What Is the Treatment of Atrophic Vaginitis for Vulvovaginal Dryness, Dyspareunia, and Irritation?
Atrophic vaginitis (genitourinary syndrome of menopause, GSM) presents with vulvovaginal dryness, dyspareunia, and discomfort or irritation. This page outlines the first-line management framework for these symptoms.
Treatment Approach
Management is guided by a shared decision-making process between clinician and patient. The approach spans both local vaginal therapies and non-hormonal options, with selection tailored to symptom burden, patient preference, and individual clinical context. Counselling on avoidance of vulvovaginal irritants also forms part of standard care. The full decision algorithm — including all available options and how to choose among them — is contained in the complete protocol.
Clinical Goals
Improvement of vulvovaginal dryness, dyspareunia, and discomfort/irritation. Symptoms typically begin improving within 1 to 2 months of initiating treatment, with continued improvement through 12 weeks.
References
DOI: 10.1097/JU.0000000000004589
- Clinicians should offer the option of local low-dose vaginal estrogen to patients with GSM to improve vulvovaginal discomfort/irritation, dryness, and/or dyspareunia.
- Local low-dose vaginal estrogen may be administered in the form of a cream, tablet, or ring and can be used to improve vaginal dryness, dysuria, dyspareunia, and vulvovaginal discomfort/irritation related to GSM.
- Clinicians should offer the option of vaginal dehydroepiandrosterone (DHEA) to patients with GSM to improve vulvovaginal dryness and/or dyspareunia.
- Clinicians may offer the option of ospemifene to patients with GSM to improve vulvovaginal dryness and/or dyspareunia.
- Clinicians should recommend the use of vaginal moisturizers and/or lubricants, either alone or in combination with other therapies, to improve vaginal dryness and/or dyspareunia in patients with GSM.
- Clinicians should counsel patients to avoid vulvovaginal irritants and/or cleansers which may exacerbate the signs and symptoms of GSM.
- For effective treatments, limited evidence and clinician experience suggest that symptoms begin improving within 1 to 2 months of initiating treatment and continue to improve through 12 weeks (average length of study follow-up).