At a glance

Vaginal atrophy and vaginal laxity are different concerns, although some women may experience symptoms of both. Vaginal atrophy is commonly associated with hormonal changes around and after menopause and is now often discussed as part of genitourinary syndrome of menopause (GSM). Vaginal laxity relates more to a sensation or finding of reduced vaginal or pelvic-floor support and may occur after childbirth or alongside other pelvic-floor changes.

Because symptoms can overlap with infection, pelvic-floor disorders, vulval skin conditions and other health issues, assessment is important before deciding what management may be appropriate.

What is vaginal atrophy or GSM?

GSM is a term used for vaginal, vulval and urinary symptoms associated with reduced ovarian hormone levels around menopause. Older terms such as vaginal atrophy or vulvovaginal atrophy may still be used, but GSM better reflects that symptoms can involve more than vaginal tissue alone.

Common symptoms can include vaginal dryness, burning, itching or irritation, reduced lubrication, discomfort or pain during intercourse, urinary urgency or frequency, discomfort when passing urine and recurrent urinary symptoms. Symptoms vary between individuals and may change over time.

GSM can occur after natural or surgical menopause and may also be relevant after some treatments that affect hormone levels. New or worsening symptoms should still be assessed because not every symptom in this area is caused by menopause.

What is vaginal laxity?

Vaginal laxity generally describes a feeling of reduced vaginal tightness or support. It is often patient-reported rather than defined by a single diagnostic test. Research has used a range of questionnaires and clinical measures, and there is not one universally accepted measurement approach.

Some women notice a change after vaginal childbirth, particularly where the pelvic floor has been stretched or injured. Ageing, pelvic-floor dysfunction and pelvic-organ prolapse may also contribute to a change in vaginal or pelvic support.

What is the difference between vaginal atrophy and vaginal laxity?

The main difference is the underlying clinical context.

A person may experience both at the same time. For example, someone after menopause may have dryness and irritation as well as pelvic-floor symptoms related to previous childbirth. Treating all of these symptoms as one condition can make it harder to identify the most appropriate care.

What can cause vaginal atrophy or GSM?

The most common driver is reduced oestrogen around and after menopause. Similar changes can also occur after surgery involving the ovaries, during some cancer treatments or at other times when hormone levels are reduced.

Vaginal dryness can also have other contributors. These may include some medicines, irritation, inflammation, smoking, diabetes, reduced arousal, stress or other underlying conditions. This is why persistent dryness should not automatically be assumed to be caused by menopause.

What can contribute to vaginal laxity?

Potential contributors include pregnancy and vaginal childbirth, pelvic-floor muscle injury or weakness, ageing, pelvic-organ prolapse and other changes affecting pelvic support. The presence of laxity does not by itself identify the cause.

If there is also a sensation of pelvic pressure, a vaginal bulge, bladder-emptying difficulty, bowel symptoms or urinary leakage, broader pelvic-floor assessment may be appropriate.

How are these concerns assessed?

Assessment begins with the symptoms themselves. A clinician may ask when symptoms began, whether they are changing, menopause status, childbirth history, urinary or bowel symptoms, pain during intercourse, bleeding or discharge, medicines, previous treatment and any history of pelvic surgery or pelvic-floor problems.

Depending on the concern, an examination may be recommended. Urine testing, pelvic-floor assessment, GP review, gynaecology review or another referral may also be appropriate. Some people can begin with a private telehealth consultation, although an in-person assessment may still be needed.

What management options may be discussed?

Management depends on the cause, symptoms and individual medical history. For dryness or irritation, supportive measures such as suitable vaginal moisturisers and lubricants may help some people. A clinician can also determine whether further medical management is appropriate.

Where pelvic-floor weakness, coordination or support is contributing to symptoms, pelvic-floor physiotherapy may be considered. If prolapse or another structural concern is suspected, further examination or specialist review may be more appropriate.

Procedural options should not be assumed to be suitable simply because someone reports laxity, dryness or sexual discomfort. Where any procedure is considered, the discussion should include the quality of available evidence, potential risks, limitations, alternatives and whether another form of care would better address the underlying concern.

When should I see a doctor?

Seek medical assessment for symptoms that are new, persistent, worsening or affecting daily life. Medical review is particularly important if you have:

• post-menopausal bleeding;
• unexplained vaginal or vulval pain;
• unusual or malodorous discharge;
• blood in the urine;
• persistent discomfort when passing urine;
• recurrent urinary infections;
• a new vulval skin change;
• a vaginal bulge or pressure sensation; or
• difficulty emptying the bladder.

These symptoms can have several possible causes and should not be self-diagnosed as GSM or vaginal laxity.

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This page provides general information and does not replace individual medical advice. Assessment and management depend on individual clinical circumstances.