Sore, itchy vagina? Why it’s important to know about vaginal atrophy in surgical menopause
Vaginal atrophy, now often referred to as Genitourinary Syndrome of Menopause (GSM), is one of the most common and least openly discussed consequences of surgical menopause. Many women are not warned about it at all. Others are told it is an inevitable part of ageing, something to put up with quietly.
Neither is true.
Vaginal atrophy is a hormone-driven tissue change, not a hygiene issue, not a lack of arousal, and not a reflection of your relationship or effort. Understanding what’s happening is the first step towards feeling more comfortable and more in control.
What vaginal atrophy actually is
Oestrogen plays a central role in maintaining the health of vaginal and vulval tissues. It supports thickness, elasticity, blood flow, lubrication, and the natural protective environment of the vagina.
When ovarian oestrogen is removed abruptly, as it is in surgical menopause, these tissues can change quickly. They may become thinner, drier, less elastic, and more fragile. Blood flow reduces. Natural lubrication decreases. The protective lining becomes more prone to irritation and infection.
This process is not caused by lack of sexual activity, and it does not require penetration to develop. It is a physiological response to hormone loss.
How vaginal atrophy can show up
Symptoms vary widely, which is one reason vaginal atrophy is often missed or misdiagnosed. Some women notice dryness or discomfort during sex. Others experience burning, itching, tearing, or soreness during everyday activities such as walking, sitting, or exercising.
Recurrent urinary tract infections, urgency, stinging when passing urine, or a feeling of pressure can also be part of GSM, because the bladder and urethra are oestrogen-sensitive too.
Importantly, symptoms can appear soon after surgery or develop gradually months or years later. Many women don’t connect these changes to surgical menopause until discomfort becomes severe.
The emotional and relational impact
Vaginal discomfort can have a profound emotional impact. Pain during sex often leads to fear or avoidance, which can affect intimacy even in strong, supportive relationships. Confidence can take a hit. Some women feel embarrassed, broken, or ashamed, particularly if they’ve never experienced sexual pain before.
It’s common to internalise these changes, assuming the problem is a lack of arousal or effort. In reality, the tissue itself has changed.
Pain is not something to push through. Doing so can reinforce fear, muscle tension, and distress, making symptoms worse over time.
What helps vaginal atrophy
Support for vaginal atrophy usually works best when it focuses directly on the tissues themselves.
Vaginal moisturisers, used regularly rather than just during sex, can help restore hydration and reduce everyday discomfort. They are different from lubricants and are designed to support tissue health over time.
Lubricants can reduce friction during intimacy and make sex more comfortable, but on their own they do not treat the underlying tissue changes. Many women find a combination of regular moisturiser and lubricant for sex works better than either alone.
For many women, local vaginal oestrogen is one of the most effective treatments. It delivers a very low dose of oestrogen directly to the vaginal tissues, helping restore thickness, elasticity, and resilience. Absorption into the bloodstream is minimal, which means local oestrogen is often considered safe even when systemic HRT isn’t suitable. This is an important conversation to have with a clinician who understands menopause care, as advice can vary and is sometimes outdated.
Pelvic health physiotherapy can also play a valuable role, particularly if pain has led to pelvic floor muscle tension. Dry, fragile tissues often coexist with muscle guarding, which can increase pain and make penetration difficult. A specialist physiotherapist can help address this safely and gradually.
When sex isn’t the priority
It’s worth saying clearly: you don’t need to be sexually active for vaginal atrophy to deserve treatment. Comfort matters in its own right. Urinary symptoms, soreness, and reduced quality of life are valid reasons to seek support.
Equally, intimacy doesn’t have to centre on penetration. Many couples find new ways to connect while tissue health is being supported and confidence rebuilt.
Giving yourself permission to address it
Vaginal atrophy is common, treatable, and nothing to be embarrassed about. What makes it difficult is silence, minimisation, and lack of clear information.
If you’re experiencing symptoms, you’re not failing to cope. Your body has changed, and it deserves care.
SURGE Suggestions
Understand vaginal atrophy as a hormone-related tissue change, not a personal issue
Use vaginal moisturisers regularly to support everyday comfort
Use lubricants to reduce friction during intimacy
Ask about local vaginal oestrogen, even if systemic HRT isn’t suitable
Consider pelvic health physiotherapy if pain or tension is present
Don’t push through pain — discomfort is a signal, not a challenge
Seek support early rather than waiting for symptoms to worsen
