<\/span><\/h2>\nAtrophic 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<\/span> in older women, it is also known as senile vulvovaginitis.<\/p>\n<\/span>What Causes Atrophic Vulvovaginitis?<\/span><\/h2>\nAtrophic vulvovaginitis is associated with estrogen<\/span> deficiency due to:<\/p>\n\n- Menopause<\/li>\n
- Lactation<\/li>\n
- Hyperprolactinemia<\/li>\n
- High dose progesterone<\/span> medicines<\/li>\n
- Chest Cancer<\/span> medications, such as tamoxifen and aromatase inhibitors.<\/li>\n<\/ul>\n
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<\/span>What are the symptoms of atrophic vulvovaginitis?<\/span><\/h2>\n\n- Vaginal or vulvar dryness<\/li>\n
- Vaginal or vulvar itching (pruritus<\/span> vulvas)<\/li>\n
- Vaginal burning<\/li>\n
- Painful sex<\/span> (dyspareunia<\/span>)<\/li>\n
- Skin division (fissure<\/span>) from the entrance to the vagina (later<\/span> fourchette)<\/li>\n
- Vaginal spotting (bleeding)<\/li>\n<\/ul>\n
Estrogen deficiency can also lead to dysuria<\/span> (burning sensation when urinating), urinary urgency, frequency and incontinence (the genitourinary syndrome<\/span> menopause).<\/p>\n<\/span>\nThe bacteria<\/span> in the vagina<\/span><\/h2>\nLack of estrogen causes changes in the normal vagina organisms<\/span>. Those seen in younger women (especially lactobacilli<\/span>) disappear and are replaced by gram-negative organisms such as Escherichia coli or those associated with bacterial<\/span> vaginosis Urinary or bladder infections are more common in postmenopausal women than in younger women.<\/p>\n<\/span>What makes an atrophic vulva<\/span> and the vagina looks like?<\/span><\/h2>\nAtrophic vulvovaginitis changes the appearance of the female genitalia:<\/p>\n
\n- Vulva appears paler<\/li>\n
- The lips are thinner and smaller.<\/li>\n
- Clitoral hood is less obvious<\/li>\n
- A red membrane or polyp may be seen at the opening of the urethra (urethral caruncle)<\/li>\n
- Vaginal skin appears thin and dry, with small blood vessels<\/span> under it resulting in patchy redness<\/li>\n
- Stretching the vulva can cause splitting of the skin in the lower part of the vagina or elsewhere.<\/li>\n<\/ul>\n
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<\/span>Should tests be done to confirm the diagnosis?<\/span><\/h2>\nTests for atrophic vulvovaginitis can be done if any symptoms are present. These may include:<\/p>\n
\n- Skin swab \/ wet mount<\/span> exam: this may reveal epithelial<\/span> Typical cells of the postmenopausal vagina can be reported and can help identify infection<\/span>\n<\/li>\n
- \nBiopsy<\/span> - This can be done to ensure that there is no inflammatory<\/span> skin disease or neoplastic<\/span> condition causing symptoms<\/li>\n
- Cystoscopy of the bladder and investigations of urinary symptoms.<\/li>\n
- \nColposcopy<\/span> of the vagina and cervix and investigations for gynecological symptoms.<\/li>\n<\/ul>\n
<\/span>General measures to improve atrophic vulvovaginitis.<\/span><\/h2>\nThe following measures are recommended.<\/p>\n
\n- Use a soap-free cleanser or wash gently with plain warm water, no more than once or twice a day<\/li>\n
- Apply emollient<\/span> cream<\/span> Suitable for sensitive skin or Vaseline if the vulva feels dry or itchy.<\/li>\n
- Use a lubricant for sexual intercourse; if it stings, try another or use oil or petroleum jelly.<\/li>\n
- A test of a vaginal wetness<\/li>\n
- Anticholinergic, antihistamine, decongestant, or antidepressant medications may be contributing to the dryness; if you take these consider stopping<\/li>\n
- Short-term use of current<\/span> steroids may be needed to dermatitis<\/span> caused by irritants<\/span> such as urine, pantyhose, or tight clothing<\/li>\n<\/ul>\n
<\/span>Estrogen treatment<\/span><\/h2>\nAtrophic 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 \u2122, 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 \u2122 pessaries (containing oestrodiol) can also be used, but are currently not funded by PHARMAC in New Zealand.<\/p>\n
Estrogen treatment produces:<\/p>\n
\n- Normalization of the cells of the vaginal wall.<\/li>\n
- Improved vaginal blood flow<\/li>\n
- Vaginal decrease pH<\/span>\n<\/li>\n
- Recolonization by lactobacilli<\/li>\n
- Improves vaginal thickness and elasticity.<\/li>\n
- Reduction in vulvovaginal<\/span> symptoms<\/li>\n
- Improved sexual function<\/li>\n
- Reduction of urinary infections.<\/li>\n<\/ul>\n
Topical estrogen is considered safe because very little is absorbed systemically. However, estrogen is generally not prescribed to women with severe liver disease.dependent<\/span> cancers or thromboembolic disease if the risk of these conditions is increased.<\/p>\nSometimes other forms of estrogen are recommended, such as tablets, transdermal patches, gels, sprays, and emulsions. Systemic<\/span> 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.<\/p>\n<\/span>Side effects and risks of vaginal estrogen therapy.<\/span><\/h2>\nTopical estrogen can cause side effects, including:<\/p>\n