Updated: 11/30/2021

Atrophic Vaginitis

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  • Snapshot
    • A 50-year-old woman presents to her gynecologist reporting difficulty with intercourse. She states having vaginal dryness and pruritus. She also reports increasingly frequent hot flashes and mood swings. Her last menstrual period was 2 months ago. Pelvic exam is notable for thin and dry vaginal vestibule. There is no abnormal discharge.
  • summary
    • Vulvovaginal irritation resulting from estrogen loss
      • commonly seen in menopausal women
      • commonly underdiagnosed
    • Associated conditions
      • menopause
      • primary ovarian insufficiency
      • bilateral oophorectomy
  • Etiology
    • Pathogenesis
      • estrogen stimulation maintains well-epithelialized vaginal vault
        • estrogen receptors on vagina, vulva, urethra, and trigone of bladder
      • loss of estrogen results in decreased vaginal blood flow and secretions
        • vaginal tissue thinning and reduced elasticity
        • vaginal dryness and itching
        • changes in vaginal pH
  • Presentation
    • Symptoms
      • vulvovaginal
        • dryness
        • burning
        • dyspareunia
      • urinary
        • urinary frequency
        • recurrent bladder infections
    • Physical exam
      • thinning of epithelial lining of vagina
      • vulvar or vaginal bleeding from fissures
  • studies
    • Labs
      • typically not necessary
      • vaginal pH
        • 5.5-6.8 in postmenopausal women
        • 3.5-5.0 normal
      • serum hormone levels
        • low estradiol
  • Differential
    • Vaginal infections
    • Vulvovaginal lichen planus
    • Vulvar lichen sclerosus
      • presents with white plaques and intense pruritus
      • treated with topical clobetasol
  • DIAGNOSIS
    • By clinical history and physical exam
  • Treatment
    • Water-based lubricants during intercourse
    • Vaginal estrogen therapy
  • Complications
    • Increased risk of urogenital infection
    • Sexual dysfunction
    • Low self-esteem
  • Prognosis
    • Unlikely to resolve spontaneously without treatment
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