Understanding Vulval and Vaginal Atrophy
Vulval and vaginal atrophy – sometimes called Genitourinary Syndrome of Menopause (GSM) – is a common condition that affects many women as oestrogen levels decline, most often during and after menopause. Despite how common it is, many women are not aware that the changes they experience – dryness, pain with intimacy, or even recurrent urinary symptoms – are linked to reduced oestrogen and changes in the tissues of the vulva and vagina.
As a pelvic floor physiotherapist, I regularly see women whose pelvic health has been significantly impacted by vulval and vaginal atrophy. Understanding the signs and available treatment options is the first step in managing symptoms effectively.
What Happens in Vulval and Vaginal Atrophy?
Oestrogen plays a key role in maintaining the health, elasticity, and thickness of the vaginal and vulval tissues. As oestrogen levels drop (most commonly due to menopause, breastfeeding, certain medications, or after gynaecological cancer treatment), these tissues can become thinner, drier, and less elastic. This can affect bladder and bowel function, as well as sexual comfort.
Common Symptoms
Women with vulval and vaginal atrophy may experience one or more of the following:
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Dryness, irritation, or burning around the vulva or vagina
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Pain with intercourse (dyspareunia) due to reduced lubrication and tissue thinning
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Recurrent urinary tract infections (UTIs) or urinary urgency/frequency
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Stinging or burning when passing urine
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Spotting or bleeding after sex due to fragile vaginal tissues
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Changes in the appearance of the vulva – tissue may appear pale, thin, or less plump
These symptoms can understandably have a big impact on confidence, relationships, and overall quality of life.
Why Pelvic Floor Function Is Affected
When tissues become dry and painful, many women hold tension in their pelvic floor muscles to protect the area. Over time, this can lead to pelvic floor overactivity, which may contribute to:
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Vaginal or pelvic pain
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Difficulty emptying the bladder or bowels
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Pain with penetration or tampon use
How a Pelvic Floor Physio Can Help
1. Education and Guidance on Oestrogen Use
Many women benefit from topical vaginal oestrogen prescribed by their GP or gynaecologist. This can improve tissue health and is safe for long-term use in most cases. As physios, we work alongside your doctor to ensure you receive the right combination of treatments.
2. Pelvic Floor Relaxation and Downtraining
Learning to relax the pelvic floor can significantly reduce pain and improve comfort. This may include:
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Maintaining vaginal canal length and flexibility using dilators
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Gentle mobility and breathing exercises to reduce tension (see some great resources here)
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Postural strategies and bladder/bowel advice
3. Vaginal Dilators and Pelvic Floor Wands
If there has been pain or avoidance of intimacy, vaginal dilators can help gently stretch and desensitise the tissues, rebuilding comfort and confidence over time. These can be used at home with guidance from a pelvic floor physio – explore options here.
Similarly, a pelvic floor wand can be helpful for women experiencing pelvic muscle tension or pain. It allows for targeted release of tender points and scar tissue (if present) – learn more here.
4. Bladder and Bowel Support
Atrophy can affect bladder and bowel habits, leading to urgency, leakage, or discomfort with passing stools. As physios, we provide tailored strategies to support these functions and restore confidence in everyday life.
When to Seek Help
If you’re experiencing any of the above symptoms, you’re not alone – and help is available. A combination of medical treatment (like topical oestrogen) and pelvic floor physiotherapy can make a huge difference.
We recommend booking an appointment with a pelvic floor physiotherapist who can guide you through treatment options and support your recovery. You can find a trusted practitioner near you via the BIEN Practitioner Locator.
