atrophic vaginitis

Last edited 06/2019 and last reviewed 03/2022

Vaginal resistance to infection and injury is reduced in the postmenopausal woman through lack of oestrogen which causes:

  • thinning of the vulval and vaginal epithelium
  • loss of glycogen
  • fall in acidity
  • absence of protective lactobacilli

Presentation is typically with:

  • irritation and soreness
  • superficial dyspareunia
  • discharge - which may be profuse and purulent and sometimes
    • however any vaginal discharge/blood-stained discharge should be investigated
      • postmenopausal bleeding - manage in context of NICE guidance (linked item)
      • vaginal discharge in woman aged 55 or over - manage in context of NICE guidance (linked item)
      • if vaginal discharge/bleeding then an infection screen may be appropriate > to exclude vaginal infections or endometritis
      • other investigations to consider are:
        • vaginal pH testing (using pH paper and sampling from the mid-vagina)
          • result is more alkaline in atrophic vaginitis
        • vaginal cytology - typically (in atrophic vaginitis) reveals lack of maturation of the vaginal epithelium


  • consider screen for diabetes (uncontrolled diabetes can contribute to symptoms)