Conditions - Atrophic Vaginitis

Question 1

What is the definition of atrophic vaginitis?

Answer 1

DRYNESS and ATROPHY of the vaginal mucosa related to a lack of oestrogen, mostly occurring in women entering menopause/post-menopausal women

Question 2

What is the aetiology/risk factor for atrophic vaginitis?

Answer 2

Oestrogen stimulates the vaginal/urinary tract epithelial lining to thicken, become more elastic, and produce more secretions. When women enter menopause, oestrogen levels fall so the lining goes the opposite way, becoming more prone to inflammation.

Question 3

What are the presenting symptoms of atrophic vaginitis?

Answer 3

Vaginal itching
Vaginal dryness
Dyspareunia
Bleeding due to localised inflammation

Question 4

What are the signs on physical exam of atrophic vaginitis?

Answer 4

Vaginal exam

• Pale mucosa
• Think skin
• Reduced skin folds
• Erythema and inflammation
• Dryness
• Sparse pubic hair

Question 5

What is the management plan for atrophic vaginitis?

Answer 5

(vaginal lubricant/moisturiser then topical oestrogen)

• Must exclude endometrial cancer
• Vaginal lubricants (esp before intercourse) + regular moisturisers
• Topical oestrogen (cream, pessaries, tablets, ring) - Ring only needs changed every 3 months
• Systemic HRT if there are co-existent menopausal symptoms
• Reconsider diagnosis if continued treatment failure
• Aim to stop treatment whenever condition improves sufficiently to do so

Question 6

What are the possible complications of atrophic vaginitis and their management?

Answer 6

Recurrent UTIs
Stress incontinence
Pelvic organ prolapse

Question 7

What is the epidemiology of atrophic vaginitis?

Answer 7

10-40% of post-menopausal women have symptoms