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Changes in the vulva and vagina throughout life*
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Miranda A. Farage, Howard I. Maibach, Aikaterini Deliveliotou, George Creatsas
During delivery, the perineal and the vaginal musculature relax and the vaginal rugae flatten to allow expansion of the vaginal tract, accommodating passage for the infant. Injury to the perineum can occur spontaneously or because of episiotomy. After delivery, the vaginal introitus is wider and the fourchette appears more flattened. Over the next 6–12 weeks, the morphology and dimensions of the vaginal tract are reestablished (42).
Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy
Published in Gynecological Endocrinology, 2021
Faustino R. Pérez-López, Pedro Vieira-Baptista, Nancy Phillips, Bina Cohen-Sacher, Susana C. A. V. Fialho, Colleen K. Stockdale
Clinical findings more specific of VVA in postmenopausal women include scarce pubic hair, loss of vulvar adiposity in the labia majora and labia minora, and loss of the clitoral protective covering. The vaginal surface may appear thin and pale with a decrease of elasticity and secretion and increased friability. Loss of vaginal rugae may make the vaginal walls appear smooth and shiny. There may be uterine descent due to decreased collagen in the uterosacral and cardinal ligaments. Superficial pain/discomfort during vaginal speculum placement, vaginal digital examination, or ultrasound probe placement may be present and will vary in relation to the severity of VVA. The diagnosis of vulvodynia requires an exhaustive genital assessment and evaluation of comorbid pain syndromes [42,43]. Postmenopausal women's clinical signs of VVA in the gynecological examination may be associated with alterations in quality of life and all FSFI domains and the Female Sexual Distress [51,52].
Vulvovaginal atrophy in women after cancer
Published in Climacteric, 2019
VVA occurs due to decreased estrogenization of the vaginal tissue and is therefore most common after the menopause. This can cause vaginal dryness, soreness, postmenopausal bleeding, and irritation, as well as urinary symptoms such as frequency, urgency, and urge incontinence10. The response of VVA to topical estrogens is rapid and sustained11. Unlike other symptoms and signs of the menopause, VVA is progressive over time. Symptoms are both variable and common, and include a decrease in vaginal rugae, decreased blood flow to the vaginal epithelium, an increase in vaginal pH, and a shift in the vaginal maturation index. The lower urinary tract has the same embryonic origin as the vagina and vulva, and decreased estrogen also leads to urinary symptoms such as dysuria, urgency, and recurrent urinary tract infections11. These symptoms are being increasingly recognized as part of the pathophysiology of VVA, and hence there has been a proposal by the International Society for the Study of Women’s Sexual Health and the North American Menopause Society to use the term genitourinary syndrome of menopause which encompasses both VVA and urinary symptoms12. When this article refers to VVA, both vulvovaginal and urinary symptoms are implied.
The vagina as source and target of androgens: implications for treatment of GSM/VVA, including DHEA
Published in Climacteric, 2023
S. Cipriani, E. Maseroli, S. A. Ravelli, L. Vignozzi
Genital examination validates clinical diagnosis of VVA. The degeneration of connective tissue and the decrease in number of epithelial layers consequent to hypoestrogenism cause a reduction in elasticity and moisture with thinning of vaginal rugae. Vulvovaginal mucosa usually appears pale and dry or erythematous with petechiae and, in severe cases, shrinkage of the labia minora and of the introitus can be observed. Pelvic organ prolapse such as that of the uterus or the vaginal vault, cystocele and rectocele are also included among the possible manifestations of the GSM [20].