Vulvovaginal Atrophy after Cancer Treatment

01-05-2025
Vulvovaginal atrophy (VVA) is a common side effect of cancer treatments like chemotherapy, radiation, and hormone therapy, causing dryness, discomfort, and pain. Various hormonal and non-hormonal treatments can help manage and relieve symptoms.

Introduction

Vulvovaginal atrophy (VVA) is a common and distressing condition that affects many women following cancer treatment. Characterized by thinning, drying, and inflammation of the vaginal walls and vulvar tissues, VVA significantly impacts quality of life, particularly sexual and urinary health. It is most often caused by a reduction in oestrogen levels—a frequent side effect of cancer treatments such as chemotherapy, radiation therapy, hormone-blocking medications, or surgical removal of the ovaries.

Chemotherapy and radiation can impair ovarian function, leading to an early or abrupt menopause. Hormonal therapies, commonly used in breast and gynecologic cancers, can further suppress oestrogen. Surgical removal of the ovaries results in immediate menopause and the sudden onset of VVA symptoms.

Common symptoms include vaginal dryness, irritation, discomfort, pain during intercourse, itching, and frequent urinary infections. These symptoms are not only physically uncomfortable but can also lead to emotional distress and reduced intimacy.

Thankfully, various treatments are available. Options include local oestrogen therapy, non-hormonal lubricants, vaginal dilators, laser and radiofrequency therapies, and emerging options like intravaginal oxygen and injectables. Early recognition, regular follow-up, and individualized care are essential to help women navigate the effects of VVA and reclaim their wellbeing after cancer treatment.

Author

Dr Nabil Elmahdawi

Dr. Nabil Elmahdawi is a Senior Clinical Oncologist and expert in cancer care, aesthetics, and women's health, focusing on menopause and recovery after cancer treatment. He leads oncology services and co-founded eJoli Clinic.

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Vulvovaginal Atrophy after Cancer Treatment:

Cancer treatment, particularly treatments like chemotherapy, radiation, and hormone therapy or surgery, can have significant effects on the body, including the vaginal and vulvar areas. One common side effect that many women experience is vulvovaginal atrophy (VVA), which is the thinning, drying, and inflammation of the vaginal walls and vulvar tissues. It is often a result of decreased oestrogen levels, which can be a consequence of cancer treatments such as chemotherapy, radiation, or hormonal therapy or as surgical removal of the ovaries resulting into surgical menopause.

Causes of Vulvovaginal Atrophy after Cancer Treatment:
1. Chemotherapy: Chemotherapy drugs can affect the ovaries, leading to a decrease in oestrogen production. This can result in symptoms of vaginal dryness, irritation, and discomfort.
2. Radiation Therapy: If radiation is directed at the pelvic region, it can damage the vaginal and vulvar tissues, leading to reduced elasticity, dryness, and thinning of the tissues.
3. Hormone Therapy: Certain cancer treatments, such as those for breast or gynaecological cancers, may involve hormone-blocking medications (like aromatase inhibitors) that lower oestrogen levels. Oestrogen is crucial for maintaining healthy vaginal and vulvar tissues, and without it, VVA symptoms can occur.
4. Surgery: Primary surgical procedures that result in removal of the ovaries (Oophorectomy) prior to the full establishment of the menopause leading to a decrease oestrogen body level, which can result in vulvovaginal atropy.

Symptoms of Vulvovaginal Atrophy:
• Vaginal dryness and discomfort
• Pain during intercourse (dyspareunia)
• Itching or irritation of the vulva
• Decreased vaginal lubrication
• Vaginal infections or frequent urinary tract infections (UTIs)
• Vaginal bleeding or spotting
• Urinary urgency or incontinence

Treatment Options for Vulvovaginal Atrophy:


1. Local Oestrogen Therapy: This is often the first-line treatment for VVA, especially in women who are undergoing or have undergone cancer treatment. It can be applied directly to the vaginal area as a cream, tablet, or ring. Local treatments generally involve lower doses of oestrogen and have fewer systemic effects.
2. Non-hormonal Lubricants and Moisturizers: For women who cannot use hormones, water-based lubricants and vaginal moisturizers can help alleviate symptoms of dryness and discomfort.
3. Vaginal Dilators: These are used to maintain vaginal elasticity and improve blood flow, which may be reduced after cancer treatments.
4. Pelvic Floor Physical Therapy: A pelvic floor therapist can help women with techniques to improve vaginal health and reduce discomfort during intercourse.
5. Systemic Hormone Replacement Therapy (HRT): In certain cases, hormone replacement therapy may be considered if the woman is not at high risk for hormone-sensitive cancer recurrence.
6. Laser Therapy, Radiofrequency: Some women may benefit from Intravaginal and vulva fractional CO2 laser therapy or non-ablative radiofrequency , which helps stimulate collagen production and improve vaginal and vulva skin health.
7. Intra vaginal Oxygen with and without hyaluronic acid: New emerging technology which has backing research evidence as very tolerated effective treatment.
8. The use of injectables: Hyaluronic acid and PRP more supportive research however, biostimulators like polynucleotides, exosomes and stem cells thy lack the concrete evidence of safety and effectiveness in female cancer survivors

Additional Support:

  • Regular Follow-up: It's important for women who have undergone cancer treatment to continue regular check-ups with their oncologist and gynaecologist, especially if they experience symptoms of VVA.
  • Counselling and Support: Dealing with sexual health changes post-cancer treatment can be emotionally challenging. Speaking with a counsellor or a support group can be helpful in managing the psychological and emotional aspects of these changes.

Medical Help:

If you're looking for medical help who specialize in treating vulvovaginal atrophy (VVA) after cancer treatment, you would typically seek professionals in a few areas, including:

  1. Gynaecologists (with a focus on oncology or menopausal care)
  2. Oncologists (specifically those who focus on survivorship care)
  3. Pelvic Floor Physical Therapists
  4. Urogynaecologist (specializing in the female urinary and reproductive systems)
  5. Menopause specialists or hormone specialists
  6. General Practitioners
  7. Specialised Nurse