The trouble many women who reached postmenopausal age is atrophic vaginitis. According to statistics this disease affects up to 40% of the fairer sex. Atrophic vaginitis requires constant supervision by a gynecologist and long-term treatment.
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Definition of the disease
Atrophic vaginitis is a complex of symptoms that develops against the backdrop of involution and degeneration of the vaginal mucosa due to lack of estrogen and that is manifested by dryness, itching and recurrent inflammatory changes.
Other names of the disease serve as senile or postmenopausal vaginitis (senile) vaginitis or atrophic vaginitis. The disease is diagnosed after 5 – 6 years after the onset of the artificial menopause or after physiological.
Depending on the reasons for which you developed a disease there may be 2 forms of atrophic vaginitis: associated with artificial menopause and postmenopausal.
The causes and development of disease
Atrophic vaginitis occurs in 40% of women within 5-6 years after the development of physiologic or artificial menopause, the Vagina is covered with stratified squamous epithelium, which is sensitive to the level of estrogen in the body. While reducing the content of female sex hormones, the epithelium becomes thinner, the number of cells containing glycogen, decreases, and the secretion of vaginal glands reduced. Glycogen is known to serve as a nutrient medium for lactobacilli (the main component of the vaginal flora), which produce acid that maintains acidic environment in the vagina. Since the reduced glycogen content, respectively, and decreases the number of lactobacilli, the pH shifted to the alkaline side, predisposes to the colonization of vaginal pathogenic flora. Thinning and fragile vaginal epithelium is constantly injured (during intercourse or gynecological and hygiene), in turn, are microtrauma gateway for infection. As a result of weak immunity and existing chronic extragenital diseases develops local inflammation that becomes recurrent.
It becomes clear that the leading cause of the disease is the lack of estrogen (hypoestrogenia). Atrophic vaginitis is usually diagnosed in the following cases:
- after the onset of the physiological menopause;
- early menopause;
- removal of the ovaries;
- radiation therapy of the pelvic organs (ovaries and suffer);
- have hypothyroidism, diabetes or other endocrine pathologies;
- a weakened immune system (HIV).
The disease is aggravated by disregard for the rules of intimate hygiene, the preference of synthetic underwear and using scented cosmetic means for intimate hygiene.
The symptoms of atrophic vaginitis
In the early stage, the disease is almost asymptomatic. Later joined by itching at the area of the external genitalia and periodic burning pain that is worse after urinating or cleaning. The patient also worried about vaginal dryness, pain during intercourse and after it. Is observed frequent urination and urinary incontinence often associated with trophic disorders of the bladder wall and low tone pelvic floor muscles. After intercourse or a pelvic examination can be observed sukrovichnye or slight bleeding that is explained easily traumatized mucosa of the vagina. Sometimes a woman observes a small leukorrhea whitish in color.
Diagnosis of atrophic colpitis
Diagnosis of atrophic vaginitis is gynecological examination the Diagnosis of senile vaginitis is not difficulties. When gynecological examination with mirrors revealed atrophic mucosa is pale, with multiple cracks and bleeding, as well as small areas not covered with epithelium, which are easily injured and bleed. If joining a secondary infection, revealed local or diffuse hyperemia of the vaginal epithelium, the mucous membrane covered with a grayish bloom, and purulent discharge. It is also seen that the cervix is atrophied, and when bimodules palpation uterine size is reduced (in relation to the cervix be 2/1). Due to the marked dystrophy and degeneration of the vaginal vaults is smoothed or partially spliced.
Cytological examination of the smear revealed atrophic pattern: superficial cells of stratified squamous epithelium are almost there, but the predominant cells of the parabasal and basal layers.
Moreover, it investigates the pH of the vagina with the help of test strips. If women of childbearing age the vaginal environment content is in the range of 3.5 to 5.5, in patients with atrophic vaginitis increased pH and reaches to 5.5 – 7.
A study of the vaginal flora (dabs) can detect a sharp decrease in lactobacilli, increased numbers of leukocytes and a variety of conditionally-pathogenic flora. To avoid genital infections is shown examination of a scraping of the vagina by PCR.
Characteristic data after the colposcopic examination. Found a pale and thinned mucosa with multiple petechiae and dilated capillaries. Schiller’s test (Lugol staining) weak positive (unevenly colored collar in light brown color).
The treatment of atrophic vaginitis
Therapy of senile vaginitis the problem is quite complex. And the only effective treatment is hormone replacement therapy. Hormonal drugs are applied systemically (by mouth) and topically (intravaginal administration).
Local medicines are used drugs containing estriol (ovestin in suppositories and ointment, astrocade). Vaginal suppositories are introduced twice a day for 2 weeks.
As systemic therapy appointed the following drugs: Angelique, klimodien, tibolone and other. The pill is held continuously for 5 years.
In the case of accession of secondary infection and the development of specific vaginitis appointed anti-inflammatory and antibacterial drugs.