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Atrophic vaginitis and Lichen sclerosus. Kalpana Navaratnarasah GPVTS ST2. Atrophic vaginitis. Atrophic vaginitis is inflammation of the vagina due to thinning tissue and decreased lubrication. Low oestrogen – Menopause, drugs , RXT/CXT
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Atrophic vaginitis and Lichen sclerosus KalpanaNavaratnarasah GPVTS ST2
Atrophic vaginitis • Atrophic vaginitis is inflammation of the vagina due to thinning tissue and decreased lubrication. • Low oestrogen – Menopause, drugs, RXT/CXT • Oestrogen –Affects glands that produce fluids and mucus and keep vagina moist Causes lining of vagina to be more elastic and thicker Stimulates cells to produce glycogen
Lack of oestrogen • Thinning of tissues around vaginal area • Reduction in number of glands producing mucus • Lose of fat tissue around genital area • Vagina – less elastic, shorter and more dry • Changes can take months to years after onset of menopause • 50% of women experience some Sx.
Symptoms • Dyspareunia – smaller, less lubricated and more sensitive • Discomfort/pain – vagina or vulva inflamed • Vaginal discharge – Due to infection • Itch – Itch/scratch cycle • Urinary Sx – Due to thinning and weakening of tissues around the neck of bladder and urethra e.g. urgency, recurrent UTIs
Treatment • Lubricating gels – Vaginal dryness and dyspareunia • Oestrogen creams – Cream , pessary, vaginal ring. Every day for 2 weeks and twice weekly for further 3 months. Localised treatment. • HRT – If other menopausal symptoms also a problem.
Lichen sclerosus • Skin condition that affects the vulva of women (less commonly affects other areas of skin) • Affects 1/1,000 women • In males typically affects the foreskin and end of penis • 15% of cases occur in children • Small ‘pearly white spots’ on the vulva which may become larger and join together • Skin around the anus can be affected • Skin condition – does not extend to vagina or anus
Symptoms • White irregular spots • Skin becomes white and thickened • Inflammation may develop and cause splitting and cracking of skin. Blistering • Scar formation – vulva shrinks in size and tightening of vagina opening • Itch and irritation • Painful intercourse • Susceptibility to infections
Cause • Cause not clear • Genetic susceptibility to an autoimmune reaction which is triggered by infection • Possible link with other auto-immune conditions e.g. thyroid disease, vitiligo • Possible link with Borrelia infection – 25% of cases have antibodies to the organism • Not sexually transmitted
Diagnosis • Typical appearance • Vulval biopsy under LA • Routine blood test for autoimmune conditions e.g. TFTs • Associated with small risk of developing vulval cancer
Treatment • Topical steroid treatment – Potent steroids may be used. Initially for 3 months • Regular Emollients – avoid scented soaps, bubble baths etc • Antibiotics/Antifungals – Infection • Vaginal dilator/surgery – vaginal narrowing • Circumcision in men
Cancer risk • Small risk of developing cancer • Regular follow-up • Vulva cancer • Itching soreness, burning of vulva • Lump, swelling or growth like wart • Bleeding or blood stained discharge • Pain in vulva • Ulcerated area • Mole changes shape, size, colour