Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to not enough

estrogen Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal activ ...

. Symptoms may include pain with sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does not resolve without ongoing treatment. Complications may include

urinary tract infections A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...

. The lack of estrogen typically occurs following

menopause Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often ...

. Other causes may include when

breastfeeding Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that brea ...

or as a result of specific medications. Risk factors include

smoking Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...

. Diagnosis is typically based on symptoms. Treatment is generally with estrogen cream applied to the vagina. Other measures that may help include vaginal lubricants. It is recommended that soaps and other irritants are avoided. About half of postmenopausal women are affected. Many however are not being treated. Women often report reduced enjoyment in sex as well as life generally.

Signs and symptoms

After menopause the

vaginal epithelium The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basa ...

changes and becomes a few layers thick. Many of the signs and symptoms that accompany menopause occur in atrophic vaginitis. Genitourinary symptoms include * dryness * pain * itching * burning * soreness * pressure * white discharge * malodorous discharge due to infection * painful sexual intercourse * bleeding after intercourse * painful urination * blood in the urine * increased urinary frequency * incontinence * increased susceptibility to infections * decreased vaginal lubrication * urinary tract infections * painful urination * difficulty sitting * difficulty wiping

Diagnosis

Since women can have signs and symptoms that could be attributed to other causes, diagnosis is based upon the symptoms that cannot be better accounted for by another diagnosis. Lab tests usually do not provide information that will aid in diagnosing. A visual exam is useful. The observations of the following may indicate lower estrogen levels: little pubic hair, loss of the labial fat pad, thinning and resorption of the

labia minora The labia minora (Latin for 'smaller lips', singular: ''labium minus'', 'smaller lip'), also known as the inner labia, inner lips, vaginal lips or nymphae are two flaps of skin on either side of the human vaginal opening in the vulva, situated be ...

, and the narrowing of the vaginal opening. An internal exam will reveal the presence of low vaginal muscle tone, the lining of the vagina appears smooth, shiny, pale with loss of folds. The cervical fornices may have disappeared and the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

can appear flush with the top of the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

. Inflammation is apparent when the vaginal lining bleeds easily and appears swollen. The vaginal pH will be measured at 4.5 and higher.

Treatment

Symptoms of genitourinary syndrome of menopause (GSM) will unlikely be resolved without treatment. Women may have many or a few symptoms so treatment is provided that best suits each woman. If other health problems are also present, these can be taken into account when determining the best course of treatment. For those who have symptoms related to sexual activities, a lubricant may be sufficient. If both urinary and genital symptoms exist, local, low-dose estrogen therapy can be effective. Those women who are survivors of hormone-sensitive cancer may need to be treated more cautiously. Some women can have symptoms that are widespread and may be at risk for osteoporosis. Estrogen and adjuvants may be best. Topical treatment with estrogen is effective when the symptoms are severe and relieves the disruption in pH to restore the microbiome of the vagina. When symptoms include those related to the urinary system, systematic treatment can be used. Recommendations for the use of the lowest effective dose for the shortest duration help to prevent adverse endometrial effects. Some treatments have been developed more recently. These include

selective estrogen receptor modulator Selective estrogen receptor modulators (SERMs), also known as estrogen receptor agonist/antagonists (ERAAs), are a class of drugs that act on the estrogen receptor (ER). A characteristic that distinguishes these substances from pure ER agonists a ...

s, vaginal

dehydroepiandrosterone Dehydroepiandrosterone (DHEA), also known as androstenolone, is an endogenous steroid hormone precursor. It is one of the most abundant circulating steroids in humans. DHEA is produced in the adrenal glands, the gonads, and the brain. It functi ...

, and

laser therapy Laser medicine consists in the use of lasers in medical diagnosis, treatments, or therapies, such as laser photodynamic therapy, photorejuvenation, and laser surgery. Lasers Lasers used in medicine include in principle any type of laser, but ...

. Other treatments are available without a prescription such as vaginal lubricants and moisturizers.

Vaginal dilator A vaginal dilator (sometimes called a vaginal trainer) is an instrument used to gently stretch the vagina. They are used when the vagina has become narrowed ( vaginal stenosis), such as after brachytherapy for gynecologic cancers, and as therapy ...

s may be helpful. Since GSM may also cause urinary problems related to pelvic floor dysfunction, a woman may benefit from pelvic floor strengthening exercises. Women and their partners have reported that estrogen therapy resulted in less painful sex, more satisfaction with sex, and an improvement in their sex life.

Epidemiology

Up to 50% of postmenopausal women have at least some degree of vaginal atrophy. It is likely to be underdiagnosed and undertreated.

Terminology

''Vulvovaginal atrophy,'' and ''atrophic vaginitis'' have been the preferred terms for this condition and cluster of symptoms until recently. These terms are now regarded as inaccurate in describing changes to the entire genitourinary system occurring after menopause. The term ''atrophic vaginitis'' suggests that the vagina is inflamed or infected. Though this may be true, inflammation and infection are not the major components of postmenopausal changes to the vagina. The former terms do not describe the negative effects on the lower urinary tract which can be the most troubling symptoms of menopause for women. Genitourinary syndrome of menopause (GSM) was determined to be more accurate than ''vulvovaginal atrophy'' by two professional societies. The term atrophic vaginitis does not reflect the related changes of the

labia The labia are part of the female genitalia; they are the major externally visible portions of the vulva. In humans, there are two pairs of labia: the '' labia majora'' (or the outer labia) are larger and thicker, while the ''labia minora'' are f ...

clitoris The clitoris ( or ) is a female sex organ present in mammals, ostriches and a limited number of other animals. In humans, the visible portion – the glans – is at the front junction of the labia minora (inner lips), above the ope ...

, vestibule,

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

and

bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

Research

The FDA has approved the use of lasers in the treatment of many disorders. The treatment of GSM is not specifically mentioned in the list of disorders by the United States' Food and Drug Administration (FDA) but laser treatments have had success. Larger studies are still needed. The laser treatment works by resurfacing the vaginal

epithelium Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellul ...

and activating growth factors that increases blood flow, deposition of collage and the thickness of the vaginal lining. Women treated with laser therapy reported diminished symptoms of dryness, burning, itching, pain during sexual intercourse, and painful urination. Few adverse effects were noted. In 2018, the FDA issued a warning that lasers and other high energy devices were not approved for this application and it had received multiple reports of injuries.

References

External links

{{DEFAULTSORT:Atrophic Vaginitis Menopause Inflammations Noninflammatory disorders of female genital tract Vaginal diseases Wikipedia medicine articles ready to translate