About Atrophic Vulvovaginitis
Atrophic vulvovaginitis is caused by decreased estrogen levels in the genital tissue. The pathophysiologic causes of atrophic vulvovaginitis include:
- Decreased estrogenization of the genital tissue due to menopause or surgical/pharmacological ovarian failure.
- Chronic progressive disease involving the female genital and lower urinary tract.
The non-modifiable risk factors for atrophic vulvovaginitis cannot be changed or controlled. These include:
- Advanced age, as it is more common in post-menopausal women.
- History of breast cancer, as adjuvant therapies can cause VVA.
The modifiable risk factors for atrophic vulvovaginitis can be influenced or changed. These include:
- Hormonal changes due to menopause or ovarian failure, which can be managed with hormone replacement therapy.
- Lifestyle factors such as smoking, excessive alcohol consumption, and a sedentary lifestyle may contribute to symptoms.
- Poor diet lacking in fruits and vegetables.
It's important to note that these risk factors may increase the likelihood of developing atrophic vulvovaginitis, but they do not guarantee its development. It's always best to consult with a healthcare professional for personalized advice and management options.
The most common early symptoms of atrophic vulvovaginitis include:
- Vaginal dryness
- Pain during sexual intercourse (dyspareunia)
- Thin, watery, yellow or gray discharge
- Paleness and thinning of the labia and vagina
- Irritation when wearing certain clothes or sitting on a bike seat
- More frequent urinary tract infections (UTIs)
As atrophic vulvovaginitis progresses or becomes more severe, additional symptoms may occur, such as:
- Painful urination
- Blood in the urine
- Increased frequency of urination
- Incontinence
- Increased likelihood and occurrence of infections
- Reduction in pubic hair
- Narrowing and decreased elasticity of the vagina
It's important to note that these symptoms can vary from person to person. If you experience any of these symptoms, it is recommended to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.
To diagnose atrophic vulvovaginitis, the following examinations, tests, and procedures are commonly performed:
- Medical history and gynecological examination: The healthcare provider will gather information about symptoms, medical history, and medications. A thorough examination of the vulva and vagina is conducted to assess clinical signs such as mucosal thinning, dryness, erythema, and vestibular atrophy.
- Vaginal pH measurement: The pH level of the vagina is measured to determine if it is within the normal range.
- Microscopy: Saline and potassium hydroxide microscopy are used to examine vaginal discharge for the presence of yeast or other infections.
- Yeast cultures and STI screening: Cultures are done to identify specific pathogens that may be causing the symptoms. Screening for sexually transmitted infections (STIs) is also performed.
Additional examinations, tests, and procedures may include:
- Vaginal maturation index (VMI): This test evaluates the maturation status of vaginal cells by examining their appearance under a microscope.
- Evaluation of vaginal elasticity, secretions, pH, epithelial mucosa integrity, and tissue hydration: These elements are assessed using the vaginal health index (VHI) score. A score below 15 indicates atrophic vaginitis.
- Assessment of sexual function: This includes evaluating sexual desire, arousal, lubrication, orgasm, satisfaction, and pain using validated questionnaires like the female sexual function index (FSFI).
Remember that these procedures should be performed by a healthcare professional. It's important to consult with your doctor for an accurate diagnosis and appropriate treatment.
The goals of treatment for atrophic vulvovaginitis are to alleviate symptoms, improve vaginal health, and enhance the overall quality of life for women suffering from this condition. Here are the various treatment options and how they work towards achieving these goals:
Medications:
- Hormonal Therapy: Estrogen-based creams, tablets, or rings can be prescribed to restore vaginal tissues and alleviate symptoms of AVV.
- Non-Hormonal Prescription Medications: Certain medications, such as ospemifene, can help improve the symptoms of AVV without containing estrogen.
Therapies and Therapeutic Procedures:
- Pelvic Floor Physiotherapy: This therapy can help strengthen the pelvic floor muscles, improving symptoms like urinary incontinence and dyspareunia.
Self-care and Health Behavior Changes:
- Vaginal Moisturizers: Over-the-counter moisturizers can provide relief from vaginal dryness and discomfort by increasing moisture and improving flexibility.
- Lubricants: Vaginal lubricants help reduce friction during sexual activity and provide temporary relief from dryness.
- Regular sexual activity: This can help improve blood flow to the vaginal area, promoting vaginal health.
- Smoking Cessation: Quitting smoking can reduce symptoms of AVV as smoking is known to worsen vaginal dryness.
It's important to note that treatment options may vary depending on individual circumstances. Consult with your healthcare professional to determine the most suitable approach for your specific situation.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.