Atrophic Vaginitis

Atrophic Vaginitis originates from the following process: degenerative.

Presentation

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

urogenital
Vaginal Dryness
  • Vaginal dryness can also be linked to Sjögrens syndrome, or vaginal disorders such as lichens sclerosis or vulvodynia.[project-aware.org]
  • It also helps decrease vaginal dryness.[nlm.nih.gov]
  • Video of the Day Along with menopause, there are other causes of vaginal dryness.[livestrong.com]
  • Atrophic vaginitis is vaginal dryness.[goodrx.com]
Vaginal Discharge
  • A small amount of daily vaginal discharge is normal.[labtestsonline.org]
  • Symptoms of Vaginitis Profuse vaginal discharge.[wgurology.com]
  • Symptoms include vaginal discharge, irritation, pruritus, and erythema.[merckmanuals.com]
  • Women with atrophic vaginitis may also experience vaginal itching, burning, frequent urination, or vaginal discharge.[health.harvard.edu]
  • Bacterial vaginosis must be thought always in the presence of particularly abundant vaginal discharge (leukorrhea).[womanhealthgate.com]
Vaginal Bleeding
  • Vaginal bleeding or postcoital bleeding.[patient.info]
  • When To Call A Professional Schedule an appointment with your doctor if you experience any vaginal bleeding, vaginal dryness, burning or itching, or if painful sexual intercourse is not relieved with a water-soluble lubricant.[drugs.com]
  • Contraindications of local estrogen Unexplained vaginal bleeding Pregnancy Estrogen-sensitive tumors, End-stage liver failure and Past history of estrogen-related thromboembolization. www.freelivedoctor.com 21.[slideshare.net]
  • You should also see your doctor if you experience unusual vaginal bleeding, discharge, burning, or soreness.[healthline.com]
  • Vaginal estrogen may have the following rare side effects: vulvar itching or irritation, vaginal discharge, and vaginal bleeding; however, a switch to a different dosage or preparation may reduce or eliminate these problems.[mmgyn.com]
Dysuria
  • Dysuria or dyspareunia may occur.[merckmanuals.com]
  • Urinary tract symptoms include dysuria, urinary frequency, urethral discomfort, or, infrequently, hematuria.[uptodate.com]
  • […] vulval dryness Vaginal or vulval itching ( pruritus vulvae ) Vaginal burning Painful sex ( dyspareunia ) Skin splitting (fissuring) of the entrance to the vagina ( posterior fourchette) Vaginal spotting (bleeding) Deficiency of oestrogen may also lead to dysuria[dermnetnz.org]
  • I- History : of -Frequency of urine, dysuria, nocturia, hematuria and incontinence.[slideshare.net]
  • Itching Burning Dyspareunia - Painful Sex Burning leukorrhea Pruritis Vulvae Feeling of pressure Yellow malodorous vaginal discharge Urinary :- Dysuria Urinary Frequency Nocturia - Bladder emptying at night Cystitis Urinary tract infection Urinary Stress[2womenshealth.com]
Sexual Dysfunction
  • The spectrum of adverse consequences makes long-term treatment essential in many women, not only for relief of symptoms, but also for the more troublesome problems that may occur, such as sexual dysfunction, postcoital bleeding, and recurrent urinary[uptodate.com]
  • As a result, menopausal women frequently experience a variety of symptoms such as hot flushes, sleep and mood disorders, weight gain and sexual dysfunction.[dx.doi.org]
  • Over time, the lack of vaginal lubrication often results in sexual dysfunction and associated emotional distress.[aafp.org]
Postcoital Bleeding
  • The spectrum of adverse consequences makes long-term treatment essential in many women, not only for relief of symptoms, but also for the more troublesome problems that may occur, such as sexual dysfunction, postcoital bleeding, and recurrent urinary[uptodate.com]
  • Vaginal bleeding or postcoital bleeding.[patient.info]
  • The sensation of itching, burning (heat) can sometimes be really very busy and associated with dyspareunia and postcoital bleeding, pelvic pain and urinary symptoms.[womanhealthgate.com]
Hematuria
  • Urinary tract symptoms include dysuria, urinary frequency, urethral discomfort, or, infrequently, hematuria.[uptodate.com]
  • I- History : of -Frequency of urine, dysuria, nocturia, hematuria and incontinence.[slideshare.net]
  • View/Print Table TABLE 2 Presenting Symptoms of Atrophic Vaginitis Genital Dryness Itching Burning Dyspareunia Burning leucorrhea Vulvar pruritus Feeling of pressure Yellow malodorous discharge Urinary Dysuria Hematuria Urinary frequency Urinary tract[aafp.org]
Pruritus Vulvae
  • Vaginal or vulval dryness Vaginal or vulval itching ( pruritus vulvae ) Vaginal burning Painful sex ( dyspareunia ) Skin splitting (fissuring) of the entrance to the vagina ( posterior fourchette) Vaginal spotting (bleeding) Deficiency of oestrogen may[dermnetnz.org]
Vulvar Pain
  • more...
  • hematological
  • more...
  • cardiovascular
    Hypertension
    • […] related medical categories: Chronic Major Diseases that are commonly Undiagnosed: High Cholesterol -- Undiagnosed Heart Disease -- Undiagnosed Cancer -- Undiagnosed Depression -- Undiagnosed Type 2 Diabetes -- Undiagnosed Type 1 Diabetes -- Undiagnosed Hypertension[rightdiagnosis.com]
  • more...
  • Entire body system
    Physician
    Recurrent Urinary Tract Infection
    • Recurrent urinary tract infections (UTIs) This is another form of “waterworks” problem that affects women of all ages, but increases with age with many elderly women being particularly troubled.[womens-health-concern.org]
    • Vaginal atrophy causes vaginal dryness, soreness and irritation, dysuria, increased vaginal discharge, recurrent urinary tract infections, pain and vaginal bleeding associated with sexual activity.[dx.doi.org]
    Burning Pain
    • Vaginal or vulval dryness Vaginal or vulval itching ( pruritus vulvae ) Vaginal burning Painful sex ( dyspareunia ) Skin splitting (fissuring) of the entrance to the vagina ( posterior fourchette) Vaginal spotting (bleeding) Deficiency of oestrogen may[dermnetnz.org]
    • Discharge due to vaginitis is accompanied by pruritus, erythema, and sometimes burning, pain, or mild bleeding.[merckmanuals.com]
    • The women affected may have vaginal dryness, itching, and/or burning, pain during sexual intercourse, and a small amount of bleeding after sexual intercourse.[labtestsonline.org]
    Recurrent Infection
    • 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]
    • Recurrent infections with C. glabrata can be treated with topical boric acid 600 mg daily for 2 weeks.[clevelandclinicmeded.com]
  • more...
  • Workup

    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].

    Laboratory

    Serum
    Estrogen Decreased
    • Estradiol, a form of estrogen , decreases in post menopause when the ovaries are no longer producing eggs.[bodylogicmd.com]
    • Decreased estrogen predisposes to inflammatory (particularly atrophic) vaginitis.[merckmanuals.com]
    Estrogen Increased
    • A lack of estrogen increases the pH value, rendering the body susceptible to vaginal/urinary infections.[dovemed.com]
  • more...
  • Treatment

    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.

    Prognosis

    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.

    Complications

    Vaginal Candidiasis
    • Vaginal candidiasis often manifests with a compatible history and normal pH and negative microscopy.[clevelandclinicmeded.com]
    • candidiasis Vaginal infections more complications...»[rightdiagnosis.com]
    • The treatment of vaginal candidiasis is a very important topic.[womanhealthgate.com]
    • Candidiasis Bacterial vaginosis Trichomoniasis Contact irritation or reaction to: Perfumes Powders Deodorants Panty liners Perineal pads Soaps Spermicides Lubricants Tight-fitting or synthetic clothing TABLE 3 Differential Diagnosis of Atrophic Vaginitis[aafp.org]
    Pruritus Vulvae
    • Vaginal or vulval dryness Vaginal or vulval itching ( pruritus vulvae ) Vaginal burning Painful sex ( dyspareunia ) Skin splitting (fissuring) of the entrance to the vagina ( posterior fourchette) Vaginal spotting (bleeding) Deficiency of oestrogen may[dermnetnz.org]
    Vaginitis
    • Vaginal atrophy can also be idiopathic .[en.wikipedia.org]
    • vaginitis , Senile (atrophic) vaginitis , Vaginitis;senile , atrophic vaginitis , Postmenopausal atrophic vaginitis (disorder) , Senile atrophic vaginitis , Senile vaginitis , atrophic; vaginitis, postmenopausal , postmenopausal; atrophic vaginitis ,[fpnotebook.com]
    • Key Topics Covered: Vaginal Atrophy (Atrophic Vaginitis) Overview Vaginal Atrophy (Atrophic Vaginitis) Pipeline Therapeutics Vaginal Atrophy (Atrophic Vaginitis) Therapeutics under Development by Companies Vaginal Atrophy (Atrophic Vaginitis) Late Stage[businesswire.com]
    • Vaginal pH Vaginal pH is obtained by placing a drop of the vaginal discharge on a pH strip.[clevelandclinicmeded.com]
    • Atrophic Vaginitis - Introduction Atrophic vaginitis (also known as vaginal atrophy, senile vaginal atrophy or urogenital atrophy) is inflammation of the vagina due to the thinning and shrinking of the vaginal epithelium ('skin').[2womenshealth.com]
    Vaginismus
    • Physical findings among the women included 68 cases of vaginismus, 1 case of vaginal agenesis, and 6 cases of atrophic vaginitis .[thefreedictionary.com]
    Postmenopausal Atrophic Vaginitis
    • Concepts Disease or Syndrome ( T047 ) ICD9 627.3 ICD10 N95.2 SnomedCT 156054004 , 52441000 English Postmenopausal atrophic vaginitis , Postmenop atrophic vaginitis , postmenopausal atrophic vaginitis , postmenopausal atrophic vaginitis (diagnosis) , Atrophic[fpnotebook.com]
    • 2012 ICD-9-CM Diagnosis Code 627.3 Postmenopausal atrophic vaginitis Short description: Atrophic vaginitis.[icd9data.com]
    • Questions related to N95.2 Postmenopausal atrophic vaginitis The word 'Includes' appears immediately under certain categories to further define, or give examples of, the content of thecategory.[icd10coded.com]
    • ICD-10-CM Codes › N00-N99 Diseases of the genitourinary system › N80-N98 Noninflammatory disorders of female genital tract › N95- Menopausal and other perimenopausal disorders › Postmenopausal atrophic vaginitis 2016 2017 2018 Billable/Specific Code Female[icd10data.com]
    Enteritis
    • Enter it here: When you buy this you'll get access to the ePub version, a downloadable PDF, and the ability to print the full article.[nursingcenter.com]
    • Other causes of decreased estrogen levels are decreased ovarian functioning due to radiation therapy or chemotherapy, immune disorder, removal of the ovaries, entering the post-partum period, and lactation.[en.wikipedia.org]
    • While the majority of cases occur in women 50-79 years of age, perimenopausal women may also experience vaginal dryness 5 to 10 years prior to entering menopause.[project-aware.org]
    • Atrophic vaginitis—this condition, occurring in some women entering or in menopause , is defined as a thinning of the walls of the vagina.[labtestsonline.org]
    • All the patients gave their written informed consent before entering the study.[dx.doi.org]
    Hypertension
    • […] related medical categories: Chronic Major Diseases that are commonly Undiagnosed: High Cholesterol -- Undiagnosed Heart Disease -- Undiagnosed Cancer -- Undiagnosed Depression -- Undiagnosed Type 2 Diabetes -- Undiagnosed Type 1 Diabetes -- Undiagnosed Hypertension[rightdiagnosis.com]
    Endometriosis
    • […] removal of the ovaries before the age of natural menopause, which can be done at the same time as a hysterectomy (removal of the uterus) Treatment with medications used to decrease estrogen levels in women who have conditions such as uterine fibroids or endometriosis[drugs.com]
    • However this condition can occur in other circumstances that result in decreased estrogen such as breastfeeding and the use of medications intended to decrease estrogen too, for example, treat endometriosis .[en.wikipedia.org]
    • Estrogen-reducing medications include hormones used to treat endometriosis, infertility, fibroids, and breast cancer and also some chemotherapy agents.[healthgrades.com]
    • The following may also cause estrogen levels to drop: Medicines or hormones used in the treatment of breast cancer, endometriosis, fibroids, or infertility Surgery to remove the ovaries Radiation treatment to the pelvic area Chemotherap.[nlm.nih.gov]
    Stress
    • It can be a nagging psychological stress factor in women with the condition Low hormonal levels of estrogen, increases the susceptibility of urogenital and vaginal area to many secondary infections, and brings about a loss of vitality and mechanical strength[dovemed.com]
    • Urinary symptoms that may be associated with atrophic vaginitis include urgency, frequency, urinary tract infections, and stress or urge incontinence.[project-aware.org]
    • […] qt postmenopausal stress incontinence&alt sh.[uspharmacist.com]
    • Find a 5-Star Ob/Gyn Near You Estrogen levels can also be decreased by medications, excessive exercising, anorexia, stress, or depression.[healthgrades.com]
    • Some suffer from genuine stress incontinence, which is leaking of urine on coughing, sneezing or jumping, for instance.[womens-health-concern.org]

    Etiology

    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.

    Causes

    Hypertension
    • […] related medical categories: Chronic Major Diseases that are commonly Undiagnosed: High Cholesterol -- Undiagnosed Heart Disease -- Undiagnosed Cancer -- Undiagnosed Depression -- Undiagnosed Type 2 Diabetes -- Undiagnosed Type 1 Diabetes -- Undiagnosed Hypertension[rightdiagnosis.com]

    Epidemiology

    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.

    Sex distribution
    Age distribution

    Pathophysiology

    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.

    Prevention

    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.

    Summary

    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.

    Patient Information

    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.

    Other symptoms

    No Ovaries
    Normal
    • Vagina: What's normal, what's not.[labtestsonline.org]
    • It is found in small numbers in the normal vagina.[acog.org]
    • The most common types are Normally in women of reproductive age, Lactobacillus sp is the predominant constituent of normal vaginal flora.[merckmanuals.com]
    • Expected Duration The condition will continue until it is treated or estrogen levels return to normal.[drugs.com]
    • Alteration in the normal vaginal discharge is something noticed by most women after the menopause and also rarely discussed.[womens-health-concern.org]
    Sexually Active
    Chemotherapy
    • Other causes of decreased estrogen levels are decreased ovarian functioning due to radiation therapy or chemotherapy, immune disorder, removal of the ovaries, entering the post-partum period, and lactation.[en.wikipedia.org]
    • Hence, the condition is also known by the term Postmenopausal Atrophic Vaginitis Treatment for cancer - both chemotherapy and radiotherapy Prescription drugs and medicines that have anti-estrogen effects Disorders/conditions affecting the function of[dovemed.com]
    • Other causes also include hyperprolactinaemia, chemotherapy and radiation therapy, as well as medications such as tamoxifen and danazol. 2 Lack of sexual intercourse, smoking and nulliparity can also cause the condition. 1 Oestrogen stimulates the vaginal[independentnurse.co.uk]
    • Estrogen-reducing medications include hormones used to treat endometriosis, infertility, fibroids, and breast cancer and also some chemotherapy agents.[healthgrades.com]
    Stimulant
    • “It’s a thin-dot laser applied to skin to stimulate the production of collagen.[medicaldaily.com]
    • The follicle stimulating hormone attempts in vain to stimulate egg production.[bodylogicmd.com]
    • A low-dose estriol cream can be used to stimulate rapid reproduction and repair of the vaginal epithelium cells.[medicalnewstoday.com]
    • Increasingly, vaginally administered estrogens based on low dose of estriol are used to stimulate the vaginal epithelium proliferation.[en.wikipedia.org]
    • Thinning and atrophy of the vaginal epithelium usually resulting from diminished endocrine stimulation and seen most commonly in postmenopausal women.[dictionary.reference.com]
    Immunization
    • View your Preventive Services to see whether you are due for a routine screening or updated immunization.[mydoctor.kaiserpermanente.org]
    • Other causes of decreased estrogen levels are decreased ovarian functioning due to radiation therapy or chemotherapy, immune disorder, removal of the ovaries, entering the post-partum period, and lactation.[en.wikipedia.org]
    • This fungus has particular tendency to adhere to the mucous membranes and take advantage of any element that leads to a reduction of the immune system tends to have a very high percentage of recurrences.[womanhealthgate.com]
    • It hinders the immune system, causes insomnia, and speeds the atrophy of the brain, to name a few.[dictionary.reference.com]
    Tamoxifen
    • Various medications can also cause or contribute to vaginal atrophy, including tamoxifen (Nolvadex), danazol (Danocrine), medroxyprogesterone acetate (Depo-Provera), leuprolide (Lupron), and nafarelin acetate (Synarel).[en.wikipedia.org]
    • Other causes also include hyperprolactinaemia, chemotherapy and radiation therapy, as well as medications such as tamoxifen and danazol. 2 Lack of sexual intercourse, smoking and nulliparity can also cause the condition. 1 Oestrogen stimulates the vaginal[independentnurse.co.uk]
    • Atrophic vulvovaginitis is associated with oestrogen deficiency due to: Menopause Lactation Hyperprolactinaemia High-dose progesterone medicines Breast cancer medication, such as tamoxifen and aromatase inhibitors.[dermnetnz.org]
    • Tamoxifen, Danazol, Medroxyprogesterone, GnRh agonists 5-Immediately after delivery or breast feeding 6-Anorexic women & women who have recently lost a significant body weight 6-idiopathic www.freelivedoctor.com 4.[slideshare.net]
    • Anti-oestrogenic treatments - eg, tamoxifen, aromatase inhibitors.[patient.info]
    Medroxyprogesterone
    • Various medications can also cause or contribute to vaginal atrophy, including tamoxifen (Nolvadex), danazol (Danocrine), medroxyprogesterone acetate (Depo-Provera), leuprolide (Lupron), and nafarelin acetate (Synarel).[en.wikipedia.org]
    • Tamoxifen, Danazol, Medroxyprogesterone, GnRh agonists 5-Immediately after delivery or breast feeding 6-Anorexic women & women who have recently lost a significant body weight 6-idiopathic www.freelivedoctor.com 4.[slideshare.net]
    • Side effects of antiestrogen medications, including medroxyprogesterone (Provera), tamoxifen (Nolvadex), danazol (Danocrine), leuprolide (Lupron) and nafarelin (Synarel), are also implicated as causes of atrophic vaginitis. 6 An increase in the severity[aafp.org]
    • […] vaginal or systemic estrogen therapy is introduced to effectively relieve vaginal dryness and itchiness and to improve vaginal elasticity. 2,4 In women who have not undergone a hysterectomy, systemic estrogen therapy is accompanied by a progestin, such as medroxyprogesterone[uspharmacist.com]
    • Other approaches, such as hormonal manipulation with depot medroxyprogesterone, eating yogurt, and desensitization to candida antigen, lack sufficient data to support recommending their use.[clevelandclinicmeded.com]
    Leukorrhea
    • .- ) senile (atrophic) vaginitis ( N95.2 ) severe dysplasia of vagina ( D07.2 ) trichomonal leukorrhea ( A59.00 ) vaginal intraepithelial neoplasia [VAIN], grade III ( D07.2 ) Type 2 Excludes: N76 ICD-10-CM Diagnosis Code N76 Other inflammation of vagina[icd10data.com]
    • Itching Burning Dyspareunia - Painful Sex Burning leukorrhea Pruritis Vulvae Feeling of pressure Yellow malodorous vaginal discharge Urinary :- Dysuria Urinary Frequency Nocturia - Bladder emptying at night Cystitis Urinary tract infection Urinary Stress[2womenshealth.com]
    • Bacterial vaginosis must be thought always in the presence of particularly abundant vaginal discharge (leukorrhea).[womanhealthgate.com]
    • […] cocci and coliforms; parabasal cells 10% KOH examination Negative Pseudohyphae ( 70%) Negative Negative Negative Miscellaneous — Culture if microscopy is negative Culture of no value Culture if microscopy is negative — Differential diagnosis Physiologic leukorrhea[clevelandclinicmeded.com]
    • A decrease in vaginal lubrication is an early hallmark of hormone insufficiency. 10 Genital symptoms include dryness, burning, dyspareunia, loss of vaginal secretions, leukorrhea, vulvar pruritus, feeling of pressure, itching and yellow malodorous discharge[aafp.org]
    Danazol
    • Various medications can also cause or contribute to vaginal atrophy, including tamoxifen (Nolvadex), danazol (Danocrine), medroxyprogesterone acetate (Depo-Provera), leuprolide (Lupron), and nafarelin acetate (Synarel).[en.wikipedia.org]
    • Other causes also include hyperprolactinaemia, chemotherapy and radiation therapy, as well as medications such as tamoxifen and danazol. 2 Lack of sexual intercourse, smoking and nulliparity can also cause the condition. 1 Oestrogen stimulates the vaginal[independentnurse.co.uk]
    • Tamoxifen, Danazol, Medroxyprogesterone, GnRh agonists 5-Immediately after delivery or breast feeding 6-Anorexic women & women who have recently lost a significant body weight 6-idiopathic www.freelivedoctor.com 4.[slideshare.net]
    • Side effects of antiestrogen medications, including medroxyprogesterone (Provera), tamoxifen (Nolvadex), danazol (Danocrine), leuprolide (Lupron) and nafarelin (Synarel), are also implicated as causes of atrophic vaginitis. 6 An increase in the severity[aafp.org]
    Radiation Therapy
    • Other causes of decreased estrogen levels are decreased ovarian functioning due to radiation therapy or chemotherapy, immune disorder, removal of the ovaries, entering the post-partum period, and lactation.[en.wikipedia.org]
    • Other causes also include hyperprolactinaemia, chemotherapy and radiation therapy, as well as medications such as tamoxifen and danazol. 2 Lack of sexual intercourse, smoking and nulliparity can also cause the condition. 1 Oestrogen stimulates the vaginal[independentnurse.co.uk]
    • A decline in estrogen can occur at other times besides menopause, including: during breastfeeding after removal of ovaries (surgical menopause) after chemotherapy for treatment of cancer after pelvic radiation therapy for treatment of cancer after hormonal[healthline.com]
    • In nonmenopausal women, production of ovarian estrogen can be interrupted by radiation therapy, chemotherapy, immunologic disorders and oophorectomy.[aafp.org]
    Breast Feeding
    • Tamoxifen, Danazol, Medroxyprogesterone, GnRh agonists 5-Immediately after delivery or breast feeding 6-Anorexic women & women who have recently lost a significant body weight 6-idiopathic www.freelivedoctor.com 4.[slideshare.net]
    • It can also occur postpartum or with breast-feeding, due to reduced oestrogen levels.[patient.info]
    • Breast-feeding should be delayed or withheld for 24 hours after taking metronidazole.[clevelandclinicmeded.com]
    Menstruation
    • This “loss” typically occurs shortly before and during menopause (When menstruation subsides) or after surgical removal of the ovaries.[mmgyn.com]
    • Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for 1 year.[acog.org]
    • Symptoms sometimes worsen after menstruation or sexual intercourse.[womanhealthgate.com]
    • Hormonal imbalances Rarely, a foreign body in the vagina (such as a small piece of toilet tissue in a child or a forgotten tampon in a menstruating woman); this can irritate and cause an infection.[labtestsonline.org]
    Leuprolide
    • Various medications can also cause or contribute to vaginal atrophy, including tamoxifen (Nolvadex), danazol (Danocrine), medroxyprogesterone acetate (Depo-Provera), leuprolide (Lupron), and nafarelin acetate (Synarel).[en.wikipedia.org]
    • Side effects of antiestrogen medications, including medroxyprogesterone (Provera), tamoxifen (Nolvadex), danazol (Danocrine), leuprolide (Lupron) and nafarelin (Synarel), are also implicated as causes of atrophic vaginitis. 6 An increase in the severity[aafp.org]
    Nafarelin
    • Various medications can also cause or contribute to vaginal atrophy, including tamoxifen (Nolvadex), danazol (Danocrine), medroxyprogesterone acetate (Depo-Provera), leuprolide (Lupron), and nafarelin acetate (Synarel).[en.wikipedia.org]
    • Side effects of antiestrogen medications, including medroxyprogesterone (Provera), tamoxifen (Nolvadex), danazol (Danocrine), leuprolide (Lupron) and nafarelin (Synarel), are also implicated as causes of atrophic vaginitis. 6 An increase in the severity[aafp.org]
    Postpartum Period

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    References

    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.
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