And when your vagina starts itching, burning, tearing (yikes), or feeling like sandpaper, it can be confusing to figure out what’s actually going on.

So let’s break it down: what is vaginal atrophy? How does it differ from GSM? And why does it feel so different for every woman?

How is Atrophy Defined?

Vaginal atrophy is the thinning, drying, and loss of elasticity in the vaginal and vulvar tissues due to decreased estrogen levels, most commonly in perimenopause and post-menopause. Estrogen helps maintain vaginal blood flow, tissue integrity, and moisture. When levels decline, so does vaginal health (Sturdee & Panay, 2010).

The word "atrophy" stems from Greek roots meaning “without nourishment.” Not exactly the empowering vibe we’re going for—but unfortunately, that’s exactly what happens when estrogen leaves the party.

Without it, vaginal tissues:

• Thin and become fragile
• Lose their ability to stretch
• Produce less lubrication
• Become more susceptible to tearing and inflammation

Yet, the lived experience of this can be wildly different depending on the woman—and even the day.

Ok, What About GSM?

Genitourinary Syndrome of Menopause (GSM) was introduced in 2014 to better describe the constellation of symptoms caused by the decline in estrogen and androgens during menopause (Portman & Gass, 2014). The term replaced "vaginal atrophy" because:

• It includes urinary symptoms like urgency and recurrent UTIs
• It reflects sexual symptoms like low libido and painful sex
• It moves away from pathologizing or shaming language

Why the update matters: around 50-70% of postmenopausal women experience GSM symptoms, yet fewer than 25% seek help (Kingsberg et al., 2013). Why? Because shame, stigma, and poor communication mean many women suffer in silence.

Let’s Talk Vaginal Pain...

Not all vaginal discomfort is the same. In fact, many women experience:

• Itching & burning: Common early signs, often confused with yeast infections. These sensations may stem from inflammation, pH imbalance, and thinning of the epithelium.
• Microtears and tearing during sex: Caused by fragile mucosa with reduced collagen and blood flow. Even normal movement or wiping can cause tears in advanced cases.
• Stabbing or sharp pain: May indicate exposed nerve endings or pelvic floor dysfunction. Chronic pain like this can affect body image and sexual confidence.
• Soreness or rawness: A constant, dull ache tied to thinning tissues, low estrogen, and pelvic tension.

Psychologically, these symptoms often lead to anticipatory anxiety. Women begin to fear sex or routine activities like riding a bike or wearing certain underwear. Research shows that sexual pain is closely associated with lower self-esteem, anxiety, and avoidance behavior—which can negatively affect relationships and mental health (Nappi et al., 2003).

You can read more about vaginal pain - and why each is happening in more detail (including other things that might be at play) - in this blog on vaginal pain.

Sex, Drugs, & Rock and Roll

(By that we mean: Hormones)

Let’s get honest. When pain or dryness shows up, libido doesn’t just leave—it sprints out the door.

Here's why:

• Pain leads to fear – The brain quickly links sexual activity with discomfort. This creates a cycle of fear, tension, and more pain (vaginismus), especially if sex continues without addressing the root cause.
• Medications don’t help – SSRIs, antihistamines, and antihypertensives can worsen dryness or suppress libido. One study estimates that up to 50% of women on SSRIs report some degree of sexual dysfunction (Serretti & Chiesa, 2009).
• There’s a huge treatment gap – Testosterone replacement is FDA-approved for men, but no equivalent libido-boosting hormone is routinely approved or prescribed for women. Gee, we wonder what is going to happen with that disparity? 🙄
• Sexual scripts change – Women often report a drop in spontaneous desire but maintain responsive desire—meaning desire arises only in safe, supported, and non-painful sexual settings (Basson, 2000).
• Relationships suffer – A 2021 survey of postmenopausal women found that 65% felt that GSM symptoms negatively impacted their intimacy, and 42% reported relational tension because of it.

This isn’t just a vaginal issue—it’s a whole-self issue.

Why Estriol Works

Estriol is a gentle form of estrogen that’s especially effective at treating vaginal atrophy when applied topically. Unlike estradiol (the stronger form), estriol has minimal systemic absorption and works locally where it's needed.

How it helps:

• Rebuilds tissue: Estriol stimulates epithelial cell growth, improves collagen production, and restores thickness (Leibbrand et al., 1992).
• Restores moisture & elasticity: Estrogen increases mucopolysaccharides and vascularity—key for hydration and stretch. The ELI5? Estriol helps your mucous membranes - which is a definitively un-sexy way of saying… It helps keep you wet.
• Normalizes vaginal pH: A healthy pH (around 4.5) supports lactobacilli, the beneficial bacteria that protect against infections.
• Improves sexual function: Clinical trials show that estriol significantly improves lubrication, comfort during sex, and overall sexual satisfaction (Krychman et al., 2017).

It’s fast, effective, and safe. Which brings us to…

A Little Silky Relief…

Meet Silky Peach Estriol Cream—our best-selling, bioidentical vaginal cream formulated to relieve dryness, tearing, itching, and irritation.

Whether you're:

• Just starting perimenopause
• Struggling through painful sex
• Sick of living with sandpaper sensations down there...

Silky Peach is here to help restore comfort, confidence, and connection.

✅ 0.5 mg of gentle, topical estriol per pump
✅ Designed to restore pH, moisture, and elasticity
✅ Works locally with minimal systemic effect
✅ No added junk—just results

You can read more about how it works, here.

References:
Basson, R. (2000). The female sexual response: A different model. Journal of Sex & Marital Therapy, 26(1), 51–65. https://doi.org/10.1080/009262300278641
Kingsberg, S. A., Wysocki, S., Magnus, L., & Krychman, M. (2013). Vulvar and vaginal atrophy in postmenopausal women: Findings from the REVIVE survey. Journal of Sexual Medicine, 10(7), 1790–1799.
Krychman, M., Graham, S., Bernick, B., Mirkin, S., & Portman, D. (2017). The Women’s EMPOWER survey: Sexual health during the menopausal transition and beyond. Journal of Sexual Medicine, 14(6), 733–741.
Leibbrand, H., Schmidt-Gollwitzer, M., Gollwitzer, U., & Neiss, A. (1992). Clinical effectiveness of estriol in treating vaginal atrophy. Maturitas, 15(Suppl), 59–70.
Nappi, R. E., Palacios, S., Panay, N., & Particco, M. (2003). Psychological symptoms and their correlation with sexual function in postmenopausal women. Climacteric, 6(5), 394–403.
Portman, D. J., & Gass, M. L. (2014). Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy. Menopause, 21(10), 1063–1068.
Serretti, A., & Chiesa, A. (2009). Treatment-emergent sexual dysfunction related to antidepressants: A meta-analysis. Journal of Clinical Psychopharmacology, 29(3), 259–266.
Sturdee, D. W., & Panay, N. (2010). Recommendations for the management of postmenopausal vaginal atrophy. Climacteric, 13(6), 509–522.