Vulvovaginal atrophy (atrophic vaginitis) affects roughly a third of breast cancer survivors and negatively impacts their quality of life in multiple ways.

The condition can lead to thinning, drying, and inflammation of the vaginal walls and typically occurs when the body produces less estrogen than normal. It can make daily life and activities uncomfortable, and can make also make sex painful. Vulvovaginal atrophy (VVA) affects about half of all postmenopausal women.

Research has shown that it is a significantly underreported condition.

“It’s not just a minor lifestyle problem,” said Holly L. Thacker, MD, Professor and Director of Cleveland Clinic Center for Specialized Women’s Health. “There’s a lot of significant known risk of untreated atrophy: bleeding, pain, sexual dysfunction, destroyed relationships, recurrent bladder infections that can even lead to urosepsis.”

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Additional terms that are sometimes used to describe symptoms associated with VVA include vaginal atrophy, atrophic vaginitis, urogenital atrophy, or genitourinary syndrome of menopause (GSM). All are caused by low estrogen levels in vulvovaginal tissue.

According to the National Center for Biotechnology Information, only about 7% of women affected seek treatment when they first notice the symptoms, and 25% of women with the condition said it had a negative effect on other areas of their life, like sleep, sexual health, and general happiness.

A long life expectancy paired with the onset of the condition around menopause means some women are spending more than a third of their lives with VVA.

There are available treatments to ease symptoms, yet many women don’t seek them out. This could be due to the patient’s embarrassment or reluctance to talk about her vagina with her doctor, and/or the hesitancy of healthcare professionals to broach such a sensitive topic during routine visits.

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Recent research on vulvovaginal atrophy in breast cancer survivors was led by a Delphi Panel and published in the journal Supportive Care in Cancer.

Delphi Panel methodology relies on a panel of experts (including academics and doctors) who follow a structured, scientific process of collecting and analyzing information about a problem when there is a lack of complete and definitive evidence. They send out open-ended surveys, analyze feedback, and send out additional surveys for reassessment until each expert has created a comprehensive summary of the issue.

For this study, an Italian Delphi Panel analyzed risk factors for vulvovaginal atrophy, its coexisting conditions, current treatments, areas of care that can be improved, and more.

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The panel researched the issue, emailed a questionnaire to participants in Italy, engaged in a 1-day panel, sent out two more rounds of follow-up interviews, and then completed their analysis. The entire process took about two years.

They found that VVA affects about 30% of breast cancer survivors (115,000 cases out of 380,000). They also found that depression and other psychological issues were common in VVA patients, and more severe in patients who had a history of breast cancer.

In order to meet the needs of breast cancer patients with VVA, the panel estimated that more doctor visits need to be made. Specifically, they recommend there needs to be 33.4 additional gynecological visits a year for every 100 current visits, 22.8 additional cancer screenings, 7.07 additional outpatient visits, and 5.04 screenings for human papillomavirus.

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Simple and effective treatments are readily available, including non-hormonal treatments like vaginal gels, moisturizers, and lubricants.

In particular, a non-hormonal, oral pill called Ospemifene can be used to treat VVA in women with a history of breast cancer. Vaginal laser was also seen to be helpful in treating VVA in breast cancer survivors, but there is not enough evidence to conclude how helpful it is in the long term.

According to the Mayo Clinic, regular sexual activity (with or without a partner) could help prevent symptoms of VVA because sexual activity increases blood flow to the vagina, which, in turn, helps keep vaginal tissues healthy.