Atrophic Vaginitis Essay

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Atrophic Vaginitis Atrophic vaginitis is defined as inflammation of the vaginal epithelium that is due wholly or in part to a lack of estrogen. It is important for the clinician to distinguish between the symptomatic woman with an inflamed atrophic vagina and the woman who has vaginal atrophy, which is considered generally asymptomatic and is not inflamed. The importance of this distinction lies in the fact that atrophic vaginitis is uncommon, whereas atrophic vaginas are common. There are three stages during life when the vagina is atrophic. These times are before menarche, during breast-feeding, and postmenopausally. The physiology of the vagina during these stages is similar. The epithelium is thin and lacks glycogen owing to a decrease in the endogenous estrogen. The pH increases to 6.5 to 7.0, which can support smoldering bacterial infections. However, this pH environment usually does not support candidal, trichomonal, or gonorrheal infections. A. History 1. Atrophic vaginitis is very rare in children. However, if present, the signs tend to be discharge or spotting (or both), which occurs from the development of a chronic vaginitis. 2. If atrophic vaginitis occurs during breast-feeding, the complaint is of vaginal dryness or dyspareunia. 3. Postmenopausal women are the ones most commonly affected with atrophic vaginitis. The presenting signs and symptoms are localized burning, dryness, soreness, dyspareunia, vulvar and vaginal irritation, occasional spotting, or a combination of these symptoms. B. Physical examination The vaginal walls appear thin, dry and smooth with little or no rugations. Inflammation, petechial hemorrhage, or exudate may be present. C. Investigative procedures 1. The wet mount preparation shows multiple WBCs with many bacteria present. 2. Vaginal and cervical cultures are not recommended since the

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