I laughed out loud when I heard Esther and Holly talking about ‘cardboard vaginas’ on the Women’s Running podcast the other week. It’s a pretty good description of a vagina that’s lost it plumpness and lubrication due to low oestrogen levels. And while the term is funny, the condition is no laughing matter. Vaginal atrophy affects more than half of post menopausal women and 15 per cent of women before the menopause. It can make sex, life and running painful. So, what actually is an vaginal atrophy? How can atrophic vaginitis affect your running? And, importantly, how do you treat an atrophic vagina?

What is atrophic vaginitis?

You hear vaginal atrophy and atrophic vaginitis used interchangeably. The word ‘atrophy’ means wasting away or thinning and ‘itis’ on the end of a word means inflammation. So put quite simply, the term atrophic vaginitis means a thin, inflamed vagina. The lining of the vagina is usually thick, moist, bouncy and rippled. When oestrogen levels fall during the peri and post menopause years, this has an effect on the tissues lining the vagina. They become thinner, flatter drier and less elastic. This happens to some extent to all women although some are worse affected than others. The older you are, the more likely you are to have atrophic vaginitis.

How does atrophic vaginitis feel?

You may not have any symptoms from the condition but if you do, you might experience:

  • Painful sex
  • Discomfort during cervical screening
  • A dry vagina
  • Burning sensation in the vagina
  • A mild vaginal itch
  • Needing to pee more often
  • Frequent urinary infections
  • Urinary incontinence
  • Frequent vaginal infections
  • Spotting of blood (never assume this is due to atrophic vaginitis – get checked)

How can atrophic vaginitis affect my running?

Running is a very repetitive movement. If the tissues of your vagina and vulva are dry, the friction from long runs could irritate them and cause pain, itch or spots of blood (again, never assume bleeding is from this). Thin tissues are also not as good at keeping away germs so you might find you get more infections such as thrush or more urinary infections than you used to. If you’re cross training on a bike then sitting on the saddle can feel uncomfortable too.

What’s the treatment for atrophic vaginitis?

First up, there are things you shouldn’t do such as over washing your vulva, douching your vagina or using perfumed washes (even if they say they’re for your ‘intimate areas’). This goes for all women with or without atrophic vaginitis. Runners tend to have a lot of showers and get extra sweaty so it’s easy and tempting to over wash. Plain water is fine.

Moisturise. You can add moisture back to the vagina with a vaginal moisturiser which you can buy over the counter. You can use this regularly or whenever you need to. You could for example, apply it before your long run. Make sure you buy one which is fragrance-free. Don’t use a moisturiser that’s not designed for your vagina. Your anti-chafing skin lubricant that you use on your inner thighs for example, is not suitable. If sex is uncomfortable then use a water-based lubricant.

Replace oestrogen. Rather than just soothing the dryness with a moisturiser, you can treat the cause and replace oestrogen. Systemic (full body) Hormone Replacement Therapy (HRT) is one option but oestrogen replacement can be done directly via the dry tissues themselves with a vaginal cream, gel or pessary (tablet which you insert into the vagina). There is also a vaginal ring which sits high in the vagina and slowly releases oestrogen too. All of these currently need to be prescribed by a doctor who will want to ask you some questions and examine you first, to make sure there are no other reasons for your discomfort. You’ll usually be asked to use a vaginal oestrogen daily for a couple of weeks and then reduce to twice a week for maintenance. They’re suitable for the majority of women, can be used long-term and in addition to HRT if you still have vaginal symptoms.

What if it’s not atrophic vaginitis?

Don’t self diagnose this condition, go and see your doctor. Remember, you don’t need to shave your legs, wax your bikini line or wear your best knickers to get checked, just make the appointment.

You can see from the list of symptoms why it’s easy to make the wrong diagnosis:

  • If you have an itch or vaginal discharge, you need to have a vaginal infection excluded.
  • If you have recurrent urine infections you will need to give a urine sample and possibly have other investigations.
  • It’s a tricky area to examine yourself and if you have discomfort then you may have a skin lesion or a cyst that requires different treatment.
  • If you’re leaking urine then you need to be examined to assess your pelvic floor and check for prolapses.
  • Any unexpected vaginal bleeding such as between periods, after sex or after the menopause needs to be checked out, usually the cause is harmless but very occasionally it can be something serious such as a cancer.

Once the doctor is certain that atrophic vaginitis is the diagnosis then treatment can start and it can make a HUGE difference. If you don’t want to, or can’t take full HRT, then topical (applied to the skin) vaginal oestrogen might still be an option for you so don’t rule it out and have a conversation with your doctor.

Don’t let a cardboard vagina ruin your running!

If you’d like more tips on running and the menopause then sign up for my newsletter below and you’ll get some every week, straight to your email inbox. Also, why not have a look at my Run Through the Menopause video course?

Sand Image by Anita S. from Pixabay

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  1. Great advice and I love the fact that you make it clear that getting dressed up, shaved or waxed is NOT a requirement when visiting your GP!,

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