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. 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

Risk Factors

Screening

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 3 categories:[1]

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Symptoms of atrophic vaginitis can be divided into two categories:[1][2][3]

  • External Genital Symptoms
    • Vaginal dryness
    • Vaginal irritation
    • Vaginal itching
    • Vaginal discharge
    • Painful sexual intercourse (dyspareunia)
    • Postcoital bleeding

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:[1]

  • Nonhormonal therapy: this includes vaginal moisturizers and lubricants
  • Hormonal therapy: this includes vaginally administered local estrogens

Primary Prevention

Secondary Prevention

References

  1. 1.0 1.1 1.2 1.3 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.
  2. 2.0 2.1 Pandit L, Ouslander JG (1997). "Postmenopausal vaginal atrophy and atrophic vaginitis". Am. J. Med. Sci. 314 (4): 228–31. PMID 9332260.
  3. 3.0 3.1 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.


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