It is heartbreaking how often this issue is overlooked by doctors.
The vaginal and urethra/bladder tissues are loaded with estrogen- responsive cells. Estrogen increases blood flow and maintains thickness and elasticity (think cushion-y). It keeps the vagina moist and able to lubricate.
Lack of estrogen in the vagina, vulva and urethra can cause Urogenital Atrophy. It is also called Vaginal Atrophy or Atrophic Vaginitis, but these terms exclude the effect on the urinary tract.
Symptoms may include:
Vaginal and genital pain
Narrowed vaginal opening
External and internal irritation
Itching, severe burning, discharge
Vaginal tissue more easily damaged: thinner and dryer, sores on the vaginal walls can occur
Some women develop fear of pelvic examinations
Changes in pH and mucous can lead to more yeast infections
Decreased sex drive
Decreased responsiveness (lowered sensitivity to stimulation)
More difficulty achieving orgasm
The bladder and urethra are also affected:
Increased urinary tract infections
Increased urinary frequency
Estrogen can be applied directly to the vaginal tissue in cream, suppository, or inserted ring. It acts directly on the tissue and only a tiny bit gets into the general circulation.
Oral or patch estrogen also helps. One, the other, or both forms may be helpful. The presence of estrogen can reverse these changes to a great extent.