An Overview of Atrophic Vaginitis

Atrophic Vaginitis

Definition :

It is thinning, drying and inflammation of the vaginal walls due to estrogen deficiency.

Fig : Atrophic Vaginitis.

For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms.

Fig : Vaginal wall in Atrophic vaginitis

Synonym :

▪Vaginal atrophy,
▪Senile vaginitis.

Symptoms :

▪ Vaginal dryness
▪ Vaginal burning
▪ Vaginal discharge
▪ Genital itching
▪ Dyspareunia (Dyspareunia is pain when sexual intercourse or other sexual activity that involves penetration is attempted or pain during these activities)
▪ Sometimes post coital bleeding
▪ Burning sensation of micturition
▪ Urgency

Causes :

  1. Due to estrogen deficiency
    (Perimenopause, menopause)
  2. A decline in estrogen can occur at other times besides menopause –

➡ After removal of ovaries ( surgical removal )

➡ After chemotherapy for Rx of cancer

➡ After pelvic radiation for Rx of cancer

➡ After hormone therapy for Rx of breast cancer

Fig : Effects of the mechanism of estrogen in Actrophic Vaginitis.
  1. Uncontrolled Diabetes Mellitus
  2. Severe stress, depression
  3. Other substances like soaps, laundry detergents, lotions, perfumes or douches cause further irritation / dryness of vagina.
  4. Sometimes infections like yeast infection may also trigger or worsen vaginal dryness.

Complication :

  1. Atrophic vaginitis causes acidic environment in the vagina which makes it easier for bacteria,yeast and other organisms to thrive.
  2. It increases the risk of urinary system atrophy.
  3. Urinary tract infection.
  4. Urinary incontinence.

Diagnosis :

1) History taking

2) Examination

➡ On P/V examination:
Palpate pelvic organs, external genitalia for physical signs of atrophy –

▫ Pale, smooth, shiny vaginal lining
▫ Loss of elasticity
▫ Sparse pubic hair
▫ Smooth thin external genitalia
▫ Stretching of uterine support tissue
▫ Shortening and tightening of the vaginal canal
▫ Evidence of pruritus vulvae (Excoriation).
▫ The characteristics of the discharge is yellowish or blood stained.
▫ Vaginal examination is often painful and walls are found inflamed.
▫ Patchy ulceration can result in adhesion forming between the Vaginal walls.

3) Infection screening

Incase of discharge / bleeding

▫ Blood sugar test

▫ Urine R/M/E

▫ Ultrasonogram

▫ Hormone analysis

▫ Vaginal smear test

It looks for certain types of cells and bacteria that are more prevalent with vaginal atrophy.

Fig : Vaginal smear test

▫ Vaginal acidity test

Normal pH is 4.5 or less of this area.When pH is more than 4.6 or higher, it indicates atrophic vaginitis.

Fig : pH measurement in Vaginal Acidic Test.

Treatment :

  1. Treatment is focused on symptoms or the underlying cause. Water based lubricants can help to treat dryness.
  2. If symptoms are severe then give HRT ( hormone replacement therapy)
    Estrogen improves vaginal elasticity, raises the glycogen content and lower vaginal PH and keeps normal moisture.

Orally : To remove PMS ( Post Menopausal Symptoms)
Topically : To remove vaginal dryness.

  1. Don’t use any perfumes, lotions which can cause vaginal dryness.
  2. Rx of candidiasis or other vaginal infection.
  3. Control Diabetes.
  4. Counselling for stress or depression.
  5. In menopause other Rx like Vit-D, Calcium, Gabapentin or Anxiolytic if needed.

Prevention :

  1. Wear cotton underwear :
    To improve air circulation around the genitals and make them a less ideal environment for bacterial growth.
  2. Sexually activity :
    It has no effect on estrogen levels but by improving blood circulation, it also keeps pelvic organ healthier for longer.

Dr. Tania Hafiz
Z.H Sikder Women’s Medical College and Hospital

কারিতাস ঠিকানা প্রকল্প
মিরপুর, রুপনগর, ঢাকা-১২১৬,কারিতাস বাংলাদেশ

প্ল্যাটফর্ম একাডেমিক / সাদিয়া কবির

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