Vaginal atrophy, also known as genitourinary syndrome of menopause (GSM) is a condition that affects anyone with declining estrogen levels. This includes cisgender women experiencing perimenopause and menopause, as well as transmasculine and nonbinary individuals undergoing testosterone-based hormone replacement therapy (HRT). Despite its prevalence, open conversations about vaginal health are often stigmatized, leaving many people in the dark about this condition.
Luckily, LGBTQ+ health experts are sharing crucial information about vaginal atrophy, its symptoms, available treatments, and how to improve sexual health and well-being.
What is vaginal atrophy?
Vaginal atrophy refers to the thinning, dryness, and inflammation of the vaginal walls due to reduced estrogen levels. Common symptoms include vaginal burning, itching, spotting, microtears, pain during sex, and recurrent urinary tract infections. These symptoms can significantly impact an individual’s quality of life.
Dr. Amira Bhaiji, a sexual health expert and medical board member for Daye, explains that vaginal atrophy can lead to uncomfortable complications. Lasara Firefox Allen, an accredited menopause educator and author of Gender queer Menopause, adds that the condition can also cause urinary issues, infections, and pH imbalances. Jericho Feng, a therapist with 12 years of experience in LGBTQ-affirming therapy, describes the symptoms as a painful sensation between the belly button and vagina, often accompanied by microtears that cause discomfort with every movement.
The impact of vaginal atrophy on cisgender women and transgender men
For cisgender women, vaginal atrophy often occurs during perimenopause and menopause when the ovaries produce less estrogen. This condition can cause pain and sexual dysfunction, yet it remains under-recognized and under-researched. Despite affecting at least half of women during these stages, there is a lack of awareness and understanding about the condition.
Transgender men and transmasculine individuals undergoing gender-affirming hormone therapy (GAHT) with testosterone can also experience vaginal atrophy. Testosterone suppresses the body’s estrogen production, leading to changes in vaginal tissues similar to those experienced by cisgender women during menopause. However, this side effect is often overlooked and understudied in the trans community.
Jericho Feng shares their personal experience with vaginal atrophy after starting testosterone. The pain and discomfort were unlike anything they had experienced before, and the lack of information made it difficult to understand and manage the symptoms. Feng emphasizes the need for detailed resources to help trans individuals recognize and address vaginal atrophy.
Treatment options for vaginal atrophy
There are several treatment options available for managing vaginal atrophy symptoms. Topical estrogens, such as creams, tablets, or vaginal rings, can help restore vaginal tissue’s thickness, elasticity, and lubrication. Systemic hormone replacement therapy (HRT) may also be an option for those experiencing broader menopausal symptoms.
For transgender men and transmasculine individuals, the same treatments are available, but the choice may be influenced by gender identity and potential dysphoria. Dr. Bhaiji notes that trans men often face additional barriers, including stigma and gender dysphoria, when accessing vaginal care. However, finding the right estrogen option can be life-changing, as hormones have no gender, and all bodies need sex hormones in different proportions.
Lasara Firefox Allen shares their positive experience with low-dose, steady-state estrogen, which helped alleviate their symptoms without causing dysphoria. They encourage trans individuals to explore estrogen options, as genitally applied estrogens do not pose a risk of feminization.
Maintaining a healthy sex life with vaginal atrophy
As estrogen levels decrease, sexual health can be significantly impacted. Painful sex, changes in orgasms, and reduced libido are common concerns. Dr. Bhaiji advises open communication with partners about symptoms and exploring alternative forms of intimacy that focus on arousal rather than penetration.
Jericho Feng highlights the importance of discussing symptoms with healthcare providers and sexual partners. Adjusting sexual activities, using extra lube, wearing softer clothing, and changing positions can help manage symptoms and maintain a pleasurable sex life. Lasara Firefox Allen recommends using pH-safe lubricants to decrease the risk of tears and irritation and increase pleasurability.
