Atrophic Vaginitis

by Janna Gordon, RPh, MBA
November 2007

brought to you by Bellevue Pharmacy, a ProjectAWARE sponsor

Primarily impacting women, particularly Hispanic, obese or diabetic females during and after menopause, atrophic vaginitis is associated with vaginal dryness, itching, burning and discharge. These symptoms can be so uncomfortable that patients will avoid sex and even have trouble with daily activities such as sitting, standing, exercising, urinating, or working. Urinary symptoms that may be associated with atrophic vaginitis include urgency, frequency, urinary tract infections, and stress or urge incontinence.

While the majority of cases occur in women 50-79 years of age, perimenopausal women may also experience vaginal dryness 5 to 10 years prior to entering menopause. In some patients, vaginal dryness can be linked to the drying effects of feminine sprays, douches, antibacterial and deodorant soaps, as well as laundry detergents. Other causes include stress, dehydration from low hydration or consumption of alcohol and caffeinated drinks, low fat diet, and medications such as antihistamines for cold and allergy treatment and antidepressants, which can dry vaginal tissues. Vaginal dryness can also be linked to Sjögrens syndrome, or vaginal disorders such as lichens sclerosis or vulvodynia. Finally, hormone imbalance, associated with peri menopause, menopause, PCOS, and hysterectomies, is a primary cause of atrophic vaginitis.

Treatment of vaginal dryness include:

• Limit alcohol and caffeine beverages and stay hydrated with water
• Look for pH balanced soaps, limit douching and perfumed feminine hygiene sprays
• Eat a balanced diet and limit sugar and white flour carbohydrates
• Increase uptake of soy, flaxseed, and other foods that naturally contain isoflavones, such as legumes, nuts, apples, celery, and cherries that can help normalize hormone levels
• Add vitamin E suppositories or oral vitamin A, beta carotene, B vitamins, and omega-3 fatty acids to help with vaginal dryness and hormone balance
• Use preservative and glycerin-free lubricants

When nonpharmacological treatments fail to provide relief, localized estrogen therapy in a vaginal cream or hormone replacement therapy have been shown to reduce vaginal dryness, irritation, itching, and painful intercourse. In addition, studies have found these treatments improve vaginal mucosal elasticity and increase vaginal secretions, blood flow, and sensations.

Treatments can lead to the normalization of the cervicovaginal mucosa, lower vaginal pH, and may prevent urinary tract infections as well as help improve painful intercourse. Bellevue Pharmacy recommends prescription strength estriol vaginal cream used twice weekly to restore vaginal tone, and improve dryness. Testosterone can also be added to can improve the strength of the urethral sphincter, which can help with urinary urgency and incontinence.

For questions and further information, contact Bellevue Pharmacy.

Source: US Pharmacist, Sept 2006