Atrophic Vaginitis

Question 1

What is it?

Answer 1

Inflammation and thinning of genital tissues due to reduced oestrogen levels, most commonly seen after menopause

Question 2

What are signs of it?

Answer 2

Thinning of the vaginal mucosa
Loss of pubic hair
Narrowed introitus
Loss of vaginal rugae (folds)

Question 3

What are symptoms?

Answer 3

Vaginal dryness and itching
Dyspareunia
Post-coital bleeding
Vaginal discharge from inflammation
Urinary symptoms such as dysuria and recurrent UTI

Question 4

If there is postmenopausal bleeding, what are common differentials?

Answer 4

Malignancy, endometrial hyperplasia

Question 5

If there is genital itching/discharge, what are common differentials?

Answer 5

Sexually transmitted infection, vulvovaginal candidiasis, skin conditions such as lichen sclerosis, lichen planus, diabetes

Question 6

If there is a narrowed female introitus, what are common differentials?

Answer 6

FGM

Question 7

If there are urinary symptoms, what are the common differentials?

Answer 7

Urinary tract infection, bladder dysfunction, pelvic floor disfunction, cystitis

Question 8

If there is dyspareunia, what is a common differential?

Answer 8

Malignancy, vaginismus

Question 9

What investigations are carried out?

Answer 9

Clinical examination, including speculum examination if tolerated, to look for vaginal signs of atrophy
Transvaginal ultrasound and endometrial biopsy, if necessary, to exclude endometrial cancer
An infection screen if itching or discharge is present
A biopsy of any abnormal skin lesions, if needed

Question 10

What are hormonal treatment options?

Answer 10

Systemic hormone-replacement therapy (oral or transdermal)

Topical oestrogen preparations

Question 11

What are non-hormonal treatment options?

Answer 11

Lubricants, which provide short-term improvement to vaginal dryness, alleviating symptoms such as dyspareunia

Moisturisers, which should be used regularly