This problem happens after menopause in up to 75% of all women, and can also happen to some women after childbirth. A large number of postmenopausal women (who are not using topical estrogen) have at least some degree of vaginal atrophy; however, many women do not actively ask that medical attention be paid to this, possibly because it is naturally caused, or because of the taboo that still exists surrounding aging and sexuality.
What are the symptoms of Atrophic Vaginitis?A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
A woman may experience one or several of these symptoms of atrophic vaginitis, to varying degrees: vaginal dryness, pain during sex (dyspareunia), changes in appearance of the labia and vagina (it looks paler and thinner), irritation when wearing certain clothes such as tight jeans or when doing certain activities, an increase in urinary tract infections.
Urinary symptoms include painful urination, blood in the urine, increased frequency of urination, incontinence, and increased likelihood and occurrence of infections.
What are the causes of Atrophic Vaginitis?The most common cause of this condition is the decrease in estrogen after menopause; although, it can be caused by other conditions such as those requiring treatment with anti-estrogen drugs.
A woman's ovaries make estrogen until menopause, which happens at about 55 years of age. Before menopause, estrogen in a woman's bloodstream helps keep the skin of the vagina healthy and stimulates vaginal secretions. After menopause, when the ovaries stop making estrogen, the walls of the vagina become thin, and vaginal secretions are lessened. Similar changes can happen to some women after childbirth, but in this case these changes are temporary and less severe.
Medications or hormones used to decrease estrogen levels in women, as part of the treatment for breast cancer, endometriosis, fibroids, or infertility can lead to atrophic vaginitis. Also, radiation treatment to the pelvic area or chemotherapy , severe stress, depression, or rigorous exercise can be causes.
Atrophic vaginitis may occur in younger women who have had surgery to remove their ovaries. Some women develop the condition immediately after childbirth or while breastfeeding, since estrogen levels are lower at these times.
The vagina can also become further irritated from soaps, laundry detergents, lotions, perfumes, or douches. Certain medications, smoking, tampons, and condoms may also cause or worsen vaginal dryness.
Diagnosing Atrophic VaginitisIt is important not to assume a diagnosis of atrophic vaginitis in the postmenopausal patient who presents with urogenital complaints. A patient history should include attention to exogenous agents that may cause or further aggravate symptoms.
Perfumes, powders, soaps, deodorants, panty liners, spermicides and lubricants often contain irritant compounds. In addition, tight-fitting clothing and long-term use of perineal pads or synthetic materials can worsen atrophic symptoms.
Atrophic epithelium appears pale, smooth and shiny. Often, inflammation with patchy erythema, petechiae and increased friability may be present. External genitalia should be examined for diminished elasticity, turgor of skin, sparsity of pubic hair, dryness of labia, vulvar dermatoses, vulvar lesions and fusion of the labia minora.
Ecchymoses and minor lacerations at peri-introital and posterior fourchette may also recur after coitus or during a speculum examination. Vaginal examination or sexual activity can result in vaginal bleeding or spotting. Vulvar signs of irritation caused by urinary incontinence may also be identified on pelvic examination.
What are the treatment options for Atrophic Vaginitis?Before self treating your symptoms, a doctor must determine if they are caused by decreased estrogen, an infection, irritant, or other reason.
If symptoms are mild, they may be relieved by using a water-soluble vaginal lubricant during intercourse. Do not use petroleum jelly, mineral oil, or other oils. These may increase the chance of infection and may damage latex condoms or diaphragms.
Hormone Replacement Therapy (HRT) can be taken as a tablet, gel, patch or implant, which supplies oestrogen to the whole body. It is effective although there is debate about the risks of taking it in the long-term. Localised HRT is another option - vaginal tablets, creams, rings and pessaries can be taken internally to supply oestrogen to the vaginal area only.
Regular exercise is important as it keeps blood flow and genital circulation high. Experimenting with your diet can also prove effective. Soy isoflavones (plant oestrogens), linseeds, fish oils, and black cohosh have been found to be helpful.
Sexual activity is a healthful prescription for postmenopausal women who have a substantially estrogenized vaginal epithelium. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation. Women who participate in sexual activity report fewer symptoms of atrophic vaginitis and, on vaginal examination, have less evidence of stenosis and shrinkage in comparison with sexually inactive women.
Preventing Atrophic VaginitisUse of vaginal estrogen 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, topical treatment (vaginal tablets or cream) based on low dose of estriol are used to stimulate the vaginal epithelium proliferation.
Written by Sy Kraft (B.A.)