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
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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
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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
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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
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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
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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

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