteristics

Atrophic vaginitis refers to the thinning, drying, and inflammation of the vaginal walls, often linked to reduced estrogen levels during menopause. Key symptoms include:

• Irregular bleeding
• Yellow or brown discharge
• Itching or discomfort
• Pain during intercourse (dyspareunia)
• Frequent urination or pain during urination
• Foul odor

The vaginal environment, which naturally maintains an acidic pH due to resident bacteria, undergoes changes during menopause. Reduced estrogen levels decrease the number of these bacteria, weakening the vagina’s natural defenses and making it more susceptible to infections and irritation. This contributes to the symptoms of atrophic vaginitis, also referred to as "senile vaginitis."

Causes of Atrophic Vaginitis

The primary cause of atrophic vaginitis is the natural decline in estrogen production during menopause. Other contributing factors include:

• Aging: A natural decrease in hormonal levels.
• Childbirth and Breastfeeding: Temporary hormonal changes that often stabilize over time.
• Smoking: Disrupts hormonal balance and increases the risk of various health issues.
• Stress: Can indirectly affect hormone production through its impact on the brain's regulation of the endocrine system.
• Unhealthy Lifestyle: Poor diet, lack of exercise, and insufficient sleep can exacerbate hormonal imbalances.
• Post-Cancer Treatments: Some treatments, such as chemotherapy or radiation, can affect estrogen production.

Managing Risk Factors

While hormonal changes during menopause are natural, maintaining a healthy lifestyle can help reduce the severity of symptoms. Regular exercise, a balanced diet, stress management, and avoiding smoking are crucial for promoting overall well-being and mitigating hormonal imbalances.

Examination for Atrophic Vaginitis

A pelvic examination is essential for diagnosing atrophic vaginitis. This examination helps rule out serious conditions such as uterine or breast cancer, which are more common after age 40. Early detection of such conditions allows for timely treatment. Although the prospect of a pelvic exam may cause anxiety, it is generally quick and minimally painful.

Treatment for Atrophic Vaginitis

The primary treatment for atrophic vaginitis is hormone replacement therapy (HRT) to replenish estrogen levels. Options include vaginal suppositories, creams, patches, or oral medications. These treatments are effective in addressing the underlying hormonal deficiency and typically improve symptoms within one to three weeks.

While over-the-counter products such as vaginal moisturizers and lubricants can provide temporary symptom relief, they do not address the hormonal cause. Consultation with a healthcare provider is recommended to determine the most appropriate treatment.

Preventing and Managing Recurrence

Since atrophic vaginitis is linked to aging and hormonal changes, recurrence is possible even after treatment. Regular follow-ups with a healthcare provider, a healthy lifestyle, and stress management can help minimize the likelihood of recurrence and maintain long-term vaginal health.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.