🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Atrophic vaginitis

Specialties > General practice

Background knowledge 🧠

Definition

  • Atrophic vaginitis is the inflammation of the vaginal epithelium due to thinning and shrinking of the tissues, typically related to decreased oestrogen levels.
  • Often occurs in postmenopausal women but can also be seen in premenopausal women with hypoestrogenism.

Epidemiology

  • Affects around 10-40% of postmenopausal women.
  • Higher prevalence in women who have undergone surgical menopause or those receiving anti-oestrogen treatments.
  • Less common in premenopausal women but can occur in cases of premature ovarian insufficiency.
  • Underreported due to embarrassment or misunderstanding of symptoms.

Aetiology and Pathophysiology

  • Caused by reduced oestrogen levels, leading to thinning of the vaginal epithelium.
  • Decreased glycogen content leads to reduced lactic acid production by lactobacilli, resulting in increased vaginal pH.
  • Thinning of epithelium reduces elasticity, increases friability, and reduces lubrication.
  • Associated with other hypoestrogenic states such as breastfeeding, oophorectomy, and chemotherapy.

Types

  • Postmenopausal atrophic vaginitis: Most common form, typically occurring several years after menopause.
  • Lactational atrophic vaginitis: Occurs during breastfeeding due to temporary hypoestrogenism.
  • Iatrogenic atrophic vaginitis: Caused by medications such as aromatase inhibitors or after surgical menopause.

Clinical Features 🌡️

Symptoms

  • Vaginal dryness, itching, and burning sensation.
  • Dyspareunia (painful intercourse) due to loss of lubrication and thinning of the epithelium.
  • Urinary symptoms such as urgency, frequency, and dysuria.
  • Vaginal discharge, which may be yellowish or tinged with blood.
  • Potential for increased frequency of vaginal infections due to altered pH and microbiota.

Signs

  • Pale, thin, and dry vaginal epithelium on examination.
  • Reduced vaginal elasticity and rugae (folds).
  • Presence of petechiae or small areas of bleeding, especially after minimal trauma.
  • Vaginal pH typically above 5.0.

Investigations 🧪

Tests

  • Vaginal pH testing: Elevated pH (above 5.0) is suggestive.
  • Microscopy: May show a decrease in lactobacilli and an increase in other flora.
  • Estrogen assays: Not routinely used but may be considered in complex cases.
  • Exclusion of infections: Swabs may be taken to rule out other causes of symptoms such as bacterial vaginosis or candidiasis.

Management 🥼

Management

  • Topical oestrogen therapy is the mainstay, available as creams, pessaries, or rings.
  • Non-hormonal lubricants and moisturisers for symptomatic relief.
  • Regular sexual activity or vaginal dilators may help maintain vaginal elasticity.
  • Consider systemic hormone replacement therapy (HRT) if there are other menopausal symptoms and no contraindications.
  • Patient education on the chronic nature of the condition and the need for ongoing management.

Complications

  • Increased susceptibility to vaginal infections.
  • Sexual dysfunction due to discomfort and dyspareunia.
  • Potential for urinary symptoms to progress, leading to recurrent UTIs.
  • Increased risk of vaginal prolapse in severe cases due to weakened pelvic tissues.

Prognosis

  • With appropriate treatment, symptoms can be significantly alleviated.
  • Ongoing management is usually required as symptoms may recur if treatment is stopped.
  • Regular follow-up is important to monitor symptoms and adjust treatment.

Key Points

  • Atrophic vaginitis is common in postmenopausal women and should be considered in any woman with vaginal or urinary symptoms.
  • Topical oestrogen therapy is effective and generally well-tolerated.
  • Non-hormonal treatments are available for those who cannot use oestrogens.
  • Patient education is crucial for long-term management and adherence to treatment.

No comments yet 😉

Leave a Reply

General practice