Key points
Atrophic vaginitis (also called climacteric or urogenital vaginitis) is an inflammation of the vagina and its mucosa, which does not depend directly on bacterial or fungal infections.
Causes
Atrophic vaginitis is caused by a reduction in oestrogenic levels, which is in turn a consequence of: menopause, breast-feeding, chemotherapy drugs, radiotherapy, drugs for the treatment of endometriosis and uterine fibroids, therapy for breast cancer.
Symptoms
In atrophic vaginitis the vaginal mucosa becomes thin, fragile and more exposed to the risk of infection. The characteristic symptoms of atrophic vaginitis are: vaginal burning / dryness, dyspareunia, urinary incontinence, leucorrhoea, bloody leakage after intercourse, vaginal itching.
Diagnosis
The hypothesis of atrophic vaginitis is ascertained by pelvic examination, pap test, vaginal swab and urinalysis.
Therapy
The symptoms of atrophic vaginitis can be lightened by following specific estrogen therapy. We recommend the application of lubricating creams as a remedy for dryness and vaginal itching.
Definition of atrophic vaginitis
Atrophic (or urogenital) vaginitis is an inflammation of the vaginal mucosa and of the female urinary tract, due to a significant reduction in serum estrogen levels. Not surprisingly, atrophic vaginitis is also known as climacteric vaginitis : during menopause, in fact, the woman undergoes an inevitable alteration of the hormonal structure, in which the levels of estrogen - and especially progesterone - are extremely low, while the dosage of FSH (follicle stimulating hormone) and LH (luteinizing hormone) shows high values.
The above does not exclude that atrophic vaginitis may also occur outside the menopausal period: in fact, some women complain of the same discomfort in the postpartum period, during breastfeeding or following surgical removal of the ovaries.
Causes
Atrophic vaginitis is the consequence of all the conditions that reduce the levels of estrogen: in similar circumstances, the vaginal walls become thinner, become fragile and more subject to inflammation. Let us briefly recall that - in addition to intervening in the regulation of the menstrual cycle - estrogens guarantee the physiological vaginal lubrication, thus maintaining the genital mucosa healthy and in good condition.
Precisely because of the estrogenic reduction, in the atrophic vaginitis the vaginal mucosa thins, becomes less elastic, more fragile and less lubricated.
In most cases, atrophic vaginitis occurs in the event of physiological changes such as:
- Menopause, the main cause of atrophic vaginitis
- Breastfeeding
- Early menopause (the characteristic symptoms of menopause appear before the age of 40)
In some women, however, estrogen reduction does not depend on physiological changes in the body; rather it is the consequence of surgical interventions, pharmacological therapies or serious pathologies:
- Drugs for the treatment of endometriosis and uterine fibroids: LH-RH synthesis analogues (Leuprorelin, Goserelin, Triptorelin), progestogens (Norethindrone, Medroxyprogesterone etc.), gonadotropin antagonists (eg Danazol, Gestrinone) or combined estrogens . In these cases, atrophic vaginitis arises as a "side effect" of a specific drug therapy.
- Some women must undergo surgical removal of the ovaries or uterus (hysterectomy): inevitably, similar interventions block the synthesis of estrogen, thus causing atrophic vaginitis
- Changes in the immune system
- Drugs for the treatment of breast cancer
- Abnormal ovarian function due to chemotherapy / radiotherapy
- Idiopathic atrophic vaginitis: no precise cause can be traced
Risk factors
Some predisposing factors for atrophic vaginitis have been identified.
First and foremost, the smoking habit: smoking damages the correct circulation of the blood, partially depriving the tissues, including the vaginal tissue, of the oxygen necessary for the correct metabolism. It is precisely the reduction of oxygen at the vaginal level which favors atrophic vaginitis. And don't forget that smoking interferes with normal estrogen synthesis. It has also been observed that women who smoke are prone to menopause earlier than women who do not smoke, therefore they are more prone to early atrophic vaginitis.
A scientific study has observed an interesting "coincidence": mothers who gave birth to their children by caesarean section are more prone to vaginal atrophy than those who gave birth naturally (by vaginal route).
Symptoms
Atrophic vaginitis is always symptomatic although symptoms and their intensity may vary widely from woman to woman. The most common symptoms are:
- Alteration of vaginal pH
- Increased risk of genital bacterial / fungal infections
- Vaginal burning
- Dyspareunia (pain during sexual intercourse)
- Urinary incontinence
- Leucorrhoea (vaginal whitish discharge)
- Mild bleeding after sexual intercourse
- Painful urination
- Frequent urination
- Vaginal itching
- Vaginal dryness
Do not forget the psychological impact induced by physical symptoms: the menopausal woman suffering from atrophic vaginitis - already emotionally fragile due to the delicate period she is experiencing - tends to become anxious, irritated and stressed.
Sometimes, vaginal atrophy occurs so slowly that women do not perceive any symptoms until 5-10 years after the onset of menopause.
Diagnosis
Even only in the case of suspected atrophic vaginitis, a gynecological examination is strongly suggested, to go back to the triggering cause and possibly choose whether to intervene pharmacologically or not.
The pelvic exam is particularly indicated for this purpose: the gynecologist examines the internal and external genitals of the woman, checking for signs of vaginal dryness, local redness / irritation and evaluating a possible prolapse of the pelvic organs.
The Pap test - which involves the collection of a sample of cervical cells for a subsequent cytological laboratory test - diagnoses the presence of a possible tumor in the cervix.
Even the vaginal swab is an important investigative test, used in case of suspected atrophic vaginitis: it identifies possible pathogens in the vaginal and cervical flora, and detects the pH of the vaginal microenvironment. We recall, in fact, that in atrophic vaginitis the vaginal pH is generally altered (above normal, therefore less acidic).
The urine test is indicated when the woman complains of urinary symptoms.
Cures and treatments
Vaginal atrophy is normally treated with targeted estrogen therapy: the most useful active ingredients for this purpose are: estradiol, Estradiol + norethindrone, Esterified estrogens and Estropipate.
The drugs described above can be found in the form of:
- cream to be applied locally
- tablets to be taken by mouth
- vaginal eggs to be inserted deeply into the vagina
- vaginal ring inserted into the vagina and released there for three months: during this time, the vaginal ring slowly releases an adequate amount of estrogen, useful for reducing the symptoms of atrophic vaginitis
- estrogen based patch (slow release) to be applied to the skin once or twice a week
To alleviate the disorder, women can apply special lubricating creams to the vaginal mucosa: these products, while not acting on the triggering cause, are an effective remedy to alleviate vaginal dryness induced by atrophic vaginitis.
In some women, atrophic vaginitis is accompanied by urinary symptoms such as incontinence: in such circumstances, Kegel exercises should be performed regularly to strengthen the pelvic floor and bladder muscles. Kegel gymnastics is also indicated as a remedy for the prolapse of the pelvic organs: many menopausal women also complain of this disorder associated with atrophic vaginitis.
