This is a vaginal condition characterised by inflammation, thinning of tissues, shrinkage of tissues, and dryness due to decreased lubrication.
Oestrogen deficiency, usually as a result of menopause.
Other causes include:
- Chemotherapy for other conditions,
- Radiotherapy to the pelvis,
- Anti-oestrogen medication such as Tamoxifen,
- Normal decreased oestrogen production after giving birth, and especially during breastfeeding, and
- Raised prolactin levels due to pituitary problems.
In most (60-90 percent) patients, vaginal atrophy is mild, and causes no symptoms, or causes only mild symptoms which cause no problems. However, as the vaginal walls become thinner, less elastic and drier, a number of symptoms are possible, and become worse with time if untreated:
- Burning sensation of the vagina,
- Painful intercourse,
- Vaginal bleeding or spotting,
- Unpleasant yellowish vaginal discharge, and/or
- Painful urination.
No special tests are needed for the diagnosis, which is purely clinical. However, four tests may be used to assess the severity of the condition if necessary:
- Vaginal pH - measures the acidity of he vagina. This should be acidic (3.5 - 5.0) but pH values of 6 or more are often found in atrophic vaginitis.
- Cytology - looking at the cells from a smear of the vagina can detect signs of oestrogen deficiency.
- Blood hormone levels - these are not very reliable in post-menopausal women, and results may vary widely with different laboratories.
Treatment is aimed at relieving symptoms, and can be continued for as long as symptoms persist.
The most effective treatment is oestrogen therapy (unless contraindicated), which may be delivered in several ways: orally, transdermally (skin patches) or vaginally (creams and pessaries). CAUTION: The use of oestrogen in patients with breast cancer must first be discussed with the patient’s oncologist.
Water-based gel lubricants are helpful, and sexual activity is encouraged to retain suppleness of vaginal tissues.
Any co-existing disorders such as cystitis are treated appropriately.
Most women respond very well to treatment. If treatment is discontinued and symptoms return, treatment may be resumed and continued until no longer needed.
(Dr A G Hall)