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Vaginal or Vulvovaginal Atrophy/Atrophic Vaginitis/Genitourinary Syndrome of Menopause (GSM)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Vaginal symptoms associated with menopause are common, affecting 40%–60% of postmenopausal women.1 Vulvovaginal atrophy, or atrophic vaginitis, is thinning and inflammation of the vaginal walls leading to a loss of elasticity. This leads to symptoms of uncomfortable or painful intercourse (dyspareunia), localized dryness, burning, pruritus, dysuria, and urinary incontinence. Loss of libido is also possible.
DRCOG MCQs for Circuit C Questions
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Causes of dyspareunia include:Fixed, retroverted uterus.Atrophic vaginitis.Postpartum perineal repair.Climacteric.Pelvic congestion.
Common diseases of the vulva
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Diane Elas, Colleen K. Stockdale
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 Depo medroxyprogesterone or tamoxifen. Atrophic vaginitis does not affect all women. Typically, women with atrophic vulvovaginitis experience burning that can range from intermittent to constant, vaginal dryness, and pain with sexual activity. Some women experience urinary urgency, frequency, nocturia, and/or frequent urinary tract infections. Symptoms can be exacerbated during and after urination. In advanced cases, the skin becomes so thin and fragile that it will bleed with minimal trauma such as wiping or patting with toilet tissue after urination. Examination of the vulvar tissue demonstrates a pale to erythematous mucosa. A urethral caruncle can be present (Figure 11.5). The maturation index from microscopic evaluation of the 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 white blood cells seen microscopically (14).
Efficacy of intradermal hyaluronic acid plus polynucleotides in vulvovaginal atrophy: a pilot study
Published in Climacteric, 2022
M. Angelucci, F. Frascani, A. Franceschelli, A. Lusi, M. L. Garo
Atrophic vaginitis was reported by 39 patients (VHI < 15) at baseline, four patients at T1 and no patients at T2. There was a significant improvement in VHI at T1 and T2 compared with baseline (VHI at T0 = 11, IQR = 5; at T1 = 17, IQR = 3; at T2 = 19; IQR = 3; p < 0.001 in both comparisons) (Figure 2a). VVA was observed in 45 patients at T0 (VuHI > 8), in 36 patients at T1 and in 30 patients at T2. The median VuHI score dropped significantly at T1 (VuHI at T0 = 16, IQR = 7; at T1 = 11, IQR = 3; p < 0.001) and T2 (VuHI = 10, IQR = 5; p < 0.001) (Figure 2b). The pH had dropped significantly by T1, and continued to improve at T2 (pH at baseline = 5.7, IQR = 0.8; at T1 = 5.5, IQR = 0.4; at T2 = 5.2, IQR = 0.5; p < 0.001) (Figure 2c). There was a statistically significant improvement in FSFI score at T2 (FSFI at T0 = 13.2, IQR = 15.6; at T2 = 24.9, IQR = 12.3; p < 0.001) (Figure 2d). There was also a statistically significant improvement for each FSFI domain between T0 and T2, as presented in Table 2. The comparison between before and after treatment are shown in Figure 3 and Figure 4.
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
The menopause is associated with both systemic and genital changes related to the progressive reduction and loss of estrogen production; vulvovaginal atrophy (VVA) is among the most prevalent and disturbing clinical condition of menopause. The self-reported prevalence of vaginal atrophy symptoms varies from 4% in early postmenopausal years to 50% among late postmenopausal women (>10 years of menopause) [1–3]. Several denominations are used to describe the VVA occurring due to hypoestrogenism, including atrophic vaginitis, urogenital atrophy, urogenital syndrome, and more recently VVA has been included as part of the genitourinary syndrome of menopause [4]. Some clinicians use the term atrophic vaginitis when inflammation is present, along with atrophy [5]. Unlike hot flashes and metabolic adjustments, which usually subside with time, VVA is likely to persist and become worse if left untreated [6].
Clinical management of vaginal bleeding in postmenopausal women
Published in Climacteric, 2020
The initial physical examination should include a detailed evaluation of the external and internal genitalia, aiming to determine the bleeding site and looking for suspicious lesions, skin lacerations, or the presence of foreign bodies. A detailed inspection of the vulva, the urethra, and the anus is also recommended. A vaginal speculum examination should be performed, inspecting the vaginal mucosa and looking for atrophic vaginitis or suspicious vaginal lesions. Cervical cytology, if indicated, should be collected as part of the evaluation. Any cervical visible macroscopic lesion suspicious for cancer must be biopsied. A bimanual examination should then be performed to evaluate uterine size, mobility, the presence of adnexal pathology, and cervical motion tenderness. It may be appropriate to collect a vaginal swab if the presence of a sexually transmitted infection is suspected. To conclude, a general physical examination should be performed to look for signs of systemic illness.