A Family Doctor's Tale -ATROPHIC VAGINITIS

DOC I HAVE ATROPHIC VAGINITIS

Vaginal atrophy is the thinning of the vaginal wall of a woman appearing during or after menopause (the end of menstrual cycles).

Menopause in women usually occur between the age of 45 - 55 years old.

The cause of atrophic vaginitis is the decline of estrogens level in the female as she reaches menopause.

The loss of estrogen cause the lining of the vagina to become thinner and dryer.

Symptoms and signs of Atrophic Vaginitis are:

1.Irritation and itchiness from the dryness of the vaginal wall

2.Pain on sexual intercourse ( dyspareunia) as result of the dryness and lack of lubrication

3.Atrophic urethritis (inflammation of the opening of the bladder) -there is discomfort and frequent passing of urine with resultant urinary tract infections

4.Other menopausal symptoms such as hot flushes and night sweats, mood changes and tiredness

5. The vaginal mucosa is dry thin and shiny and bleeds easily.

The vagina is thus prone to infections.

The Pap smear show presence of small blue staining basal and parabasal cells in the mucosa of the vagina and cervix

The treatment of Atrophic Vaginitis is:

If the patient do not show any discomfort from the dryness and thinning of the vaginal wall , no treatment is necessary.

In Patients with symptoms, treatment involves:

1.Oestrogens  is an effective treatment for vaginal atrophy -reducing dryness and discomfort but must be used with precaution as it can cause stroke and thrombosis and endometrial cancer of the uterus.

It can prevent osteoporosis if taken early enough.

It however do not cause breast cancer or heart disease.

Estrogens can be given in the form of oral pills and skin implants.

2.Combined estrogen and progesterone therapy also reduce the effect of menopause such as vaginal atrophy, dryness of the internal lining of the genital tract and the skin and hot flushes.

It has been found that there is an increased risk of heart attack, cancer of the breast , thrombosis, and stroke.

Because of all these risks,  female hormone replacement therapy has fallen out of favor.

Instead of chemical hormones , natural plant female hormones such as primrose, soy, etc are used instead to reduce the symptoms of menopause.

3.Topical estrogen cream can be applied to the lining of the vagina once a week to reduce the dryness and discomfort in the vaginal wall.

4. Other moisturizer such as KY Vaginal moisturizer can also be used to reduce the dryness in atrophic vaginitis.

Prognosis of Atrophic Vaginitis is good if precautions are taken to prevent the dangerous side effects of female hormonal treatment.