Atrophic vaginitis
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| Atrophic vaginitis | |
| ICD-10 | N95.2 |
|---|---|
| ICD-9 | 627.3 |
| DiseasesDB | 32516 |
| MedlinePlus | 000892 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Synonyms and keywords: Atrophic vulvovaginitis; vaginal atrophy; urogenital atrophy; genitourinary syndrome of menopause
Overview
Historical Perspective
Classification
Pathophysiology
Pathogenesis
The pathogenesis of atrophic vaginitis is related to decreased estrogen levels. Estrogen is a vasoactive hormone, which increases blood flow and maintain vaginal lubrication through fluid transudation from blood vessels.[1] The following are the manifestations of decreased estrogen levels:[1][2][3]
- A hypoestrogenic state, such as that seen in menopause, causes the vaginal epithelium to lose its rugae, as well as become thin and pale or erythematous with fine petechial hemorrhages.
- Decreased glycogen content within the epithelium due to decreased thickness leads to less glycogen content available for the lactobacilli to utilize and turn it into lactic acid. As a result, the vaginal pH rises with a resultant overgrowth of other bacteria, such as group B streptococci, Staphylococci and diptheroids. As a result, vaginal infections, UTI and inflammation become more common in the setting of atrophic vaginitis.
Genetics
Gross Pathology
Microscopic Pathology
Associated Conditions
Causes
Epidemiology and Demographics
- Atrophic vaginitis is often an underdiagnosed condition, because many women are embarrassed to discuss their symptoms. Some others think of the symptoms associated with atrophic vaginitis as a process of natural aging.[1]
- Based on self-reported symptoms of vaginal dryness, the prevalence of atrophic vaginitis ranged from 4% to 47%, depending on the stage of menopause (early or late menopause).[2]
Risk Factors
The risk factors associated with vaginal atrophy are related to decreased estrogen levels, which can be due to menopause (most common cause) or other causes that may lead to hypoestrogenism or vaginal atrophy. These include:[1][4]
- Menopause (most common cause)
- Bilateral oophorectomy
- Premature ovarian failure
- Decreased ovarian function, due to chemotherapy or radiation
- Medications with an anti-estrogenic side effect:
- Tamoxifen
- Danazol
- Medroxyprogesterone acetate
- GnRH agonsists: leuprolide, nafarelin, goserelin
- GnRH antagonists: ganirelix
- Elevated prolactin levels during lactation
- Sexual abstinence
- Vaginal nulliparity
- Smoking
- Alcohol abuse
- Lack of exercise
Screening
There are no screening recommendations for atrophic vaginitis.[5]
Differentiating atrophic vaginitis from other diseases
Atrophic vaginitis must be differentiated from other disease processes that may present with similar symptoms. These can be divided into 4 categories:[2] [1]
- Vaginal infections: Candida vulvovaginitis, bacterial vaginosis and trichomoniasis
- Vulvovaginal dermatoses: lichen sclerosus, lichen planus and lichen simplex chronicus
- Cancer and precancerous lesions: vulvar intraepithelial neoplasia, vulvar cancer and extramammary Paget disease
- Others: foreign body, sexual trauma and contact irritants
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Symptoms of atrophic vaginitis can be divided into three categories:[2][3][1]
- External genital symptoms:
- Vaginal dryness
- Vaginal irritation
- Vaginal itching
- Vaginal discharge
- Sexual symptoms:
- Painful sexual intercourse (dyspareunia)
- Postcoital bleeding
- Loss of bleeding
- Loss of arousal
- Pelvic pain
- Urological symptoms:
- Burning on urination (dysuria)
- Urinary frequency
- Urinary urgency
- Nocturia
- Urinary incontinence
- Recurrent urinary tract infections (UTI)
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
The mainstay of treatment of atrophic vaginitis is medical therapy. It can be categorized into two groups:[2][6]
- Nonhormonal therapy: this includes vaginal moisturizers and lubricants
- Hormonal therapy: this includes vaginally administered local estrogens, which can be in the form of cream, ring or tablet
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, Khan SA (2016). "Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management". Am. J. Obstet. Gynecol. doi:10.1016/j.ajog.2016.07.045. PMID 27472999.
- ↑ 2.0 2.1 2.2 2.3 2.4 Mac Bride MB, Rhodes DJ, Shuster LT (2010). "Vulvovaginal atrophy". Mayo Clin. Proc. 85 (1): 87–94. doi:10.4065/mcp.2009.0413. PMC 2800285. PMID 20042564.
- ↑ 3.0 3.1 Pandit L, Ouslander JG (1997). "Postmenopausal vaginal atrophy and atrophic vaginitis". Am. J. Med. Sci. 314 (4): 228–31. PMID 9332260.
- ↑ Bachmann GA, Nevadunsky NS (2000). "Diagnosis and treatment of atrophic vaginitis". Am Fam Physician. 61 (10): 3090–6. PMID 10839558.
- ↑ U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=atrophic+vaginitis. Accessed on Oct. 24, 2016
- ↑ Holmgren PA, Lindskog M, von Schoultz B (1989). "Vaginal rings for continuous low-dose release of oestradiol in the treatment of urogenital atrophy". Maturitas. 11 (1): 55–63. PMID 2498619.