Atrophic Vaginitis (Complete) Flashcards
Define Atrophic Vaginitis
Inflammation and thinning of genital tissues due to reduced oestrogen levels, most commonly seen after menopause.
Atrophic Vaginitis is alternatively known as?
Vulvovaginal atrophy
What is the most common cause of atrophic vaginitis?
Menopause (Reduced oestrogen levels)
What are the main signs and symptoms of atrophic vaginitis
Sympmtoms:
Vaginal dryness and itching
Dyspareunia (Painful intercourse)
Vaginal discharge and inflammation
Urinary symptoms (Frequent UTIs)
Spotting
Post-coital bleeding
Signs:
Thinning of vaginal mucosa (Loss of vaginal rugae)
Loss of pubic hair
Narrowed introitus (narrow vaginal opening)
Vaginal dryness
Why is atrophic vaginitis associated with increased risk of UTI?
Changes in vaginal flora can result in increased bacterial infection due to proximity to urethra
Protective mucosal lining of the urinary tract is compromised in the absence of adequate estrogen
What differentials should be considered alongside atrophic vaginitis?
Red-flags:
Malignancy (Endometrial hyperplasia): Post-menopausal bleeding
STI: Vaginal itchiness/discharge
Female genital mutilation: Narrowed introitus
Other:
Vulvovaginal candidiasis
Lichen sclerosis
Lichen planus
Diabetes
UTI
Bladder dysfunction
Pelvic floor disfunction
Cystitis
Vaginismus
What differential should be considered if patient with atrophic vaginitis presents with post-coital bleeding or spotting?
Malignancy (Endometrial hyperplasia)
What differential should be considered if patient with atrophic vaginitis presents with dyspareunia?
Malignancy
Vaginismus
What differential should be considered if patient with atrophic vaginitis presents with urinary symptoms?
UTI
Pelvic floor dysfunction
Cystitis
What differential should be considered if patient with atrophic vaginitis presents has a narrowed introitus?
Female genital mutilation
What differentials should be considered if patient with atrophic vaginitis presents with vaginal dryness/itchiness?
STI
Vulvovaginal candidiasis
Skin conditions: lichen sclerosis, lichen planus, diabetes
What is lichen sclerosus?
Skin condition that causes itchy white patches on the genitals or other parts of the body.
What is lichen planus?
chronic inflammatory condition affecting the skin and mucosal surfaces
What examinations/investigations should be performed in patients suspected of atrophic vaginitis?
Bedside examinations::
Speculum examination (Vaginal signs of atrophy)
Bloods/Labs:
FBC: Check anaemia if any bleeding
Infection screen: If discharge and vaginal dryness
Imaging:
Transvaginal utrasound: Exclude endometrial cancer
Endometrial biopsy: Exlcude endometrial cancer
Biops of any abnormal skin lesions
What signs on speculum examination are suggestive of atrophic vaginitis?
Pale vaginal epithelium
Vaginal dryness
Loss of vaginal rugae
Thinning of vaginal epithelium
Erythema and inflammation
Petechiae (due to fragility of tissue)
Friability: Blood from speculum exaamination
What is the management plan for patients with atrophic vaginitis?
Non-hormonal treatment:
Lubricants: Short-term solution for vaginal dryness and dyspareunia
Moisturisers: Should be used regularly
Pharmacological treatment:
Topical oestrogen therapy: For local symptoms
Hormone replacement therapy (oral or transdermal): For systemic symptoms
Transvaginal laser therapy: Not currently reccomended
What is transvaginal laser therapy?
Laser in the vagina to increase its strength and elasticity, to improve symptoms of urogenital atrophy
How frequently should women using intravaginal oestrogen cream be reviewed?
Anually
N.B. Long-term effects of cream currently unknown
