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Diagnosing Atrophic Vaginitis

Diagnosing Atrophic Vaginitis
It is important not to assume a diagnosis of atrophic vaginitis in the postmenopausal patient who presents with urogenital complaints. A patient history should include attention to exogenous agents that may cause or further aggravate symptoms.
Perfumes, powders, soaps, deodorants, panty liners, spermicides and lubricants often contain irritant compounds. In addition, tight-fitting clothing and long-term use of perineal pads or synthetic materials can worsen atrophic symptoms.

Atrophic epithelium appears pale, smooth and shiny. Often, inflammation with patchy erythema, petechiae and increased friability may be present. External genitalia should be examined for diminished elasticity, turgor of skin, sparsity of pubic hair, dryness of labia, vulvar dermatoses, vulvar lesions and fusion of the labia minora.

Ecchymoses and minor lacerations at peri-introital and posterior fourchette may also recur after coitus or during a speculum examination. Vaginal examination or sexual activity can result in vaginal bleeding or spotting. Vulvar signs of irritation caused by urinary incontinence may also be identified on pelvic examination.
What are the treatment options for Atrophic Vaginitis?

Before self treating your symptoms, a doctor must determine if they are caused by decreased estrogen, an infection, irritant, or other reason.

If symptoms are mild, they may be relieved by using a water-soluble vaginal lubricant during intercourse. Do not use petroleum jelly, mineral oil, or other oils. These may increase the chance of infection and may damage latex condoms or diaphragms.

Hormone Replacement Therapy (HRT) can be taken as a tablet, gel, patch or implant, which supplies oestrogen to the whole body. It is effective although there is debate about the risks of taking it in the long-term. Localised HRT is another option - vaginal tablets, creams, rings and pessaries can be taken internally to supply oestrogen to the vaginal area only.

Regular exercise is important as it keeps blood flow and genital circulation high. Experimenting with your diet can also prove effective. Soy isoflavones (plant oestrogens), linseeds, fish oils, and black cohosh have been found to be helpful.

Sexual activity is a healthful prescription for postmenopausal women who have a substantially estrogenized vaginal epithelium. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation. Women who participate in sexual activity report fewer symptoms of atrophic vaginitis and, on vaginal examination, have less evidence of stenosis and shrinkage in comparison with sexually inactive women.
Preventing Atrophic Vaginitis

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.

Increasingly, topical treatment (vaginal tablets or cream) based on low dose of estriol are used to stimulate the vaginal epithelium proliferation.