Atrophic vulvovaginitis

What is it atrophic vulvovaginitis?

Atrophic vulvovaginitis means thinned genital tissue in women. It is often shortened to atrophic vaginitis, as it is the vaginal tissue that is often symptomatic. Because of his predominance in older women, it is also known as senile vulvovaginitis.

What Causes Atrophic Vulvovaginitis?

Atrophic vulvovaginitis is associated with estrogen deficiency due to:

• Menopause
• Lactation
• Hyperprolactinemia
• High dose progesterone medicines
• Chest Cancer medications, such as tamoxifen and aromatase inhibitors.

What are the symptoms of atrophic vulvovaginitis?

• Vaginal or vulvar dryness
• Vaginal or vulvar itching (pruritus vulvas)
• Vaginal burning
• Painful sex (dyspareunia)
• Skin division (fissure) from the entrance to the vagina (later fourchette)
• Vaginal spotting (bleeding)

Estrogen deficiency can also lead to dysuria (burning sensation when urinating), urinary urgency, frequency and incontinence (the genitourinary syndrome menopause).

The bacteria in the vagina

Lack of estrogen causes changes in the normal vagina organisms. Those seen in younger women (especially lactobacilli) disappear and are replaced by gram-negative organisms such as Escherichia coli or those associated with bacterial vaginosis Urinary or bladder infections are more common in postmenopausal women than in younger women.

What makes an atrophic vulva and the vagina looks like?

Atrophic vulvovaginitis changes the appearance of the female genitalia:

• Vulva appears paler
• The lips are thinner and smaller.
• Clitoral hood is less obvious
• A red membrane or polyp may be seen at the opening of the urethra (urethral caruncle)
• Vaginal skin appears thin and dry, with small blood vessels under it resulting in patchy redness
• Stretching the vulva can cause splitting of the skin in the lower part of the vagina or elsewhere.

Should tests be done to confirm the diagnosis?

Tests for atrophic vulvovaginitis can be done if any symptoms are present. These may include:

• Skin swab / wet mount exam: this may reveal epithelial Typical cells of the postmenopausal vagina can be reported and can help identify infection
• Biopsy - This can be done to ensure that there is no inflammatory skin disease or neoplastic condition causing symptoms
• Cystoscopy of the bladder and investigations of urinary symptoms.
• Colposcopy of the vagina and cervix and investigations for gynecological symptoms.

General measures to improve atrophic vulvovaginitis.

The following measures are recommended.

• Use a soap-free cleanser or wash gently with plain warm water, no more than once or twice a day
• Apply emollient cream Suitable for sensitive skin or Vaseline if the vulva feels dry or itchy.
• Use a lubricant for sexual intercourse; if it stings, try another or use oil or petroleum jelly.
• A test of a vaginal wetness
• Anticholinergic, antihistamine, decongestant, or antidepressant medications may be contributing to the dryness; if you take these consider stopping
• Short-term use of current steroids may be needed to dermatitis caused by irritants such as urine, pantyhose, or tight clothing

Estrogen treatment

Atrophic vulvovaginitis is treated with topical estrogens, a prescription drug. This can be provided as a vaginal cream, pessaries, or vaginal ring. In New Zealand, Ovestin ™, which contains estriol, is used at a dose of 0.5 mg / day for 1 to 2 weeks and then once or twice a week. It can be inserted with an applicator or with the tip of a finger. Vagifem ™ pessaries (containing oestrodiol) can also be used, but are currently not funded by PHARMAC in New Zealand.

Estrogen treatment produces:

• Normalization of the cells of the vaginal wall.
• Improved vaginal blood flow
• Vaginal decrease pH
• Recolonization by lactobacilli
• Improves vaginal thickness and elasticity.
• Reduction in vulvovaginal symptoms
• Improved sexual function
• Reduction of urinary infections.

Topical estrogen is considered safe because very little is absorbed systemically. However, estrogen is generally not prescribed to women with severe liver disease.dependent cancers or thromboembolic disease if the risk of these conditions is increased.

Sometimes other forms of estrogen are recommended, such as tablets, transdermal patches, gels, sprays, and emulsions. Systemic estrogen is generally mixed with progestogens. There are significant risks and side effects, so they are generally not used if atrophic vaginitis is the only problem.

Side effects and risks of vaginal estrogen therapy.

Topical estrogen can cause side effects, including:

• Vaginal itching and burning
• Increased risk of vaginal Candida albicans infection (vaginal yeast infection)
• Breast discomfort (rare)
• Vaginal bleeding (rare).

When used only once or twice a week, there are no other side effects described with higher doses or modes of estrogen administration.

Other treatments for atrophic vulvovaginitis

Experimental options for vulvovaginal rejuvenation in symptomatic women who are unfit or intolerant of local or systemic estrogen therapy include:

• Platelet-Rich plasma injections

• Hyaluronic acids or fat implants (lipofilling of the labia majora)

• Fractional carbon dioxide To be, non-ablative erbium: YAG lasers, diode lasers, and monopolar radio frequency devices
• Vaginal surgery (vaginoplasty).

The optimal regimens, effectiveness, and safety of these procedures have yet to be determined.