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Vulvovaginal atrophy

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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


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

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