SEPTEMBER 2008
The Vaginal Infection Connection:
Why & How to Treat

Menopause can cause vulvovaginal symptoms. Decreases in estrogen levels may cause tissues of the vulva (tissue surrounding the vagina) and the lining of the vagina to become thin, dry, and less elastic—a condition called atrophy. Additionally, vaginal secretions diminish, resulting in decreased lubrication. Loss of estrogen also results in an increase in vaginal pH, changing the healthy acidic environment to an alkaline one that is more susceptible to vaginal inflammation and infection.

Symptoms should be investigated by a clinician to identify the cause and most appropriate treatment. All peri- and postmenopausal women should have a thorough, regular evaluation of vulvovaginal health, regardless of whether or not they have symptoms or are sexually active.

Beyond and sometimes in addition to the effects of hormone changes in the vulvovaginal area, the following infections may be diagnosed around menopause.

  • Yeast infection. Extreme itching (sometimes burning), redness and swelling, pain with urination, discomfort during sex, and a thick, white vaginal discharge are likely signs of a yeast infection. This common ailment is caused by an overgrowth of the fungus Candida, which usually lives in the vagina in small quantities under normal conditions.
    Yeast infections can be treated with antifungal medicines in the form of over-the-counter (nonprescription) vaginal creams, tablets, ointments, or suppositories. An oral medication, fluconazole, is also available by prescription. The first time a woman thinks she has a yeast infection, it is recommended that she sees her healthcare provider for confirmation. Repeat yeast infections can be treated with one of many over-the-counter remedies -- but with caution. Studies show that two-thirds of women who buy antifungal products do not really have a yeast infection and using these medicines may make the problem worse.
  • Postmenopausal women are less susceptible to yeast, but it is not uncommon for women who start on estrogen therapy who have had yeast infections before to get a recurrence as their tissues respond to the estrogen.
  • Bacterial vaginosis. Another common bacterial imbalance also associated with minor itching and burning is bacterial vaginosis (BV). An abnormal and fishy odor is often present along with a discharge that can be thin and milky or gray. BV is treated with the prescription antibiotics metronidazole or clindamycin, which can be given orally or in vaginal gels. 
  • Sexually transmitted infections. When women and their partners don’t practice safe sex, the spread of sexually transmitted infections (STIs) such as gonorrhea or chlamydia is always a possibility. These infections sometimes cause vaginal inflammation, discharge, pain, or itching. Recommended treatments are usually prescription antibiotics. Other STIs, such as herpes, are viruses that cannot be cured, but treatment is available to control symptoms.

Finally, in addition to vaginal infections and atrophy, there are a variety of skin conditions that can affect the vulvovaginal area. If things don’t feel right “down there,” consult a health provider expert in women’s heath.

Last reviewed: September 2008


The Co-Editors of Menopause Flashes are Elizabeth Contestabile, RNC, BScN, Nurse Educator, Shirley E. Greenberg Women's Health Centre, The Ottawa Hospital, Riverside Campus, Ottawa, ON, Canada; and Marcie K. Richardson, MD, Co-director, Harvard Vanguard Menopause Consultation Service, Boston, MA.

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