Hello and welcome to the zero to finals podcast. My name is Tom and in this episode I'm going to be

talking to you about atrophic vaginitis. And you can find written notes on this topic at zero definals.com

slash atrophic vaginitis or in the gynecology section of the zero definals, obstetrics, and

gynecology book. So let's get straight into it. Atrophic vaginitis refers to dryness and atrophy

of the vaginal mucosa associated with a lack of estrogen. Atrophic vaginitis can also be

referred to as genitone urinary syndrome of

menopause. It occurs in women from menopause onwards. The epithelial lining of the vagina and

the urinary tract responds to estrogen by becoming thicker, more elastic and producing secretions. As women enter

the menopause, the estrogen levels fall, resulting in the mucosa becoming thinner, less elastic

and more dry. The tissue is more prone to inflammation. There are also changes in the vaginal pH and the microbial flora that can

contribute to localized infections. Estrogen also helps to maintain healthy connective tissues around the

pelvic organs and a lack of estrogen can contribute to pelvic organ prolapse and stress incontinence.

So how does atrophic vaginitis present? Well it usually presents in postmenopausal women with

symptoms of itching, dryness, dysparanunia, which is discomfort or pain with sex, and bleeding due to localized inflammation.

You should also consider atrophic vaginitis in older women presenting with recurrent urinary tract infections,

stress incontinence and pelvic organ prolapse.

Treatment with topical estrogen where appropriate may improve the symptoms of these conditions.

It's worth asking specifically about symptoms of vaginal dryness and discomfort,

as women will often be reluctant to bring it up spontaneously during a consultation.

If they report these symptoms, they can be straightforward to treat and make a big difference to

their quality of life. Let's talk about examination.

Examination of the labia and the vagina will demonstrate a pale mucosa, thin skin, reduced skin folds, erythema and inflammation,

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