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Atrophic vaginitis and Lichen sclerosus

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

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  1. Atrophic vaginitis and Lichen sclerosus KalpanaNavaratnarasah GPVTS ST2

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. 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

  8. Lichen sclerosus

  9. 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

  10. Diagnosis • Typical appearance • Vulval biopsy under LA • Routine blood test for autoimmune conditions e.g. TFTs • Associated with small risk of developing vulval cancer

  11. 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

  12. 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

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