Atrophic Vaginitis

Question 1

What is this?

What is its pathophysiology?

Answer 1

➊ Dryness and atrophy due to a lack of oestrogen

➋ Oestrogen causes the vaginal epithelium to become thicker, more elastic, and produce secretions – When oestrogen levels fall, the mucosal lining becomes thinner, less elastic, and more dry, therefore making it more prone to inflammation

Question 2

How does it present?

What will be seen O/E?

How is it investigated?

Answer 2

➊ • Itching
• Dryness
• Dyspareunia
• Post-coital bleeding

➋ Pale mucosa, thin skin, reduced skin folds, dryness

➌ Exclude the differentials of its symptoms:
• Postmenopausal bleeding – Malignancy, Endometrial hyperplasia
• Itching – STI, Candidiasis
• Dyspareunia – STI, Malignancy

Question 3

Management:
What are the hormonal options?

What are the non-hormonal options?

Answer 3

➊ • HRT
• Topical Oestrogen

➋ • Vaginal lubricants for itchiness, dryness, and dyspareunia
• Moisturisers