Vaginitis: Dry, Irritated, Inflamed Vaginal Tissue
Vaginitis (inflammation of the vagina) and vaginal dryness are common problems for women around the time of perimenopause and menopause. As hormones like estrogen and testosterone decline, the health of the vaginal tissue suffers. This results in thinning of the skin, decreased lubrication, and increased friction with intercourse or inserting a tampon. Even walking can become irritating. Atrophic vaginitis refers to inflammation of the vagina due to atrophy or weakening of the vaginal tissue. It is usually associated with the decline of hormones at menopause. Vaginal dryness can also occur in 3-5% of users of certain low-dose birth control pills.
The irritated tissue is more susceptible to infection, so it is sore, raw, and sometimes bleeding. Because of the associated pain, intercourse is less desirable, which can cause relationship difficulties.
What is the Natural Treatment for Vaginitis or Vaginal Dryness?
Natural treatment for atrophic vaginitis involves:
Lubricants
The use of vaginal lubricants (preferably something natural and even edible like coconut oil) reduces inflammation and prevents friction.
Hormone Balance
Supporting appropriate hormone production at the various stages of life, even into menopause, maintains vaginal tissue health. Vitamins, minerals, diet, and herbs balance hormones, nourish the endocrine glands and support hormone-sensitive tissues.
Healing and Soothing
Vitamin A, vitamin E, and calendula may be used topically to help heal and soothe vaginal tissue.
Vaginal Microbiome and Its Role in Vaginal Health
Just like your gut, your vagina has its unique microbiome—a complex and dynamic ecosystem of bacteria that plays a critical role in maintaining vaginal health. In a healthy vaginal environment, Lactobacillus species dominate. These beneficial bacteria help maintain an acidic pH (typically between 3.8 and 4.5), which inhibits the growth of harmful microbes like yeast, Gardnerella, and E. coli.
When the balance of bacteria is disrupted—due to antibiotics, hormonal changes, sexual activity, poor hygiene, or immune imbalances—unfriendly organisms can thrive. This imbalance can lead to conditions like bacterial vaginosis (BV), yeast infections, and vaginitis, which can cause symptoms such as itching, burning, unusual discharge, and odour.
Vaginal Dryness and the Microbiome
Vaginal dryness is another common issue, especially during perimenopause, menopause, or in women with low estrogen levels. Estrogen, along with other hormones, helps maintain the thickness, elasticity, and moisture of the vaginal walls and also supports the growth of Lactobacillus. When estrogen levels decline, so does the presence of protective bacteria, and the vaginal pH rises—making the area more susceptible to infections, inflammation, and discomfort.
This is why treating vaginal dryness often involves more than just lubrication. Restoring the vaginal microbiome can be key to long-term relief. Probiotic therapies (especially vaginal or oral Lactobacillus-containing strains), hormone-balancing strategies, and avoiding harsh soaps or douches can all help rebuild a healthy vaginal environment.
Treating Vaginitis and Supporting Vaginal Health
Treating secondary infections—whether fungal, bacterial, or viral—is an important first step in restoring vaginal balance. But rebuilding the microbiome afterward is equally essential, as treatments like antibiotics or antifungals can wipe out both harmful and beneficial bacteria.
Here’s how to support vaginal health through microbiome care:
To support overall microbial and hormonal health, consume a healthy diet rich in prebiotic fibres, fermented foods, and phytoestrogens.
Use probiotics that are specifically designed for vaginal health. These often include Lactobacillus rhamnosus, Lactobacillus reuteri, or Lactobacillus crispatus.
Avoid unnecessary antibiotics, and when antibiotics are necessary, follow up with a course of probiotics.
Balance hormones naturally or with medical support if needed, especially in perimenopause or menopause.
Avoid douching and perfumed products in the vaginal area, which can disturb the delicate microbial balance.
Tests for vaginitis
If the woman’s menopausal status is uncertain, the following tests are done on day 3: LH, FSH, and estradiol; on day 21: progesterone; and at any time of the cycle: total testosterone and DHEAs. A vaginal swab determines if there is an infection with yeast, trichomonas, or Gardnerella. If there is any abnormal vaginal or uterine bleeding, a PAP smear and ultrasound are done.
For help with this or any other health problem, book an appointment here or call the clinic at 416-481-0222 for more information.
Authored by Dr. Pamela Frank, BSc(Hons), ND
Vaginitis or Vaginal Dryness Research
Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis… Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur.
Source: Am Fam Physician. 2011 Apr 1;83(7):807-15. Vaginitis. Hainer BL, Gibson MV.
Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.
Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.