sap22 - the problem with doing swabs is that, even if they find something like a strep infection, they will often not treat it. Antibiotics can actually make matters worse by encouraging thrush to develop etc. and the infection will just come back once you finish the ABs anyway. The flora balance in the vaginal changes as the area dries out with oestrogen deficiency so is far more open to infections and discomfort generally. Bacteria from the gut is easily transferred which will also aggravate.
The burning and discomfort of VA is quite common in menopausal women - though many will not seek help.
I believe it is a combination of problems which will include the thinning and dryness of the vaginal area due to oestrogen deficiency and the VA also effects the bladder and urethra making this more prone to infection and discomfort.
Did you try Vagifem for at least 3 months? It can take some time to reverse the effects of VA. If you are getting a burning urethra then the Vagifem will help but one also needs to adopt other strategies e.g. - avoiding all scented products, take showers not baths, drink plenty of water and avoid acidic drinks, alcohol and caffeine.
I have found I need to use quite specific vaginal moisturising gels to help reduce the chance of infection taking hold and also to keep things comfortable - I use Multi Gyn Actigel every day and often some Sylk - these work for me but there are other things to try. The Multi Gyn Actigel is specifically designed to keep the flora balance in the vaginal area slightly acidic so thrush and BV can't take hold. If I feel something brewing then I will use it 2-3 times a day until it's settled.
In my experience very few doctors know or understand how painful and distressing VA is. If you are under 60 then it may be worth trying a systemic HRT alongside the Vagifem as well, to really deal with total oestrogen deficiency.
Many women prefer the local oestrogen creams but I find them messy and they irritate my vaginal area too much.
I am seeing a gynae privately - a really lovely man who is based in Norwich - he suggest Vagifem as the first line of treatment for VA. I am now 60 and still sticking with systemic HRT with some Vagifem - there is no way I would be without, at least, Vagifem as I think my life would be too uncomfortable.
My HRT regime - one pump per day of Oestrogel with 12 days each month of Utrogestan (micronised progesterone) which does mean I still have a bleed each month - can't use progesterone all the time I'm afraid as it doesn't suit me. I tend to use Vagifem just once or twice a week as I'm on full HRT as well. If I stop Full HRT then I would use Vagifem 3 times a week at least. I use the MultiGyn Actigel and Sylk every day.
This is just my experience and I do feel you should try the Vagifem again and use the moisturisers alongside for 2-3 months to see if this helps before pursuing the private route. If it doesn't then work then ask for full systemic HRT. all treatment will take time so one has to patient. DG x