Atrophic Vaginitis

Definition

Definition of Atrophic Vaginitis
Atrophic vaginitis (also known as vaginal atrophy or urogenital atrophy) is an inflammation of the vagina (and the outer urinary tract) due to the thinning and shrinking of the tissues, as well as decreased lubrication. This is all due to a lack of the reproductive hormone estrogen.

Symptoms

Symptoms of Atrophic Vaginitis
Genital symptoms include dryness, itching, burning, soreness, pressure, white discharge, malodorous discharge due to infection, painful sexual intercourse, bleeding after intercourse. In addition, sores and cracks may occur spontaneously. Atrophic vaginitis is a cause of Postmenopausal bleeding (PMB).

Urinary symptoms include painful urination, blood in the urine, increased frequency of urination, incontinence, and increased likelihood and occurrence of infections.

Causes

Causes of Atrophic Vaginitis
The most common cause of vaginal atrophy is the decrease in estrogen which happens naturally during perimenopause, and increasingly so in post-menopause. However this condition can sometimes be caused by other circumstances.

Diagnosis

Diagnosis of Atrophic Vaginitis

1. A pelvic examination reveals thin, pale or red walls of the vagina.
2. A wet prep test of vaginal discharge may be done to rule out other causes for the condition.

Treatment

Treatment of Atrophic Vaginitis
Not all women have all of the above symptoms. Treatment may depend on which symptoms are the most troublesome. Because the problem is mainly due to a lack of oestrogen, it can be helped by replacing the oestrogen in the tissues.

1. Hormone Replacement Therapy (HRT): This means taking oestrogen in the form of a tablet, gel, implant or patches. This may be the best treatment for relieving the symptoms, but some women don't like the idea of taking HRT. There are advantages and disadvantages of using HRT. See separate leaflet called 'Menopause and HRT' for more detail.
2. Oestrogen Creams: Sometimes a cream, pessary or vaginal ring containing oestrogen is prescribed. This restores oestrogen to the vagina and surrounding tissues without giving oestrogen to the whole body. Usually the treatment is used every day for about two weeks, and then twice a week for a further three months. After this the effect of the treatment may be assessed by your doctor. This treatment usually works well but the symptoms may recur some time after stopping the treatment. Repeated courses of treatment are often necessary. It is important to follow the instructions about the amount of cream to use.
3. Lubricating Gels: If vaginal dryness is the only problem, or hormone creams are not recommended because of other medical problems, lubricating gels may help. There are two gels which are available in the UK that are specifically designed to help the problem of vaginal dryness.

Prognosis

Prognosis of Atrophic Vaginitis
Proper treatment will usually relieve the symptoms, at least to some extent.

Prevention

Prevention of Atrophic Vaginitis
Use of vaginally administered estrogens (including vaginal tablets or cream) before the condition becomes severe is appropriate. Regular sexual activity may be helpful. A water soluble vaginal lubricant can be helpful in mild cases.

Increasingly, vaginally administered estrogens based on low dose of estriol are used to stimulate the vaginal epithelium proliferation.