Stefanie A. Varela, Ph.D., WHNP-BC, FNP-C and Delfino Varela, Medical Student

The Vagina :Bringing the Vagina Back to Life After Menopause Non-Hormonal Treatment Approaches for Atrophic Vaginitis and Chronic UTIs in Estrogen-Restricted Women In honor of the women who have suffered in silence

This paper is dedicated to the many women I have had the privilege of treating for atrophic vaginitis during menopause. Atrophic vaginitis—characterized by vaginal dryness, tissue thinning, and the involution of the vagina, labia, and urethra—is primarily caused by estrogen deficiency. I reflect on the voices of women whose needs have been unmet due to contraindications for estrogen therapy, often stemming from a history of cancer or other medical concerns. This work seeks to explore evidence-based, non-hormonal alternatives to manage atrophic vaginitis in menopausal women who cannot undergo estrogen therapy. Atrophic vaginitis does not affect the vagina alone—it also compromises the urethra, labia minora, labia majora, and the vaginal introitus (Faubion et al., 2017). Many of my patients have expressed frustration and distress as they navigate these symptoms without access to estrogen treatment. Their suffering and pleas for relief fuel the urgency of exploring and validating safe, effective, and estrogen-free therapeutic options.