Atrophic Vaginitis Flashcards
1
Q
Definition
A
Vaginal irritation caused by thinning of the vaginal epithelium
- Aetiology → reduction in circulating oestrogen levels (i.e. post-menopause)
- Risk Factors → menopause, prolonged lactation
- True prevalence unknown, 10-40% postmenopausal women
2
Q
Aetiology / Risk factors
A
Aetiology
- This occurs due to declining oestrogen levels, predominantly in post-menopausal women. The vaginal mucosa becomes thinner and drier, less elastic and more prone to inflammation
- Oestrogen helps to protect the micro-environment of the vagina.
Risk Factors
- Menopause
- Oestrogen deficiency
- Prolonged lactation
3
Q
Symptoms and signs
A
- Vaginal dryness
- Vaginal discharge, bleeding
- Dyspareunia,
- Dysuria, itching and burning
- Incontinence
- Recurrent infection
Signs O/E
- Pale epithelium- diminished capillary blood supply
- Shiny epithelium- occurs when have thinning of epithelium
- Decreased elasticity- loss of turgor
- Loss of rugal folds
- Friable epithelium
- Cracks or fissures
4
Q
Investigations
A
- Clinical
Diagnosis of exclusion - if post menopausal and bleeding, endometrial cancer must be ruled out which can be done with a TVUSS
- Abdominal examination
- Vaginal + speculum examination
- Vaginal pH
- Swabs for any potential infection
- Biopsy for any potential malignancy or ulcers
- Endocervical swab- vaginal secretions tests for bacteria
- Amine whiff test for vaginal secretions
- Positive is indicative of BV or TV
- Wet mount microscopy
- Gram stain
- HIV test
- Nucleic acid amplification test
- Serum rapid plasma regain test
- WANT TO EXCLUDE BACTERIAL VAGINITIS
5
Q
Management
A
Depends on complaint:
- Systemic HRT (systemic progesterone + PV oestrogen)
- Bleeding on intercourse -> water-based moisturisers and lubricants
- Lose dose vaginal oestradiol- cream, ring, tablet
6
Q
Complications / Prognosis
A
- Bleeding from vaginal dryness
- Impact on quality of life
- Increased incidence of superinfection due to increase vaginal PH
Prognosis – substantial relief can be achieved with treatment