Atrophic Vaginitis

Question 1

What is atrophic vaginitis?

Answer 1

A condition caused by thinning, drying, and inflammation of the vaginal walls

Due to reduced estrogen levels

Question 2

Why are those with atrophic vaginitis susceptible to infections? (3)

Answer 2

Reduced estrogen levels lead to loss of protective lactobacilli

Increased vaginal pH

Thinner, more fragile mucosa prone to microtrauma

Question 3

What can cause atrophic vaginitis apart from post-menopausal state? (5)

Answer 3

Premature ovarian failure

Ovarian failure post chemo/radiotherapy

Tamoxifen or danazol (anti-estrogen medicines)

Postpartum changes in hormones

Any condition lowering estrogen levels

Question 4

What are the symptoms of atrophic vaginitis? (4)

Answer 4

Vaginal dryness

Dyspareunia

Postmenopausal bleeding

Urinary symptoms

Question 5

What are the signs of atrophic vaginitis?

Answer 5

Reduced pubic hair

Loss of labial fat pad

Narrowing of vaginal introitus

Thinning of labia minora

Question 6

What may need to be excluded before diagnosing atrophic vaginitis?

Answer 6

Postmenopausal bleeding in women aged 55+

Refer for 2-week wait (2WW) to exclude endometrial cancer with transvaginal ultrasound (TVUS) and biopsy

Question 7

What is the management of atrophic vaginitis? (3)

Answer 7

Topical estrogen cream

Systemic hormone replacement therapy (HRT)

Water-based moisturizers and lubricants for bleeding during sexual intercourse