"Dryness, itching and pain" in elderly women

This is the 5147th article of Da Yi Xiao Hu

In the clinic, we often see some elderly women complaining: "Doctor, I feel uncomfortable down there." When asked why they feel uncomfortable, they usually show an embarrassed expression: "I can't explain it, I just feel uncomfortable, sometimes I feel dry and uncomfortable, sometimes itchy, sometimes painful." "Do you have increased leucorrhea or abnormal vaginal discharge?" "There is some yellow discharge on the underwear." Further gynecological examinations found that these women had vulvar and vaginal atrophy, vaginal wall congestion, with or without increased vaginal discharge. The reason turned out to be "atrophic vaginitis".

1. Which women are most likely to suffer from atrophic vaginitis?

Atrophic vaginitis is closely related to the decline of estrogen, and is therefore mainly seen in women who have undergone natural menopause, ovarian surgical castration (resection), or menopause after pelvic radiotherapy due to illness. It can also be seen in women with postpartum amenorrhea or pseudomenopause treated with drugs. In the former, atrophic vaginitis often recurs because of irreversible ovarian function. In the latter, atrophic vaginitis will also improve significantly once the ovarian function returns to normal.

2. Causes of atrophic vaginitis

The main cause of atrophic vaginitis is the decline in estrogen levels. The decline or decline of female ovarian function and the decrease in estrogen levels can lead to atrophy of the vaginal wall, thinning of the mucosa, reduced glycogen content in epithelial cells, increased pH in the vagina, often close to neutral, reduced local resistance, and easy invasion and reproduction of pathogenic bacteria, causing inflammation. Clinically, it is called "atrophic vaginitis" or "senile vaginitis".

3. What are the symptoms of atrophic vaginitis?

In addition to "dryness, itching, and pain", there is often an increase in vaginal discharge, which is usually a thin yellow liquid, and in severe cases may be purulent and bloody. Gynecological examinations show that the patient's vulvar and vaginal mucosa are atrophied, the vaginal epithelium is thin, the folds disappear, and small bleeding spots are often seen in the vaginal wall mucosa. In severe cases, there may be ulcers, so some patients also complain of discomfort or pain during sexual intercourse.

4. How to diagnose atrophic vaginitis

The diagnosis is usually based on the patient's age, menopausal years, reproductive history, history of surgery, radiotherapy, and amenorrhea, combined with clinical manifestations and leucorrhea examination. However, it still needs to be differentiated from other diseases, such as: increased vaginal discharge needs to rule out infection with pathogens such as Trichomonas and Candida; for bloody discharge, cervical cancer screening is required to rule out cervical lesions, and segmental curettage is required to rule out uterine malignancies when necessary; for those with vaginal wall ulcers or abnormal tissue hyperplasia, vaginal wall biopsy is required to confirm the presence of vaginal tumors by pathology.

5. Treatment strategies for atrophic vaginitis

Atrophic vaginitis is caused by a decrease in estrogen, so the treatment principle is: supplement estrogen, enhance vaginal resistance, and inhibit bacterial growth.

1. Estrogen supplementation should be individualized

For women who are postmenopausal and do not have high-risk factors such as breast cancer or endometrial cancer, local or systemic administration can be used; for women who are amenorrhea, younger and do not have high-risk factors, sequential estrogen-progestin therapy can be considered to adjust the menstrual cycle; for women who are postpartum amenorrhea and need to breastfeed, estrogen supplementation is not recommended, but symptomatic treatment can be used, and generally the condition will improve naturally after stopping breastfeeding and resuming menstruation. In addition, estrogen supplementation should be used under the strict guidance of a professional physician, and self-supplementation is not recommended.

2. Inhibit bacterial growth

You can choose to use acidic vaginal wash to rinse the vagina or Lactobacillus vaginal suppositories to improve the pH of the vagina and the internal environment, and then combine it with local antibiotics to inhibit bacterial growth.

Conclusion

In addition to vulvar and vaginal symptoms, some women with atrophic vaginitis often also have urinary system symptoms such as frequent urination, urgency, discomfort during urination, and recurrent urinary tract infections. Therefore, for postmenopausal women with recurrent urinary tract infections, it is recommended to seek timely treatment at a gynecological clinic.

Author: Department of Gynecology, Huadong Hospital, Fudan University

Zhu LihongDeputy Chief Physician