Saturday, April 8, 2017

Pathophysiology of atrophic vaginitis

Hello!
Here's a short post on the pathophysiology of atrophic vaginitis!


What is Atrophic Vaginitis?

Atrophic vaginitis (also known as vaginal atrophy, vulvovaginal atrophy, or urogenital atrophy) is an inflammation of the vagina (and the outer urinary tract) due to the thinning and shrinking of the tissues, as well as decreased lubrication. These symptoms are due to decreased estrogen. 

What are the symptoms of atrophic vaginitis?

A decrease in vaginal lubrication is an early hallmark of atrophic vaginitis. Genital symptoms include dryness, burning, dyspareunia, loss of vaginal secretions, leukorrhea, vulvar pruritus, feeling of pressure, itching and yellow malodorous discharge. Urinary symptoms of urethral discomfort, frequency, hematuria, urinary tract infection, dysuria and stress incontinence may be later symptoms of vaginal atrophy.

Why are urinary tract symptoms seen in atrophic vaginits?

Postmenopausal changes in tissue composition are not limited to the genital tract but also include the urinary tract because of the shared common embryologic origin. Vaginal and urethral epithelia are estrogen dependent and adversely change in an estrogen-deprived environment.

What findings are seen on examination?

Atrophic epithelium appears pale, smooth and shiny. Often, inflammation with patchy erythema, petechiae and increased friability may be present. External genitalia should be examined for diminished elasticity, turgor of skin, sparsity of pubic hair, dryness of labia, vulvar dermatoses, vulvar lesions and fusion of the labia minora

Why does atrophic vaginitis cause an increase in vaginal pH?

Increased pH in vaginal atrophy is due to reduced mucosal glycogen.

Estrogen stimulation produces copious amounts of glycogen. Döderlein's lactobacilli depend on glycogen from sloughed vaginal cells. Lactic acid produced by these bacteria lowers vaginal pH levels to 3.5 to 4.5; this is essential for the body's natural defense against vaginal and urinary tract infections. Increased vaginal pH levels predispose the vagina to infection by streptococci, staphylococci, coliforms and diphtheroid.

What is the treatment of atrophic vaginitis?
Estrogen replacement, moisturizers and lubricants.

That's all!
-IkaN

Source: http://www.aafp.org/afp/2000/0515/p3090.html

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