The following are the various signs and symptoms of atrophic vaginitis:

• Vaginal dryness
• Increased urination [4]
• Itching accompanied by burning sensation in the vagina
• Urinary tract infections
• Pain during intercourse due to decreased lubrication and vaginal dryness [5]
• Vaginal canal gets shortened and tightened

• Recurrent Infection

  The vaginal epithelium may become inflamed, contributing to urinary symptoms such as frequency, urgency, dysuria, incontinence, and/or recurrent infections. [ncbi.nlm.nih.gov]

  Candidiasis: a fungal culture may be ordered to help guide treatment with persistent or recurrent infections and can be used to identify which yeast is present. [labtestsonline.org]

• Increased Susceptibility to Infections

  […] painful sexual intercourse bleeding after intercourse[7] painful urination[3] blood in the urine increased urinary frequency[3][6] incontinence increased susceptibility to infections[3] decreased vaginal lubrication[6] urinary tract infections[1][6] [en.wikipedia.org]

• Osteoporosis

  For women affected by vasomotor symptoms or osteoporosis as well as systemic estrogen-progestin deficiency, SERM, tibolone, or SERM + estrogen may be best. [medscape.com]

  ( M81.0 -) postmenopausal osteoporosis with current pathological fracture ( M80.0 -) postmenopausal urethritis ( N34.2 ) N95.0 Postmenopausal bleeding N95.1 Menopausal and female climacteric states Inclusion term(s): Symptoms such as flushing, sleeplessness [icd10coded.com]

  ( M81.0- ) postmenopausal osteoporosis with current pathological fracture ( M80.0- ) postmenopausal urethritis ( N34.2 ) Menopausal and other perimenopausal disorders Approximate Synonyms Atrophic vaginitis Atrophy of vagina ICD-10-CM N95.2 is grouped [icd10data.com]

  Low estrogen for example, leaves you at risk for osteoporosis, heart disease and genitourinary atrophy. The Solution Bioidentical hormone therapy balances hormones and relives post menopausal symptoms immediately; no significant waiting time. [bodylogicmd.com]

• No Pubic Hair

  Along with dry labia, vulvar lesions and sparse pubic hair are common. The vaginal epithelium may appear pale, smooth, dry, and friable, with a loss of rugae. Areas of inflammation with patchy erythema and petechiae may be noted. [medscape.com]

  Use a hand mirror to check for tell tale signs of atrophic vaginitis Sparse pubic hair Dry labia Lesions on the vulva Vaginal walls are pale and dry with areas of patchy redness Home Test Use some simple Litmus paper – hold it against the vaginal wall [holditsister.com]

  Signs External genitalia may show reduced pubic hair, reduced turgor or elasticity, and a narrow introitus. Be aware that vaginal examination may be uncomfortable or painful if the patient has atrophic vaginitis. [patient.info]

  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 3, 6 ( Figure 1 ). [aafp.org]

• Dermatitis

  […] oil or petroleum jelly A trial of a vaginal moisturer Anticholinergic, antihistamine, decongestant or antidepressant medication may be contributing to dryness; if taking these, consider stopping Short-term use of topical steroid may be necessary for dermatitis [dermnetnz.org]

  If symptoms have not improved with hormonal treatment, then another underlying cause of the symptoms should be considered (eg, dermatitis, vulvodynia). Prognosis Symptoms are likely to return on cessation of treatment. [patient.info]

• Eczema

  […] like trichomoniasis or chlamydia A dry, itchy vagina and pain when having sex Hormone changes from the menopause, breastfeeding or some types of contraception Itchy, sore patches around your vagina and on other parts of your body A skin condition like eczema [nhs.uk]

  Nonspecific vulvovaginitis may be triggered by fecal contamination, sexual abuse, chronic diseases, foreign bodies, nonestrogenized epithelium, chemical irritants, eczema, seborrhea, or immunodeficiency. [en.wikipedia.org]

• Skin Ulcer

  ulcerations or discharge associated with vulvovaginal infections or vaginal atrophy. [en.wikipedia.org]

• Vaginal Dryness

  It is a condition characterized by inflammation of the vagina accompanied by dryness and therefore the condition is also known as vaginal dryness. [symptoma.com]

  RESULTS: The Vaginal Maturation Index, vaginal pH, and vaginal dryness rating improved significantly at 3 and 6 months compared with baseline. [ncbi.nlm.nih.gov]

  Vaginal moisturizers and lubricants also provide symptomatic relief for vaginal dryness and dyspareunia, respectively. [scholars.northwestern.edu]

  Vaginal dryness can also be linked to Sjögrens syndrome, or vaginal disorders such as lichens sclerosis or vulvodynia. [project-aware.org]

• Incontinence

  Moreover, it has been suggested that reduced oestrogen levels may affect periurethral tissues and contribute to pelvic laxity and stress incontinence. [ncbi.nlm.nih.gov]

  Urinary incontinence. MerckManual.com. Fully Revised August 2007/Modified March 2008. www.merckmanuals.com/ professional/sec18/ch242/ ch242b.html?qt=postmenopausal stress incontinence&alt=sh. Accessed August 17, 2011. 13. [uspharmacist.com]

  As women age and become peri-menopausal and post-menopausal, they may suffer from increasing genitourinary symptoms such as stress incontinence, urinary urgency and frequency, urinary urge incontinence, vaginal dryness and atrophy. [urodynamic.com.au]

  This kind of leakage is called stress incontinence. Although there is no evidence that taking estrogen improves bladder control in women who have gone through menopause, small does may help thicken the bladder lining and decrease the incontinence. [neilbaum.wordpress.com]

• Vaginal Discharge

  […] 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 [gpnotebook.com]

  A decrease in estrogen levels in postmenopausal women may lead to thinning of the vaginal lining, resulting in atrophic vaginitis. Symptoms of Vaginitis Profuse vaginal discharge. [wgurology.com]

  Vaginal secretions also decline, which can make intercourse painful. Women with atrophic vaginitis may also experience vaginal itching, burning, frequent urination, or vaginal discharge. [health.harvard.edu]

• Vaginal Bleeding

  Vaginal discharge (usually white or yellow). Vaginal bleeding or postcoital bleeding. Urinary symptoms - eg, increased frequency, nocturia, dysuria, recurrent UTI, stress incontinence or urgency. [patient.info]

  Vaginal bleeding H. Haemorrhage requiring return to theatre To filter your results, tick the boxes above and hit the search button. If you want to clear the results untick your choices and hit the search button again. [rcog.org.uk]

  Atrophic Vaginitis (a.k.a: Vaginal Atrophy or Urogenital Atrophy) is the most common condition after menopause. It is the main cause of postmenopausal uterine bleeding. It is also seen in lactating mothers. [medlife.com]

  Symptoms Common signs of vaginal atrophy include: Vaginal dryness Vaginal itch or a burning sensation Painful sexual intercourse Light bleeding after intercourse Diagnosis If you are a middle-aged woman, your doctor will ask whether you have started menopause [drugs.com]

• Urinary Incontinence

  Incontinence Lower urinary tract symptoms are common; however, it is important to acknowledge they are attributed to underlying mechanisms that vary widely. 1 While urinary incontinence is particularly disabling and distressing in the elderly, women [uspharmacist.com]

  Some women begin to have problems with their bladder and experience overactive bladder (gotta go, gotta go right now) and urinary incontinence or loss of urine at inopportune times at the time or shortly after menopause. [neilbaum.wordpress.com]

  Urodynamic characterization of postmenopausal women with stress urinary incontinence: retrospective study in incontinent pre- and post-menopausal women. J Korean Soc Menopause 2010;16:148–152. 12. [synapse.koreamed.org]

Diagnosis of the condition starts with a medical history of the patient. Medical history would include information regarding medications, past surgical procedures and diseases if any. In addition, the following methods would be employed for diagnosing atrophic vaginitis:

• Pelvic examination to check for the signs of vaginal dryness [6]. A visual examination of the vagina is also necessary. An examination for vaginal prolapsed would also be required.
• Urinary examination to detect signs of infection.
• Acid balance test is done to examine the vagina for the acid balance. The vaginal fluids are taken for the test or an indicative strip is placed in the vagina for examination. Atrophic vaginitis secretion will present with acidic pH in the tests [7]. 
• Pelvic ultrasound can demonstrate the diminished endometrial thickness with atrophic vaginitis [8].

Lubricants and drugs often form the first line of treatment for atrophic vaginitis. The following are various topical agents and lubricants suggested for treating vaginal dryness:

• Water based lubricants and vaginal moisturizers with vitamin E are advised to improve lubrication [9]. If these work then, topical agents would not be necessary. However these only help improve the dryness, but are not very effective in treating the burning and irritation caused due to the condition. Topical creams may also be applied to relieve pruritus [10].
• Vaginal estrogen is very effective as it provides controlled release of estrogen to the vagina. Vaginal estrogen is available in various forms such as estrogen creams, estrogen rings and estrogen tablets. Estrogen rings are basically soft flexible rings containing the hormone inserted into the upper part of the vagina. Many women benefit from this method. In the beginning, any one of these therapies is advised on regular basis, and after the first few weeks, weekly application is necessary.

The prognosis of the condition is favorable if women seek treatment. With hormone replacement therapy and lubricating agents women often experience less discomfort.

Complications

Atrophic vaginitis if not treated on time can cause the following complications:

• Urinary problems such as increased frequency of urination or burning sensation while urinating can be experienced. This is so because atrophic vaginitis contributes significantly to genitourinary atrophy giving rise to several urinary problems. In addition, women may also complain of incontinence or urinary tract infections.
• Vaginal infections are the second most common complication of atrophic vaginitis. Decreased production of estrogen disrupts the acid base balance making the vagina susceptible to infections.

Decrease in the production of estrogen levels causes development of atrophic vaginitis. The following are the various factors that are known to decrease the production of the hormone estrogen:

• After menopause
• Perimenopause
• During breast feeding
• Cancer treatments such as radiation therapy and chemotherapy
• Removal of ovaries
• Hormonal treatment for breast cancer
• Chronic tricyclic antidepressant use [3]

The condition of atrophic vaginitis is a common one; however not all women in the menopausal stage develop this condition.

It has been estimated that about 20 to 50% of postmenopausal women suffer from atrophic vaginitis. Of these, only 25% seek medical help. The condition is far more common than what has been reported. Women often feel embarrassed and do not report symptoms to their doctor.

The vaginal epithelium is subject to change during various phases of life. At birth the vagina is rich in glycogen due to estrogen supply from the mother. During childhood phase, the epithelium is thin which then thickens during puberty due to increased production of estrogen.

A sufficient supply of this hormone keeps the vagina lubricated and also maintains the pH levels 3.5 – 4.5. Such level helps protect the vagina against bacterial infections. When the pH goes beyond this level, the vagina gets susceptible to urinary tract infections. During early years of menopause and post menopause, the ovaries secrete less of estrogen that causes the vagina to get dry and inflamed.

It is advised that women begin applying lubricants and vaginal estrogens to help prevent the condition from turning severe. In addition, sexual activity has also been known to improve the vaginal elasticity and lubrication. Topical treatments in the form of tablets and creams should also be practiced as this increases the vaginal epithelium proliferation.

Atrophic vaginitis is a common condition affecting majority of the women after menopause. It is a condition characterized by inflammation of the vagina accompanied by dryness and therefore the condition is also known as vaginal dryness. Such a condition arises due to low levels of estrogen, the production of which is significantly reduced once woman reach menopause [1].

Approximately 50% of women in the menopausal state to develop vaginal dryness [2]. However, breast feeding mothers also complain of vaginal dryness. Simple treatment regimes help in effective management of the condition.

Definition

Atrophic vaginitis is a condition characterized by inflammation of the vagina accompanied by dryness and itching. Decrease in estrogen levels gives rise to such a situation. Such condition is more common in women who are in the menopausal stage. Also, women who have undergone surgery to remove the ovaries also develop atrophic vaginitis. 

Cause

Decrease in the production of estrogen is the major cause that leads to development of atrophic vaginitis. The several factors causing lowered production of estrogen include menopause, cancer treatments, surgical removal of ovaries and lactation.

Symptoms

Symptoms of atrophic vaginitis include vaginal dryness, burning sensation, frequent urination, incontinence, and pain during intercourse, vaginal discharge, bleeding during intercourse, decreased lubrication, urinary tract infections and shortening of the vaginal canal.

Diagnosis

A thorough physical examination to study the vagina for signs of inflammation and dryness is carried out. In addition, pelvic examination is done to check for pelvic prolapse. The vagina is also tested to check for its acid base balance. Various laboratory tests are also required for analyzing the levels of serum hormone levels. A decrease in the levels of estrogen confirms atrophic vaginitis.

Treatment

Treatment of atrophic vaginitis includes application of moisturizing vaginal creams and lubricants to improve the dryness and lubrication. However, estrogen creams would also be required to relieve other symptoms of itching, burning sensation and irritation. These include insertion of estrogen tablets or application of estrogen creams to facilitate a controlled release of estrogen to the organ.

1. Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000; 61:3090-3096.
2. Stenberg A, Heimer G, Ulmsten U, et al. Prevalence of genitourinary and other climacteric symptoms in 61 year old women. Mauritas. 1996; 24:31-36.
3. Nactigall L. Vaginal estrogen in the controversial patient. Menopause Management. 2006; March/April: 19-22.
4. Simuniæ V, Banoviæ I, Ciglar S, Jeren L, Paviciæ Baldani D, Sprem M. Local estrogen treatment in patients with urogenital symptoms. Int J Gynaecol Obstet. 2003; 82:187-197.
5. Goldstein I, Alexander JL. Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. J Sex Med. 2005; 2:154-165.
6. Bachmann GA, Ebert GA, Burd ID. Vulvovaginal complaints. In Lobo RA ed. Treatment of the Postmenopausal Woman: Basic and Clinical Aspects. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:195-201.
7. Semmens JP, Tsai CC, Semmens EC, et al. Effects of estrogen therapy on vaginal physiology during menopause. Obstet Gynecol. 1985; 66:15-18.
8. Weisberg E, Ayton R, Darling G, et al. Endometrial and vaginal effects of low dose estradiol delivered by vaginal ring or vaginal tablet. Climacteric. 2005; 8:83-92.
9. North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of the North American Menopause Society. Menopause. 2007; 14:355-369
10. Sobel JD, Chaim W, Nagappan V, Leaman D. Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine. Am J Obstet Gynecol. Nov 2003; 189(5):1297-300.