Vulvar and vaginal atrophy

Vaginal resistance to infection and injury is reduced in the postmenopausal woman through lack of oestrogen which causes:

• thinning of the vulval and vaginal epithelium
• loss of glycogen
• fall in acidity
• absence of protective lactobacilli

Presentation is typically with:

• irritation and soreness
• superficial dyspareunia
• discharge - which may be profuse and purulent and sometimes
  • however any vaginal discharge/blood-stained discharge should be investigated
    • postmenopausal bleeding - manage in context of NICE guidance (linked item)
    • vaginal discharge in woman aged 55 or over - manage in context of NICE guidance (linked item)
    • if vaginal discharge/bleeding then an infection screen may be appropriate > to exclude vaginal infections or endometritis
    • other investigations to consider are:
      • vaginal pH testing (using pH paper and sampling from the mid-vagina)
        • result is more alkaline in atrophic vaginitis
      • vaginal cytology - typically (in atrophic vaginitis) reveals lack of maturation of the vaginal epithelium

Notes:

• consider screen for diabetes (uncontrolled diabetes can contribute to symptoms)