Atrophic vaginitis

Abstract

With the loss of estrogen that occurs with menopause, physiologic and structural changes occur within the vulvovaginal mucosa that lead to a condition commonly called atrophic vaginitis. Although mild genital changes occur in most women, 10-47% of postmenopausal women will develop one or more debilitating symptoms that include vulvovaginal dryness, dyspareunia, vulvar itching or pain, recurrent urinary tract infections, as well as abnormal vaginal discharge. Topical estrogen replacement therapies reverse these mucosal changes and are effective treatments for the symptoms of atrophic vaginitis. Vaginal moisturizers and lubricants also provide symptomatic relief for vaginal dryness and dyspareunia, respectively.

Sexuality of the ageing female – the underlying physiology

“…Basaran, Kosif, Bayar, and Covelek (2008) confirmed the thinner minora in postmenopausal women (15.4 mm § 4.7 mm, n D 50) compared to those in premenopausal women (17.9 mm § 4.1 mm, n D 50). The colour of the labia becomes a paler shade of red after the menopause (Stika, 2010) presumably because there is less blood in their reduced microcirculation.…”

Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women

“…Although Replens may not be able to reverse severe vulvovaginal mucosal atrophy, it is a viable alternative for the relief of vaginal dryness, especially in women with a contraindication to estrogen use. 72 Two prospective studies showed that Replens is an effective therapy for improving vaginal moisture, vaginal fluid volume and pH, and vaginal elasticity and for reducing symptoms of itching, irritation, and dyspareunia. 73,74 Another vaginal moisturizer, based on pectin (Summer's Eve), has the same beneficial effect on vaginal dryness as Replens.…”

“…Moisturizers are used on a chronic maintenance basis to replace normal vaginal secretions, whereas lubricants are specifically designed to reduce friction associated with sexual activity. 72 There are two basic lubricant formulations, water-or silicone-based, with water-based products being the more common. The most commonly used water-based lubricants include K-Y Jelly (McNeil-PPC Inc., Fort Washington, PA), Astroglide (BioFilm Inc., Vista, CA), and Slippery Stuff (Wallace-O'Farrell, Inc., Puyallup, WA).…”

“…Many couples find K-Y Jelly to be less effective than newer products. 72 They can be applied before intercourse to the vaginal introitus.…”

Does a diagnosis of atrophic vaginitis on Papanicolaou test signify the presence of inflammation?

“…The vaginal mucosa becomes thinner, lactobacilli decrease in number, and pH increases, with a shift in vaginal flora (with some flora being potentially pathogenic). 1 There may also be accompanying inflammation. Laboratories may separate a diagnosis of atrophy from atrophy with inflammation (atrophic vaginitis).…”