Atrophic Vaginitis

This is where there's dryness and atrophy of the vagina due to a lack of oestrogen.

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.

Presentation

• Itching

• Dyspareunia

• Dryness

• Post-coital bleeding

• O/E - Pale mucosa, thin skin, reduced skin folds, dryness

Investigations

Exclude the differentials of its symptoms:

• Postmenopausal bleeding – Malignancy, Endometrial hyperplasia

• Itching – STI, Candidiasis

• Dyspareunia – STI, Malignancy

Management

Hormonal options:

• HRT

• Topical Oestrogen

Non-hormonal options:

• Vaginal lubricants for itchiness, dryness, and dyspareunia

• Moisturisers