Vaginitis: Atrophic

Chapter 93 Vaginitis: Atrophic



INTRODUCTION



Description: Atrophic vaginitis is characterized by degeneration (atrophy) of vaginal tissues caused by the loss of ovarian steroids.

Prevalence: Occurs in 100% of postmenopausal women who do not receive estrogen replacement.

Predominant Age: 50+ (or after surgical menopause).

Genetics: No genetic pattern.


ETIOLOGY AND PATHOGENESIS



Causes: Loss of estrogen stimulation as a result of surgery, chemotherapy (alkylating agents), radiation, or natural cessation of ovarian function (menopause).

Risk Factors: Loss of ovarian function because of age, chemotherapy, radiation, or surgery.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Vaginal dryness, burning, and itching

• Pain or bleeding with intercourse (may be associated with lacerations)

• Thin, shiny, red epithelium with a smooth surface (loss of rugae)


DIAGNOSTIC APPROACH



Differential Diagnosis



• Vaginal infections

• Vulvitis (including dermatologic causes)

• Chemical vaginitis

• Changes after radiation exposure

• Lichen sclerosus


Associated Conditions: Menopause, dyspareunia, vulvodynia, atrophic vulvitis, urinary frequency, urinary urgency, urgency incontinence, increased risk of other menopause-related conditions including osteoporosis, increased risk of cardiovascular disease, hot flashes and flushes, or sleep disturbances.


Workup and Evaluation



Laboratory: No evaluation indicated.

Imaging: No imaging indicated.

Special Tests: A vaginal maturation index may be performed but is generally not required.

Diagnostic Procedures: History and clinical inspection generally sufficient.


Pathologic Findings


Thinned epithelium with loss of rugae and rete pegs (on biopsy).



MANAGEMENT AND THERAPY



Nonpharmacologic


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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Vaginitis: Atrophic

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