Vulvovaginal Changes

Question 1

What is the role of estrogen

Answer 1

1. maintains blood flow to the vulvovaginal tissue, the collagen within the epithelium, and hyaluronic acid and mucopolysaccharides with in moistened epithelial surfaces. 2. supports the microbiome and protects the tissue from pathogens

Question 2

Normal vaginal pH

Answer 2

4.5 which is maintained by the presence of lactobacilli that convert glucose to lactic acid. the glycogen in the epithelial layer us also important for maintaining vaginal health by providing the substrate for the lactobacilli to produce lactic acid

Question 3

Role of androgen

Answer 3

Androgen receptors are present in all 3 layers of the vagina. Androgens have been shown to stimulate nerve fibers as well as mucification of the epithelium

Question 4

Community state types

Answer 4

are characterized by the proportion of different lactobacilli as well as by other less common organisms. these community types appear to be reflective of vaginal health

Question 5

Menopausal changes to vagina

Answer 5

The drop in ovarian steroid production as a result of oocyte depletion results in decreased estrogen and dehydroepiandrosterone. This results in thinning of the most superficial layer of the vagina. The thinning is exacerbated by a subsequent loss in elasticity (loss of rugae). The hormone changes may lead to an overall narrowing of the vaginal canal and poor distention

Question 6

Vulvar changes

Answer 6

Thinning of vulvar tissue leading to clinical effects of external genitalia, urethra and bladder

Question 7

vaginal pH

Answer 7

Increases due to the decreased glycogen content of the hormonally deprived epithelium causes a decrease in the substate used to support the vaginal lactobacilli. This leads to decreased amount of lactic acid and therefore increased pH. The higher pH predisposes the vagina to increase in lymphocytes and plasma cells that may translate into unwanted vaginal discharge. There also is a decrease in physiologic vaginal secretions

Question 8

Urethra

Answer 8

As the vagina narrows, the urethra moves closer to the introitus. This is associated with higher rates of UTIs, frequency, urgency and dysuria. Local estrogen might improve stress incontinence. HT may positively affect muscles of the pelvic floor and local estrogen might prevent prolapse