Vaginal Atrophy

Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls due to your body having less estrogen. Vaginal atrophy occurs most often after menopause. For many women, vaginal atrophy not only makes intercourse painful, but also leads to distressing urinary symptoms. Because of the interconnected nature of the vaginal and urinary symptoms of this condition, experts agree that a more accurate term for vaginal atrophy and its accompanying symptoms is "genitourinary syndrome of menopause (GSM)." Simple, effective treatments for genitourinary syndrome of menopause — vaginal atrophy and its urinary symptoms — are available. Reduced estrogen levels result in changes to your body, but it doesn't mean you have to live with the discomfort of GSM.

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, and 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.

Causes of Vaginal Atrophy

Genitourinary syndrome of menopause (GSM) is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile. A drop in estrogen levels may occur after menopause, during the years leading up to menopause (peri-menopause) or after surgical removal of both ovaries (surgical menopause). It can be caused by other conditions such as those requiring treatment with anti-estrogen drugs. 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, fibrosis, or infertility can lead to atrophic vaginitis. Also, radiation treatment to pelvic area or chemotherapy, severe stress, depression, or rigorous exercise can also be causes. 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.

Diagnosis

Diagnosis of genitourinary syndrome of menopause may involve:

A pelvic exam, during which your doctor feels (palpates) your pelvic organs and visually examines your external genitalia, vagina and cervix. During the pelvic exam, your doctor also checks for signs of pelvic organ prolapse — indicated by bulges in your vaginal walls from pelvic organs such as your bladder or rectum or stretching of the support tissues of the uterus.
Urine test, which involves collecting and analyzing your urine, if you have urinary symptoms.
Acid balance test, which involves taking a sample of vaginal fluids or placing a paper indicator strip in your vagina to test its acid balance.

Differential Diagnosis

Genital infection for example bacterial vaginosis, trichomonas, candidiasis, endometritis.
These may co-exist, as atrophic vaginitis predisposes the vagina to bacterial infection.
Trichomonas and bacterial vaginosis also give a more alkaline result on pH testing (pH>4.5).
Other causes of vaginal bleeding or postmenopausal bleeding.
Uncontrolled diabetes may cause vaginal or urinary symptoms.
Local irritation due to soap, panty liners, spermicides, condoms, biological washing powder and tight-fitting clothes.

Treatment

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