Atrophic Vaginitis
What is Atrophic Vaginitis
Atrophic vaginitis, also known as genitourinary syndrome of menopause (GSM), is the thinning, drying, and inflammation of the vaginal walls due to decreased estrogen levels. It is most common after menopause but can also occur in younger women with low estrogen (e.g., after childbirth, breastfeeding, or certain medical treatments).
Causes
- Estrogen deficiency (menopause, oophorectomy, premature ovarian failure)
- Postpartum or during breastfeeding (temporary low estrogen state)
- Use of anti-estrogen medications (e.g., tamoxifen, aromatase inhibitors)
- Radiation or chemotherapy to pelvic region
- Surgical removal of ovaries
Risk Factors
- Women over 45 years (postmenopausal)
- History of pelvic surgery
- Hormone-suppressing treatments (for cancer or endometriosis)
- Lack of sexual activity (reduced vaginal blood flow)
Symptoms
- Vaginal dryness
- Burning or irritation
- Itching
- Painful intercourse (dyspareunia)
- Light bleeding after intercourse
- Recurrent urinary tract infections (UTIs)
- Urinary urgency or frequency
Diagnosis
- History & symptom assessment (menopausal status, medication use)
- Pelvic examination (pale, thin, dry vaginal mucosa with loss of elasticity)
- Vaginal pH testing (higher than normal, usually >5)
- Microscopic examination of vaginal secretions (reduced lactobacilli, few parabasal cells)
Treatment
1. Lifestyle Measures
- Regular sexual activity (maintains blood flow & elasticity)
- Use of water-based lubricants or vaginal moisturizers
2. Medical Treatment
- Topical estrogen therapy (cream, tablet, or ring) – most effective
- Systemic hormone replacement therapy (HRT) if other menopausal symptoms are also present
- Non-hormonal options (e.g., ospemifene, vaginal DHEA) in selected cases
3. Supportive Care
- Avoid scented soaps, douches, or irritants
- Maintain good genital hygiene
Complications
- Chronic vaginal discomfort
- Sexual dysfunction (due to painful intercourse)
- Increased risk of recurrent urinary infections
- Negative impact on quality of life and intimate relationships
Summary
Atrophic vaginitis is primarily caused by low estrogen levels, leading to vaginal dryness, irritation, and painful intercourse. Diagnosis is clinical and confirmed with vaginal exam and pH testing. Treatment mainly includes topical estrogen therapy, lubricants, and lifestyle measures.
