Approximately 40% of postmenopausal women have symptoms of atrophic vaginitis. Since this is a violation associated with estrogen deficiency
Estrogen - the key to bone health
It may develop before the onset of menopause - for example, in women taking anti-estrogen drugs, and suffered illness or surgery, which resulted in the production of estrogen decreases. Endometrial thinning and increasing the pH of the vagina caused by estrogen deficiency contributes to urinary tract infections and other problems.
The first symptom of atrophic vaginitis is usually a decrease in the secretion of vaginal fluid and as a result, vaginal dryness
Vaginal dryness: Causes and Symptoms
.
Despite the fact that this variety of vaginitis symptoms occur in a large number of women, only 20-25% of them seek medical help. In the course of routine gynecological examinations and doctors do not always pay attention to the symptoms of atrophic vaginitis. However, many gynecologists are calling on their colleagues to pay more attention to this disease, as its timely diagnosis and treatment can significantly improve the quality of life for many women.
Throughout the life cycle of women vaginal epithelium undergoes a lot of changes, which are reactions to changes in the level of estrogen in the blood
. Newborn girl on the vaginal epithelium estrogen affects the mother; this time in the epithelium contains a large amount of glycogen
. The epithelium is thin enough during childhood, until he finally begins to thicken with the onset of puberty
. This is due to the fact that the body's production of estrogen begins active
. Under the action of this hormone increases the glycogen content in the vaginal epithelium
. From glycogen depends on successful development and proliferation of lactobacilli Doderlein (also called sticks Doderlein)
. The lactic acid produced by these bacteria, reduces the vaginal pH to 3
. 5-4
. 5 units - it is essential for the effective protection of the body from pathogens of urinary tract infections
. Raising pH increases the risk of infection by streptococci, staphylococci, coliform bacteria and diphtheroids
.
Postmenopausal estrogen levels (estradiol mainly) in the blood decreases sharply - to more than 120 pg / ml (picograms per milliliter) to about 18 pg / ml. During the lowering of estrogen followed by numerous cytological changes, including - the proliferation of connective tissue, the fragmentation of elastin and collagen hyalinization. The consequences of these changes may be telangiectasia, cracks and sores on the vaginal wall, characteristic of atrophic vaginitis. Postmenopausal changes in the structure of tissues are not limited to the genitals, but often also affect the urinary system. Epithelium and vagina and urethra are dependent on estrogen, and its deficit with them almost inevitably occur various changes.
Causes
Menopause is the most common reason for the decline in estrogen levels at least, because sooner or later it comes in all women. Obviously, it is the cause of most cases of atrophic vaginitis. In women before menopause estrogen production may be disrupted due to radiotherapy, chemotherapy, immunological disorders and oophorectomy - removal of the ovaries. After birth, there is a natural decline in estrogen levels, and in addition, the body begins to actively secreted his antagonist prolactin - a hormone that stimulates the production of breast milk. The reduction of estrogen production and atrophic vaginitis can be side effects of anti-estrogen drugs such as medroxyprogesterone (Provera), tamoxifen (Nolvadex), danazol (Danocrine), leuprolide (Lupron), and nafarelin (Synarel).
After menopause especially severe symptoms of atrophic vaginitis are observed, as a rule, women who smoke, and those who have never given birth vaginally. Milder symptoms of this disorder are women who continue to lead an active sex life, those who have never done vaginal surgery, and in patients with elevated levels of androgens (male sex hormones).
Symptoms
Usually, between the beginning of lowering estrogen levels and the appearance of the first symptoms of atrophic vaginitis it takes quite a long time. The first sign of violation becomes decrease in vaginal discharge. From the genitals appear symptoms such as dryness and burning in the vagina
Burning in the vagina: find the cause
, Dyspareunia (pain in the genital and pelvic organs - especially during sexual intercourse), itching of the vulva, a feeling of pressure in the lower abdomen, unusual yellowish discharge with a bad odor. The symptoms of the urinary system usually appear later; among them - the discomfort when urinating, frequent urination, hematuria (blood in urine), an infection of the urethra and bladder, dysuria and urinary incontinence. All the symptoms of atrophic vaginitis can be exacerbated if simultaneously with developing infections such as candidiasis, trichomoniasis, or bacterial vaginosis. Gradually, vaginal dryness, discomfort, and pain during sexual intercourse can lead to sexual dysfunction and associated emotional distress.
Diagnostics
The above symptoms do not always indicate atrophic vaginitis. Intimate deodorants, powders, soaps, gaskets (especially flavored), spermicides and lubricants frequently contain substances which irritate the skin and mucous membranes, which could result in similar symptoms. Therefore, the physician must ask the patient in detail about what the funds for the care and methods of contraception she uses. Also, keep in mind that tight clothing and underwear, as well as the continued use of gaskets made of synthetic materials can exacerbate the symptoms of atrophic vaginitis.
During a pelvic exam notes several characteristic features. Atrophic epithelium looks pale, smooth, and shiny. Often there are signs of inflammation, redness of the skin and mucosal tissue damage, as well as petechiae - small reddish dots on the skin. External genitals checked for symptoms such as loss of skin elasticity, loss of pubic hair, dry labia, vulva dermatitis. Often there is a stenosis (narrowing) of the vagina. If the stenosis was not identified during the visual inspection of the genitals, the intravaginal examination can be quite painful. In atrophic vaginitis
Atrophic vaginitis - dryness, burning and itching
vaginal epithelium is especially prone to injury, which can be obtained, for example, during sexual intercourse, or pelvic exam. The signs of such damage can be not only a pain in the vagina, and vaginal bleeding - usually they stop quickly, but can easily be resumed when exposed to the epithelium. Atrophic vaginitis may be accompanied by such disorders as cystocele, urethral polyps, pelvic organ prolapse and rectocele (prolapse of the rectum).
To diagnose atrophic vaginitis are applied and laboratory tests such as pap smears and analysis of hormone levels. Cytology vaginal secretions shows an increase in the number of parabasal cells, and a decrease in the number of superficial cells. The pH (in women after menopause it is generally greater than 5 units), which is determined by a special indicator strip may also be one of the diagnostic criteria for atrophic vaginitis. Moreover, ultrasound of the uterine lining showing endometrial thinning to 4-5 mm, indicating a significant decrease in estrogen stimulation.
