Atrophic vulvovaginitis

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. Reviewed by Dr Jennifer Bradford, Gynaecologist, Sydney, Australia. Updated by Dr Oakley, February 2014.

What is atrophic vulvovaginitis?

Atrophic vulvovaginitis means thinned genital tissues in women. Often it is shortened to atrophic vaginitis, as it is vaginal tissue that is most often symptomatic.

What causes atrophic vulvovaginitis?

Atrophic vulvovaginitis is associated with oestrogen deficiency due to:

What are the symptoms of atrophic vulvovaginitis?

Deficiency of oestrogen may also lead to dysuria (burning sensation when passing urine), urinary urgency, frequency and incontinence.

Bacteria in the vagina

Lack of oestrogen causes changes in the normal vaginal organisms. Those seen in younger women (e.g. lactobacilli) disappear and are replaced by gram negative organisms such as Escherichia coli. This makes urinary or bladder infection more likely.

What does an atrophic vulva and vagina look like?

Atrophic vulvovaginitis changes the appearance of the female genitalia:

Should any tests be done to confirm the diagnosis?

Tests may be performed in atrophic vulvovaginitis if any symptoms are present. These may include:

General measures to improve atrophic vulvovaginitis

The following measures are recommended.

Oestrogen treatment

Atrophic vulvovaginitis is treated with topical oestrogen, a prescription medicine. This can be provided as vaginal cream, pessaries or vaginal ring. In New Zealand, Ovestin™, which contains oestriol, is used in a dose of 0.5 mg/day for 1-2 weeks then once or twice weekly. It can be inserted with an applicator or on a fingertip. Vagifem™ pessaries (containing oestrodiol) can also be used but are not currently funded by PHARMAC.

Oestrogen treatment results in:

Topical oestrogen is considered safe because very little is absorbed systemically. However, it is not usually prescribed to women with severe liver disease, oestrogen dependent cancers or thromboembolic disease in case it increases the risk of these conditions.

Other forms of oestrogen are sometimes recommended including tablets, transdermal patches, gels, sprays and emulsions. Systemic oestrogen is usually mixed with progestogens. There are important risks and side effects so they are not usually used if atrophic vaginitis is the only problem.

Side effects and risks of vaginal oestrogen therapy

Topical oestrogen may cause side effects, including:

When used just once or twice weekly, other side effects described with higher doses of oestrogen do not arise.

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