Term
| What causes atrophic vaginitis? |
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Definition
| Anything that causes a hypoestrogenic state. |
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Term
| Name some causes of hypoestrogenic states. |
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Definition
| Menopause, childbirth, medications, pre-mature ovarian failure, bilateral oophrectomy. |
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Term
| What affect does estrogen have on vaginal tissues. |
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Definition
| Helps keep them thick, moist, rugated, elastic, and helps ensure proper blood flow. |
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Term
| The vaginal and urinary tracts come from the same embryologic origin and are estrogen dependent...T or F? |
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Definition
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Term
| Name some subjective findings of atrophic vaginitis. |
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Definition
1)Burning/Soreness/Tenderness in vaginal area
2)Pruritus
3)Leukorrhea
4)Post-coital bleeding
5)Dyspareunia/Sexual dysfunction
6)Stress incontinence
7)Perineal pressure
8)Hematuria/Dysuria/Frequency
9)Vaginal dryness/lack of lubrication
10)Bleeding/spotting |
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Term
| Atrophic vaginitis is characterized by a sudden onset of sx...T or F? |
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Definition
| False-AV is a gradual onset with progressively worsening sx. |
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Term
| Name some objective findings of AV. |
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Definition
1)Loss of labial fat giving them a "hanging" appearance.
2)Clitoris may appear larger
3)Sparse pubic hair
4)A lower slightly reddened urinary meatus
5)Dry perineal skin
6)Irritation at the vaginal fourchette
7)Pale, dry, shiny and smooth vaginal epithelium with decreased rugae
8)Erythematous/friable vaginal walls with petechiae |
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Term
| What might you see or feel on examination of someone with AV? |
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Definition
1) A vaginal vault that is less elastic, shorter, and more narrow
2) A less protuberant cervix
3) Pelvic floor weakness
4) Vulvar lesions or ulcerations
5) Vaginal discharge
6) Loss of turgor or elasticity
7) Introital stenosis, <2 fingers |
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Term
| Name some differential diagnosis for AV. |
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Definition
1) Vaginal infection such as yeast, BV, Trich, or others
2) SE from medications that are drying to all tissues (antihistamines)
3) If having post-menopausal bleeding...endometrial and cervical cancer are also differentials
4) Foreign body
5) Irritants such as douches, soaps, and latex
6) Lichen sclerosis et atrophicus |
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Term
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Definition
Through a thorough H&P, a vaginal pH, microscopy, and the vaginal maturation index.
Labs that r/o other differentials
Serum estradiol levels to confirm menopause & pelvic ultrasound at also used. |
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Term
| Name three treatments for AV. |
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Definition
1) Water soluble lubricants
2) Topical estrogen creams, tablets, or ring
3) Oral or transdermal estrogens or combined estrogen/progesterone. |
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Term
| A patient with AV post-hysterectomy should not receive unopposed estrogen...T or F? |
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Definition
| False-If the patient doesn't have a uterus then it is safe to give them unopposed estrogen. |
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Term
| A patient with AV and an intact uterus should be given unopposed estrogen...T or F? |
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Definition
| False....If they have a uterus they must have a combined hormone replacement. |
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Term
| Name some complications of AV. |
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Definition
1) Sexual dysfunction
2) Ulcerations
3) Infections
4) Decrease QOL
5) Urogenital complications |
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Term
| When should a patient with AV follow up? |
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Definition
1) If using lubricants they should follow up when no longer working
2) If using topical or oral preparations, they need to follow up every 3-6 months until improvement and then annually at a minimum. |
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Term
| A patient presents to you who is 38 yo and appears to have signs and symptoms of AV and tells you she has been trying to conceive for 16 months now without success...what should you do? |
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Definition
| Draw a serum estradiol level and FSH to look for pre-mature ovarian failure. |
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Term
| Women during the post-partum period are in a hypoestrogenic state and could present with sx of AV...T or F? |
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Definition
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Term
| Name three potential prevention measures for AV. |
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Definition
1) Maintain an active sex life through perimenopause and beyond
2) Quit smoking
3) Have babies....Nullips suffer more from AV. |
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