Atrophic vaginitis: Difference between revisions
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*Decreased vaginal lubrication | *Decreased vaginal lubrication | ||
*Dyspareunia | *Dyspareunia | ||
*Vulvar or vaginal bleeding | *Vulvar or [[vaginal bleeding]] | ||
*Vaginal discharge | *[[Vaginal discharge]] | ||
*Pelvic pressure | *[[pelvic pain|Pelvic pressure]] | ||
*UTI symptoms | *[[UTI]] symptoms | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Infection (candidiasis, bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis) | *Infection (candidiasis, bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis) | ||
*Reaction to irritants (soaps, deodorants, lubricants, clothing) | *Reaction to irritants (soaps, deodorants, lubricants, clothing) | ||
*Vulvovaginal lichen planus | *Vulvovaginal [[lichen planus]] | ||
*Vulvar [[lichen sclerosus]] | *Vulvar [[lichen sclerosus]] | ||
*If bleeding present, malignancy should be excluded | *If bleeding present, malignancy should be excluded | ||
Revision as of 18:16, 27 September 2019
Background
- Primarily occurs in peri or postmenopausal women
- Associated with conditions or medications that induce a low estrogen state such as:
- Natural menopause
- Bilateral oophorectomy
- Spontaneous premature ovarian failure
- Ovarian failure due to radiation or chemo
- Medications: tamoxifen, danazol, medroxyprogesterone, leuprolide, ganirelix
- Postpartum reduction in estrogen production
- Prolactin elevation
Clinical Features
Symptoms are generally progressive and gradually worsen as women progress through menopause
- Vaginal dryness
- Vaginal burning/irritation
- Decreased vaginal lubrication
- Dyspareunia
- Vulvar or vaginal bleeding
- Vaginal discharge
- Pelvic pressure
- UTI symptoms
Differential Diagnosis
- Infection (candidiasis, bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis)
- Reaction to irritants (soaps, deodorants, lubricants, clothing)
- Vulvovaginal lichen planus
- Vulvar lichen sclerosus
- If bleeding present, malignancy should be excluded
Vulvovaginitis
- Bacterial vaginosis
- Candida vaginitis
- Trichomonas vaginalis
- Contact vulvovaginitis
- Bubble baths and soaps
- Deodorants, powders, and douches
- Clothing
- Atrophic vaginitis due to lack of estrogen (AKA Vulvovaginal atrophy)
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Pinworms
- Vaginal foreign body
- Toilet paper
- Other
- Genitourinary syndrome of menopause
- Foreign body
- Allergic reaction
- Normal physiologic discharge
Evaluation
- History
- Menstrual and medication history to assess for causes of hypoestrogenism
- Complete ROS to rule out other causes of urogenital symptoms
- Consider symptoms that may be secondary to infection, inflammation, local irritation
- Ask about history of pelvic radiation
- Thorough sexual history
- Pelvic Exam
- External genitalia may show scarce pubic hair, diminished elasticity, introital narrowing, or fusion of labia minora
- Loss of labial fat pad
- Pale, dry epithelium that is smooth and shiny with loss of rugation
- Use caution as exam can cause pain and bleeding
- Assess for introital stenosis with gloved finger before inserting speculum
- Labs
- Not usually necessary in ED unless concern for other causes
Management
- Topical estrogen cream or tablets
- Warm patients about possible side effects of breast or perineal pain and uterine bleeding
- Estrogen should not be used if history of cancer to reproductive organs or postmenopausal bleeding
Disposition
- Refer to gynecologist