Definition Atrophic vaginitis is an irritation of the vagina that can cause dryness, a pins-and-needles sensation, or burning.
What is going on in the body? Low levels of oestrogen cause the vaginal tissues to become less lubricated. The vagina receives less blood supply and nutrients, and thins out. Women have low levels of oestrogen at certain times of life:
The vagina is less acidic, and the bacteria normally present in the vagina are replaced by other, harmful bacteria. The vagina becomes more prone to trauma and infection.
What are the signs and symptoms of the condition? Most women have no symptoms. After menopause, however, many women report symptoms such as:
What are the causes and risks of the condition? Atrophic vaginitis occurs when the ovaries produce too little oestrogen. It is very rare in children. Girls who do have it may have spotting and vaginal discharge. Breastfeeding mothers often report vaginal dryness and painful intercourse. After menopause, as the ovaries produce less oestrogen, the vagina becomes thinner. Bacterial overgrowth and trauma during intercourse become more likely.
What can be done to prevent the condition? Oestrogen replacement therapy (ORT) is used to prevent atrophic vaginitis, as well as to treat it. Oestrogen can be given as pills, in skin patches, or in topical creams.
Some women may benefit from a diet high in foods that contain plant oestrogens, known as phytoestrogens. These include soy, flaxseeds, and red clover.
How is the condition diagnosed? A pelvic examination is done to assess the health of the vaginal tissue. Examination of the vaginal discharge will show many white blood cells and bacteria.
What are the long-term effects of the condition? Long-term effects of atrophic vaginitis include recurrent vaginal yeast infections, and abrasions of the vulva and vagina that can cause painful intercourse.
What are the risks to others? Atrophic vaginitis itself is not contagious. If a secondary infection develops, the infection may be passed to the sexual partner during intercourse.
What are the treatments for the condition? ORT is the treatment for low levels of oestrogen in a woman's body. If topical vaginal creams are used to treat atrophic vaginitis, they are usually applied 2 or 3 times a week. Oestrogen tablets alone may be given if the uterus has been removed, or combined with progesterone otherwise. Skin patches of oestrogen may be used instead of pills. The patches are changed once or twice a week.
Measures to avoid irritation of the vagina also include:
lubrication with K-Y jelly or glycerin-based ointments before sexual intercourse
more time for intimacy and foreplay before vaginal penetration
avoiding chemical irritants such as spermicides, douches, bubble baths, and deodorant sprays
non-irritant soaps for bathing
wiping from the front to back after urinating or having a bowel movement
unscented sanitary napkins instead of tampons, if vaginal bleeding is present
avoiding tight pantyhose or nylon underwear
What are the side effects of the treatments? Topical oestrogen creams can cause vaginal spotting may occur, and the cream itself may be irritating. Oestrogen pills and patches may cause breast tenderness, nausea, abdominal bloating and cramping, and vaginal spotting or bleeding. These side effects generally go away as the body adjusts within a month or so after starting ORT.
What happens after treatment for the condition? Without treatment, atrophic vaginitis and its symptoms will continue. With treatment, symptoms will improve as long as treatment goes on. Normal vaginal moisture usually returns after 2 to 4 weeks of vaginal cream therapy.
How is the condition monitored? Once treatment has eliminated the symptoms, follow-up visits to the doctor can be made once a year for a pelvic examination and physical. Any new or worsening symptoms should be reported to the doctor.
Author: Eva Martin, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 25/04/2005 Contributors Potential conflict of interest information for reviewers available on request
