Vaginal Atrophy

Atrophic vaginitis is an inflammation of the vagina (and the outer urinary tract) due to the thinning and shrinking of the tissues, as well as decreased lubrication. These symptoms are due to a lack of the reproductive hormone estrogen.

Vaginal atrophy is a common disorder in postmenopausal women that often occurs with urinary symptoms and causes considerable distress. Typically, women with vaginal atrophy experience dryness, itching, irritation, burning, and dyspareunia (painful sexual intercourse). They also commonly present with one or more urinary symptoms, including urgency, increased frequency, nocturia (excessive urination at night), dysuria (difficult urination), incontinence, and recurrent urinary tract infection (RUTI). When any of these symptoms are left untreated, they may contribute to a lower quality of life marked by vaginal discomfort, pain, and sexual dysfunction.

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, 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 can appear flush with the top of the vagina. Inflammation is apparent when the vaginal lining bleeds easily and appears swollen. The vaginal pH will be measured at 4.5 and higher.

Estrogen replacement restores normal pH levels and thickens and revascularizes the epithelium. Moisturizers and lubricants may be used in conjunction with estrogen replacement therapy or as alternative treatments. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation. 

Vaginal atrophy may be associated with several diseases including: 

Menopause

Vaginal atrophy occurs most often after menopause. Symptoms of vaginal atrophy may also remind women that they are aging, and the perception that their bodies are no longer responding or acting as they used to may create anxiety and depression. Furthermore, loss of elasticity to vulvovaginal tissues, thinning of the vaginal wall, and decreased vaginal lubrication may increase the risk for microtears or genital lesions during intercourse, which could allow easier transmission of sexually transmitted infections.