Vulvovaginal atrophy (VVA) refers specifically to the changes in the vaginal and vulvar surfaces that on examination are thin, pale, and dry. The vagina can narrow and shorten, and the introitus may constrict. The vaginal lining may exhibit petechiae and become thinner less elastic, and progressively smoother. Vaginal blood flow diminishes and lubrication during sexual stimulation is decreased and delayed. Atrophic vaginitis is usually a term used when inflammationsis also noted.1 Vulvovaginal atrophy (VVA) can have significant effect on a woman’s sexual health and quality of life. It can be progressive and less likely to resolve without intervention 
. Symptoms include lack of lubrication and pain with intercourse, which affects 20% to 45% of midlife and older women [2,3]
1. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause, Vol. 20, No. 9, 2013.
2. Lindau ST, Schumm LP. Laumann EO, Levinson W, O_Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med 2007;357:762-774.
3. Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med 2009;6:2133-2142.