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Treatment of atrophic vaginitis

Camil Castelo-Branco and Fabiola Rostro

Up to 40%of postmenopausal women have symptoms of atrophic vaginitis. Since the condition is attributable to estrogen deficiency, it may also occur in premenopausal women who take antiestrogenic medications or who have medical or surgical conditions that result in decreased levels of estrogen. The thinned vaginal epithelium and increased vaginal pH level induced by estrogen deficiency predispose the vagina and urinary tract to infection and mechanical weakness. The earliest symptoms are decreased vaginal lubrication, followed by other vaginal and urinary symptoms, such as dryness, burning, itching and dyspareunia, which may be exacerbated by superimposed infection. These symptoms can contribute to sexual dysfunction, loss of sexual intimacy and may have a negative impact on overall quality of life. Once other causes of symptoms have been eliminated, treatment usually depends on estrogen replacement. Estrogen-replacement therapy decreases vaginal pH, thickens and revascularizes the vaginal epithelium, increases the number of superficial cells and reverses vaginal atrophy, and may be provided systemically, if symptoms are severe or affect quality of life, or locally; however, the dosage and delivery method must be individualized. Vaginal moisturizers and lubricants, and participation in coitus, may also be beneficial in the treatment of women with atrophic vaginitis.