Vaginal Atrophy OSCE station Reading

Question 1

What Causes Vaginal Atrophy

Answer 1

Natural change with the menopause

Question 2

What Hormone is Largely responsible for the changes of menopause

Answer 2

Decreased levels of Oestrogen

Question 3

Signs and Symptoms of Vaginal Atrophy

Answer 3

Dryness, Itching, irritation and Pain on sexual intercourse

Question 4

Who does it affect

Answer 4

40% of Post-menopausal women, so do not be embarrassed

Question 5

What makes it different to other symptoms of the menopause (e.g hot flushes etc)

Answer 5

Hot flushes will go away with time. Unlike this, vaginal atrophy is persistent and may even get worse with time.

Question 6

What can cause Vaginal Atrophy/Menopause

Answer 6

Normal Menopause with age
Surgical procedures that remove the ovaries
Any medical treatments involving Radiation or chemotherapy that remove ovarian function.

Question 7

Why is oestrogen important to the vaginal Lining

Answer 7

The epithelium or lining of the vaginal walls have receptors in it which, when stimulated by oestrogen, help to maintain thickness and elasticity of the walls

Question 8

What happens to the Vaginal Walls when oestrogen decreases

Answer 8

with lower levels of oestrogen, the vaginal walls become thinner and drier

Question 9

What can vaginal atrophy predispose women to and why?

Answer 9

In a healthy, premenopausal vagina, the internal environment i acidic. during the menopause, the pH rises and it becomes more alkaline. this makes women more susceptible to UTIs

Question 10

What happens to the skin and surrounding tissue

Answer 10

As women age, the fatty deposits surrounding the vagina reduce. this causes the surrounding skin such as the labia and the hood of the clitoris to retract and tighten, exposing more sensitive areas. this may lead to Chaffing and Discomfort

Question 11

What changes may happen to the Muscles

Answer 11

The pelvic floor becomes slightly weaker, causing urination to become more frequent and difficult to control.

Question 12

What Symptoms can i expect

Answer 12

itch, irritation, pain and general discomfort

Dryness due to decrease in vaginal secretions - may also lead to pain and discomfort during intercourse

Light Bleeding due to more prone to injury

Atrophic Vaginitis - inflammation that may lead to pain on urination or increased infections.

Smelly Discharge - this is due to the increase in alkalinity and may sometimes be mistaken for thrush or candida.

Question 13

What can be done to limit symptoms - Clothing

Answer 13

Try to wear underwear that is made of natural fibres such as cotton

Avoid tight underwear, pantyhose, and jeans where possible as this will lead to sweating

Avoid time spend in damp swimming costumes or Exercise clothing

Avoid wearing underwear here possible e.g in bed.

Question 14

What can be done to limit symptoms - Laundry

Answer 14

try to use non-Bio oe low allergenic washing powders/detergents

Avoid fabric softeners

Consider a second rinse if symptoms worsen

Question 15

What can be done to limit symptoms - Other

Answer 15

Avoid using feminine hygiene sprays and douches

Avoid Tampons, pads and toilet paper that are scented

Avoid shaving or waxing especially if irritation is present

Wash gently with plain water or aqueous soaps - pat dry don’t rub.

Continue sexual activity - whether on your own or with a partner, this may improve symptoms as it encourages blood flow to the area - Lubricants will be covered in later cards

Stop smoking as this will decrease blood flow and increase atrophy.

Question 16

What non prescription options are available to me

Answer 16

Regular Cool compress or washing with Comfortable solutions may help symptoms - Try adding half a teaspoon of bicarbonate to a litre of water and gently washing with a cloth. pat dry and keep dry as much as possible following this.

Try using vaginal Lubricants for intercourse. K-Y jelly is a preferred option and can be used with latex condoms. Note that they may sting a little due to alcohol content. ALSO - never use oil based lubricant with latex condoms

Natural oils such as almond or avocado oil may help. Be ware of tea tree as it may cause dermatitis increasing irritation

Vitamin E either topically or orally may also help the symptoms

Question 17

What Prescription options are available to me

Answer 17

Vaginal Oestrogen either as a Topical Cream or pessaries are very helpful with symptoms - NOTE, if using vaginal oestrogen you need to take consistently, not just when having intercourse as it only work when being used regularly.

HRT may b very helpful as well - note when using HRT if you still have a uterus you must take the Combined therapyE+P

if not uterus or just using vaginal oestrogen, not progesterone needed,