Atrophic vaginitis is a condition that occurs when the vulvar vaginal tissue lacks estrogen. It occurs most commonly in postmenopausal females, but can also occur in situations that induce a hypoestrogenic state, such as when women are breastfeeding or taking medications such as depomedroxyprogesterone or tamoxifen. Atrophic vaginitis does not affect all women. Typically, women with atrophic vulvovaginitis experience burning that can range from intermittent to constant. Symptoms can be exacerbated with urination or with wiping after urination. In addition, some patients experience urinary urgency, frequency, and nocturia, and some patients also experience vaginal dryness and pain with
Figure 5 Atrophic vaginitis: thin, pale erythematous tissue. (See color insert pp. 4 and 5.)
sexual activity. In advanced cases, the skin is so thin and fragile that it is injured easily and can bleed with minimal trauma.
Examination of the vulvar tissue demonstrates a pale to erythematous mucosa. A urethral caruncle can be present (Fig. 5). The maturation index from microscopic evaluation of vaginal discharge demonstrates a decrease in the number of mature squamous epithelial cells and an increase in the number of basal and parabasal epithelial cells. Frequently, there is an increase in WBCs seen microscopically in the wet preparation sample.
Treatment for atrophic vaginitis is estrogen replacement. Intravaginal topical estrogen, either prescribed as vaginal cream or vaginal tablet, is effective. Systemic estrogen replacement, prescribed as either an oral tablet or a topical patch, can also be used. If systemic estrogen replacement is used and the patient still has her uterus, a progestin is also needed. Adhering to strict vulvar skin care hygiene guidelines, as well as using an occlusive, bland dressing to eliminate potential insult to the delicate skin as it heals, are important. Also, lukewarm water soaks can be quite soothing to these women.
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