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| ==Overview== | | ==[[Atrophic vaginitis overview|Overview]]== |
| '''Atrophic vaginitis''' (also known as '''vaginal atrophy''' or '''urogenital atrophy''') 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. This is all due to a lack of the reproductive hormone [[estrogen]].
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| The most common cause of vaginal atrophy is the decrease in [[estrogen]] which happens naturally during perimenopause, and increasingly so in post-[[menopause]]. However this condition can sometimes be caused by other circumstances.
| | ==[[Atrophic vaginitis historical perspective|Historical Perspective]]== |
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| The symptoms include vaginal soreness and itching, as well as painful intercourse, and bleeding after sexual intercourse. The shrinkage of the tissues can be extreme enough to make intercourse impossible.
| | ==[[Atrophic vaginitis classification|Classification]]== |
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| == Symptoms and signs == | | ==[[Atrophic vaginitis pathophysiology|Pathophysiology]]== |
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| Genital symptoms include dryness, itching, burning, soreness, pressure, thick yellow white discharge, malodorous discharge, infection, painful sexual intercourse, bleeding after intercourse. In addition, sores and cracks may occur.
| | ==[[Atrophic vaginitis causes|Causes]]== |
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| Urinary symptoms include painful urination, blood in the urine, increased frequency of urination, incontinence, and increased likelihood and occurrence of infections.
| | ==[[Atrophic vaginitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| == Incidence and causes == | | ==[[Atrophic vaginitis risk factors|Risk Factors]]== |
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| A large number of postmenopausal women (who are not using topical estrogen) have at least some degree of vaginal atrophy, however, many women do not actively ask that medical attention be paid to this, possibly because it is naturally caused, or because of the [[taboo]] that still exists surrounding aging and sexuality.
| | ==[[Atrophic vaginitis screening|Screening]]== |
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| The cause of vaginal atrophy is usually the normal decrease in estrogen as a result of menopause. Other causes of decreased estrogen are decreased ovarian functioning due to radiation therapy or chemotherapy, immune disorder, removal of the ovaries, after pregnancy, during lactation, idiopathic, and because of the effects of various medications (Tamoxifen (Nolvadex), Danazol (Danocrine), Medroxyprogesterone (Provera), Leuprolide (Lupron), Nafarelin (Synarel)).
| | ==[[Atrophic vaginitis differential diagnosis|Differentiating Atrophic vaginitis from other Diseases]]== |
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| == Treatment == | | ==[[Atrophic vaginitis natural history|Natural History, Complications and Prognosis]]== |
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| Topical estrogen creams or tablets may be used vaginally. Oral or transdermal estrogen may be used. See '''Boxed Warning''' about estrogen therapy below.
| | ==Diagnosis== |
| | [[Atrophic vaginitis history and symptoms|History and Symptoms]] | [[Atrophic vaginitis physical examination|Physical Examination]] | [[Atrophic vaginitis laboratory tests|Laboratory Findings]] | [[Atrophic vaginitis CT|CT]] | [[Atrophic vaginitis MRI|MRI]] | [[Atrophic vaginitis ultrasound|Ultrasound]] | [[Atrophic vaginitis other imaging findings|Other Imaging Findings]] | [[Atrophic vaginitis other diagnostic studies|Other Diagnostic Studies]] |
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| Sexual activity is also helpful. A water-soluble vaginal lubricant may be useful.
| | ==Treatment== |
| | [[Atrophic vaginitis medical therapy|Medical Therapy]] | [[Atrophic vaginitis primary prevention|Primary Prevention]] | [[Atrophic vaginitis secondary prevention|Secondary Prevention]] | [[Atrophic vaginitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Atrophic vaginitis future or investigational therapies|Future or Investigational Therapies]] |
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| === Boxed Warning === | | ==Case Studies== |
| | [[Atrophic vaginitis case study one|Case#1]] |
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| The labeling of estrogen-only products includes a [[black box warning|boxed warning]] that unopposed estrogen (without progestin) therapy increases the risk of [[endometrial cancer]].
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| Based on a review of data from the WHI, on [[January 8]] [[2003]] the FDA changed the labeling of all estrogen and estrogen with progestin products for use by postmenopausal women to include a new boxed warning about cardiovascular and other risks. The estrogen-alone sub-study of the WHI reported an increased risk of [[stroke]] and [[deep vein thrombosis]] (DVT) in postmenopausal women 50 years of age or older and an increased risk of [[dementia]] in postmenopausal women 65 years of age or older using 0.625 mg of Premarin conjugated equine estrogens (CEE). The estrogen-plus-progestin substudy of the WHI reported an increased risk of [[myocardial infarction]], stroke, invasive [[breast cancer]], [[pulmonary emboli]] and DVT in postmenopausal women 50 years of age or older and an increased risk of dementia in postmenopausal women 65 years of age or older using 0.625 mg of CEE with 2.5 mg of the progestin [[medroxyprogesterone acetate]] (MPA).<ref name=fdanewlabel>{{cite web |author=FDA |title=FDA Approves New Labels for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women Following Review of Women's Health Initiative Data |url=http://www.fda.gov/bbs/topics/NEWS/2003/NEW00863.html |date=1-8-2003 |accessdate=2006-09-20}}</ref><ref name="Medline">
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| {{cite web
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| | last =
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| | first =
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| | authorlink =
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| | coauthors =
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| | title = IMPORTANT WARNING
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| | work =
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| | publisher = MedlinePlus
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| | date =
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| | url = http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682922.html
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| | accessdate = 2006-09-18 }}
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| </ref><ref name="Times">
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| {{cite web
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| | last = Kolata
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| | first = Gina
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| | authorlink =
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| | coauthors =
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| | title = F.D.A. Orders Warning on All Estrogen Labels
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| | work =
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| | publisher = The New York Times
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| | date = 1-9-2003
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| | url = http://query.nytimes.com/gst/fullpage.html?sec=health&res=9C00E0DD103EF93AA35752C0A9659C8B63
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| | accessdate = 2006-09-18 }}
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| </ref>
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| == Prognosis ==
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| Proper treatment will usually relieve the symptoms, at least to some extent.
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| == Prevention ==
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| Use of vaginal estrogen before the condition becomes severe is appropriate. Regular sexual activity may be helpful. A water soluble vaginal lubricant can be helpful in mild cases.
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| == Notes ==
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| {{reflist|2}}
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| == References ==
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| {{cite web
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| | last = Bachmann M.D.
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| | first = Gloria
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| | authorlink =
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| | coauthors =
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| | title = Diagnosis and Treatment of Atrophic vaginitis
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| | work =
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| | publisher = American Academy of Family Physicians
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| | date = 05-15-2000
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| | url = http://www.aafp.org/afp/20000515/3090.html
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| | accessdate = 2006-09-18 }}
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| {{cite web
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| | last =
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| | first =
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| | authorlink =
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| | coauthors =
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| | title = Vaginal Atrophy (Atrophic vaginitis)
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| | work =
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| | publisher =
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| | date = 02-03-2006
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| | url = http://www.intelihealth.com/IH/ihtIH/WSAOL002/9339/9504.html
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| | accessdate = 2006-09-18 }}
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| {{Diseases of the pelvis, genitals and breasts}} | | {{Diseases of the pelvis, genitals and breasts}} |