Atrophic vaginitis, also known as vulvovaginal atrophy, is characterised by inflammation and thinning of the genital tissues due to a decrease in oestrogen levels
Aetiology
The primary cause of atrophic vaginitis is a decline in oestrogen levels, which typically occurs post-menopause
Clinical features
Thinning of the vaginal mucosa
Loss of pubic hair
Narrowed introitus
Loss of vaginal rugae (folds)
Vaginal dryness and itching
Dyspareunia
Post-coital bleeding
Vaginal discharge from inflammation
Urinary symptoms such as dysuria and recurrent UTI
Investigations
Clinical examination, including speculum examination if tolerated, to look for vaginal signs of atrophy
Transvaginal ultrasound and endometrial biopsy, if necessary, to exclude endometrial cancer
An infection screen if itching or discharge is present
A biopsy of any abnormal skin lesions, if needed
Management
Hormonal treatment:
Systemic hormone-replacement therapy (oral or transdermal)