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Vaginal Atrophy - Causes, Signs, Diagnosis, and Treatment

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Vaginal atrophy means the vaginal walls become dry, slender, and inflammation. Also known as atrophic vaginitis. Read the article to know more.

Medically reviewed by

Dr. Manwani Saloni Dilip

Published At January 13, 2023
Reviewed AtJuly 7, 2023

Introduction:

Vaginal atrophy is a severe complication often overlooked and mistaken for regular urinary tract infections. This inflammation mainly occurs in women after menopause. Menopause refers to the end of the mensural cycle in women and appears in the late forty or fifty age group. Identifying the true cause and progression of vaginal atrophy is essential. Hence, adequate diagnosis and history of infections related to the urinary tract are crucial for the appropriate management and further advancement.

What Are the Causative Factors for Vaginal Atrophy?

  • Decreased estrogen hormone levels are responsible for the thinning of the vaginal walls.

  • After menopause in a woman, many changes occur in the body. The estrogen levels are gradually decreased after menopause.

  • Radiotherapy means using high-energy rays to destroy cancer cells. Pelvic radiotherapy is also one of the causative factors for vaginal atrophy.

  • The operation to remove one or both ovaries.

  • Intake of anti-estrogen pills.

  • Vaginal atrophy can occur after the delivery of the baby.

  • In women who have lost weight and those who lack appetite.

  • Lactating mother.

  • Sudden stoppage of the menstrual cycle due to hormonal problems.

  • Smoking cigarettes.

  • Chemicals such as soaps, detergents, and deodorants.

  • Intake of illicit drugs can alter hormonal concentrations and cause this condition.

  • Premature ovarian failure.

  • Usage of sanitary products, tight-fitting clothing, or synthetic clothing.

  • Medications used for the treatment of asthma-like anticholinergics.

  • Drugs used for allergies-antihistamines.

  • Drugs used for psychosis.

What Are the Signs of Vaginal Atrophy?

  • There is vaginal dryness, and the walls are pale.

  • There is a severe burning sensation in the vagina.

  • Increased discharge from the vagina.

  • Itching sensation in the genital organs.

  • Constant burning sensation.

  • Urge to urinate frequently.

  • Repeated infections of the urinary tract.

  • Lack of control over the bladder.

  • There may be bleeding after intercourse.

  • Reduction of lubrication in the vagina.

  • There is a decrease in the length of the vaginal canal.

  • Pale and slender vagina.

  • The pH (potential of hydrogen) of the vagina is changed.

  • Increased vaginal elastic nature.

How To Diagnose Vaginal Atrophy?

For proper diagnosis of vaginal atrophy, the following steps are essential:

  • Recording the case history correctly and asking for any contact with perfumes, deodorants, or soaps.

  • Physical examination.

  • Laboratory tests.

  • In postmenopausal women, there is decreased estrogen, so a proper diagnosis is essential to differentiate it from other genital infections.

  • Other vaginal bacterial infections cause similar symptoms.

  • Record a correct history of the regularity of urine, discomfort when urinating, blood in the urine, and control over urination.

  • Any history of stinking yellow discharge.

  • Genital pain and bleeding after intercourse.

  • Itching in the vagina.

  • There is a decline in blood flow to the vagina and a reduction in vaginal lubrication.

  • Physical examination of the vagina is done by using a speculum (a tool used for pelvic examination), which is lubricated. This is done to avoid discomfort for the patient and any injury to the vaginal tissues. Analysis reveals narrow vaginal canals with a width of less than two fingers. The vagina is dry with decreased depth. There is a reduction of elasticity in the vagina.

  • Tiny round brown-purple spots on the vaginal lining.

  • There is a decrease in the size of the vulvar tissue.

  • In laboratory findings, the vaginal pH is more than 5 in vaginal atrophy.

  • There is a low concentration of estrogen hormone.

  • Microscopic examination.

What Are the Complications of Vaginal Atrophy?

There are severe cracks in the vaginal walls. Genital pain and severe bleeding after intercourse occur.

How To Treat Vaginal Atrophy?

  • Menopausal women are advised to continue sexual activity. As the activity regulates the blood circulation in the vagina.

  • Hormone replacement therapy will be recommended for women who have undergone chemotherapy.

  • They are recommended to use water-soluble vaginal lubricants.

  • Suggesting bioidentical vaginal estrogen as a replacement for normal estrogen hormone. They are present in the form of creams, tablets, and rings.

  • Follow-up visits are necessary.

  • Using Estriol vaginal cream application every night for seven to ten days, then two to three times per week.

  • The use of Vagifem vaginal insert each night for seven to fourteen days, and then one insert every two nights per week.

  • Using Estrace vaginal cream. One gram is applied every night for seven to fourteen days and reduced to one to three times a week.

  • The usage of Estring ninety-day vaginal ring. Placing one ring into the vagina, it is kept for ninety days.

  • Recommending Premarin vaginal cream.

  • The long-term use of vaginal estrogens can improve the density of bone, also decrease cholesterol levels, and also a reduction in lipoproteins.

  • Vaginal preparation treatment improves symptoms and should be continued till there is an improvement. There are some side effects of estrogen therapy, and they are discomfort in breasts, bleeding from the vagina, and endometrium proliferation.

  • Estrogen therapy is not indicated when there is excessive bleeding, liver failure, and in pregnancy.

What Is the Prevention for Vaginal Atrophy?

  • Vaginal atrophy can be prevented by maintaining good hygiene.

  • Indicate the use of soaps in which the chemical concentration is less.

  • The undergarments used should be made of soft material like cotton.

  • High-chemical deodorants are not recommended.

  • Avoid products of intimate hygiene like sprays and washes.

  • Avoid body touching and tight clothes, and practice wearing loose clothing.

  • Do not prolong the treatment.

  • Proper cleansing of the genital organs.

  • Especially after menopause, women should not neglect these signs.

  • Usage of antibiotics only when they are mandatory.

  • Avoid the usage of unnecessary medications.

  • Avoid using synthetic clothing.

Conclusion:

Vaginal atrophy symptoms correlate with other genital tract infections, making it harder to diagnose the condition and plan the appropriate treatment correctly. The vaginal atrophy condition, if not treated correctly, can lead to adverse complications. The physicians are recommended to record a proper case history and all the symptoms and evaluate to conclude. The patients do not reveal all their problems to the physician. Therefore correct examination and diagnostic tests are critical steps for planning a specific treatment. All these steps are crucial since this condition can affect health and become life-threatening.

Frequently Asked Questions

1.

What Does Vaginal Atrophy Look Like?

Vaginal atrophy appears pale, shiny, or dry if inflammation is present. Redness or paleness with petechiae (tiny purple-red spots) is also seen. The vaginal rugae (folds in the vaginal lining) disappear, shortening and narrowing of the vagina tend to develop. A watery yellow discharge is observed.

2.

What Are the Causes of Bleeding in Postmenopausal Vaginal Atrophy?

Vaginal atrophy develops post-menopause due to less amount of estrogen secretion. The condition results in drying, thinning, and inflammation of the vaginal walls. Intercourse may be painful, and some women develop distressing urinary symptoms.

3.

Can Coconut Oil Be Used for Vaginal Atrophy?

Virgin coconut oil helps treat dryness and skin conditions that develop in vaginal atrophy. Coconut oil acts as a barrier, exhibits moisturizing and antibacterial properties, is safe to use, and is widely available.

4.

What Are the Natural Methods to Treat Vaginal Atrophy?

It is important to exhibit a few lifestyle changes, such as giving up smoking, being sexually active, avoiding scented products near the vagina, exercising, and being well hydrated. Natural lubricants like jojoba, coconut oil, aloe vera, and vitamin E may help soothe the area.

5.

How Can Vaginal Atrophy Be Stopped?

Vaginal moisturizers may be used to restore moisture to the vaginal area. Water-based lubricants may be used to reduce discomfort during intercourse. Vaginal estrogen therapy is helpful to stop vaginal atrophy. Vaginal dilators may be used along with vaginal moisturizers to dilate and stretch the vaginal muscles that are narrowed.

6.

When Does Estriol Action Begin for Vaginal Atrophy?

A very low dose of 0.005 % estriol vaginal gel can rapidly improve symptoms of vaginal atrophy. Within 1 to 2 weeks of treatment, a significant improvement in vaginal epithelium was noted. The medication acts as a highly moisturizing mucoadhesive gel and exhibits faster action that helps treat vaginal atrophy.

7.

How to Treat Vaginal Atrophy Following a Hysterectomy?

Hysterectomy is a major operation in which the uterus and ovaries are removed. The removal of the uterus leads to menopause, and the women cannot reproduce. Hormonal replacement therapy with the use of estrogens may be helpful to overcome symptoms of dryness. Water-based lubricants are recommended for pain during intercourse.

8.

What Are the Supplements Used to Treat Vaginal Atrophy?

Studies have suggested that supplements of vitamin E, vitamin D, sea buckthorn oil, hyaluronic acid, fish oil, and dehydroepiandrosterone (DHEA) may be used to treat vaginal atrophy. Vitamin E improves vaginal lubrication, whereas vitamin D can reduce vaginal dryness.

9.

What Is the Hormone Replacement Therapy Used in the Treatment of Vaginal Atrophy?

Prasterone vaginal inserts deliver the hormone DHEA directly to the vagina to relieve pain during intercourse. DHEA is beneficial for producing estrogen hormones and treats moderate to severe atrophy. Estrogen pills or rings may be recommended for the treatment of vaginal atrophy.

10.

How to Treat Vaginal Atrophy While Breastfeeding?

Vaginal atrophy while breastfeeding can be treated with water-based vaginal lubricants or moisturizers. Estrogen hormone replacement therapy may also be beneficial. The use of combined contraceptives containing estrogen may also be beneficial in lactating women.
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Dr. Manwani Saloni Dilip
Dr. Manwani Saloni Dilip

Obstetrics and Gynecology

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