Key learning

  • Due to decreased oestrogen levels- > thin and inflamed vaginal walls-> less lubrication-> increased susceptibility to infection
  • Most common in post menopausal
  • Examination:
    • Dry, pale, atrophic vagina
  • Management:
    • 1st line: Vaginal lubricants
    • 2nd line: Topical oestrogen therapy

 

Pathophysiology

  • Decreased oestrogen levels, leading to thinning and inflammation of the vaginal walls
  • Results in reduced lubrication
  • Increased susceptibility to infection

Risk factors

  • Postmenopausal women due to oestrogen deficiency
  • Premenopausal women during breastfeeding 
  • Patients undergoing chemotherapy or hormonal therapy

History

  • Vaginal dryness, itching, burning
  • Dyspareunia (painful intercourse)
  • Occasional spotting
  • Urinary symptoms such as frequency or urgency

Examination Findings

  • Vaginal mucosa appears pale, dry, and atrophic
  • May have petechiae or ulceration

Investigations

  • Clinical diagnosis
  • Vaginal pH may be elevated (>5)
  • Hormonal assays may be indicated in certain cases to evaluate oestrogen levels.

Management

  • 1st line- Vaginal moisturizers, and lubricants
  • 2nd line- Topical oestrogen therapy (cream, ring, or tablet) 

Complications

  • Recurrent urinary tract infections
  • Vaginal or urethral prolapse
  • Sexual dysfunction

 

Useful links

DermNet- Atrophic Vulvovaginitis