From the Guidelines
Atrophic vaginitis symptoms include vaginal dryness, discomfort, pruritis, dyspareunia, urinary tract infections, and urinary urgency, as reported in approximately 50% of postmenopausal women 1. These symptoms occur due to decreased estrogen levels, typically during menopause, which leads to thinning of vaginal tissues, reduced lubrication, and changes in vaginal pH.
Common Symptoms
- Vaginal dryness
- Discomfort
- Pruritis (itching)
- Dyspareunia (painful intercourse)
- Urinary tract infections
- Urinary urgency The vaginal tissue appears pale, thin, and lacks normal rugae (folds), creating an environment more susceptible to irritation and infection.
Treatment Considerations
Treatment options include vaginal moisturizers, water-based lubricants during intercourse, and estrogen therapy, with vaginal estrogen preparations being effective in relieving symptoms with minimal systemic absorption 1. It is essential to note that the safety of vaginal hormones has not been firmly established in survivors of estrogen-dependent cancers, and their use should be approached with caution 1. Maintaining sexual activity can help preserve vaginal health by increasing blood flow to tissues. In cases where vaginal estrogen is considered, estriol-containing preparations may be preferable, especially in aromatase inhibitor users, due to their lower potency compared to estradiol 1.
From the Research
Symptoms of Atrophic Vaginitis
The symptoms of atrophic vaginitis include:
- Vulvovaginal dryness 2, 3, 4
- Dyspareunia (painful intercourse) 2, 3, 4
- Vulvar itching or pain 2, 4
- Recurrent urinary tract infections 2, 4
- Abnormal vaginal discharge 2
- Urinary urgency and increased frequency 4
- Sexual dysfunction 4
Severity of Symptoms
These symptoms can be debilitating, affecting 10-47% of postmenopausal women 2. Many women may experience mild genital changes, but some may develop severe symptoms that impact their quality of life.
Diagnosis and Treatment
Atrophic vaginitis is often underdiagnosed and undertreated due to embarrassment or lack of awareness among women and healthcare professionals 4, 5. Effective treatments exist, including topical estrogen replacement therapies, vaginal moisturizers, and lubricants 2, 4, 5. Low-dose vaginal estrogen therapy is considered the criterion standard for treatment 4.