Atrophic Vulvovaginitis

This is caused by estrogen deficiency affecting the tissues of the vagina and the vulva so that they become thinned and atrophic. Lack of estrogen causes thinning of the epithelial barrier function of the tissue and this tissue becomes more easily damaged by irritation and more easily infected by bacteria.

Lack of estrogen is caused by estrogen deficiency due to natural or surgical menopause is most common but this also occurs to some degree post-partum, with birth control pills, and breast feeding. Estrogen blockers like tamoxifen also cause estrogen deficiency at the tissue level

Patients complain of vulvar burning, dysuria (stinging or burning on urination), pruritus (itching), tenderness and dyspareunia (pain with sexual intercourse).

On examination the vaginal vestibule and vagina are pale, with thinned epithelium and loss of the vaginal folds. There can be introital stenosis, petechiae and fissuring and, less commonly, a malodorous discharge may occur.

Treatment is with estrogen replacement and this can be done with a patch, cream, ring or tablet. Irritants should be avoided because the tissues are thinned.