Atrophic vaginitis

Question 1

What is atrophic vaginitis?

Answer 1

Dryness and atrophy of the vaginal mucosa

Question 2

What is atrophic vaginitis caused by?

Answer 2

Decreased oestrogen

Question 3

Which women does atrophic vaginitis commonly affect?

Answer 3

Women entering menopause

Question 4

Describe the effect of oestrogen on the vagina

Answer 4

Epithelial lining of the vagina and urinary tract responds to oestrogen by becoming more elastic and producing secretions
As women enter the menopause, oestrogen levels fall, resulting in the mucosa becoming thinner, less elastic and more dry. The tissues are more prone to inflammation
Changes in vaginal pH and microbial flora that contribute to localised infection

Question 5

Describe the effect of oestrogen on the pelvic floor

Answer 5

Maintains healthy connective tissue

Question 6

Describe the presentation of atrophic vaginitis

Answer 6

Itching
Dryness
Dyspareunia
Bleeding due to localised inflammation

Question 7

Which presentations should you consider atrophic vaginitis in?

Answer 7

Recurrent UTIs
Stress incontinence
Pelvic organ prolapse

Question 8

Describe the examination findings of atrophic vaginitis

Answer 8

Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation 
Dryness
Sparse pubic hair

Question 9

Describe the management of atrophic vaginitis

Answer 9

Vaginal lubricants

Topical oestrogens - creams, pessaries, tablets, ring

Question 10

Name the contraindications of topical oestrogen

Answer 10

Breast cancer
VTE
Angina