Vaginal atrophy is a medical disorder that is present when the tissues of the vagina are no longer well-lubricated and healthy.
When these symptoms are produced by a reduced amount of estrogen in a woman's body, this disorder is called atrophic vaginitis.
Atrophic vaginitis happens very frequently in postmenopausal women due to the falling levels of estrogen.
The vaginal mucosa becomes drier, less elastic, thinner and more fragile.
It may cause inflammation of the mucosa.
Alterations in vaginal pH and vaginal flora may induce urinary tract infection (UTI) or vaginal infections.
Reduced estrogen levels may affect peri-urethral lining and muscles and lead to pelvic laxity and stress incontinence.
Other reasons may also induce estrogen levels to drop:
1. Medicines or hormones used in the treatment of breast cancer
2. Surgical procedures to remove the ovaries
3. Radiation treatment to the pelvic area
4. Chemotherapy for cancer
5. Severe stress, depression, or intense exercise
The most common symptom is dryness of the vagina.
1. Urinary symptoms - e.g., increased frequency, nocturia, recurrent UTI, dysuria, stress incontinence or urgency, burning on urination
2. Vaginal bleeding or light bleeding after intercourse
3. Painful sexual intercourse
4. Slight vaginal discharge (usually white or yellow).
5. Vaginal soreness, itching or burning
There may be burning or itching of the vagina or vulva.
6. Dyspareunia.
The external genitalia may show reduced pubic hair, reduced turgor or elasticity, and a narrow introitus.
Investigations are:
1. Vaginal pH testing (using pH paper and sampling from the mid-vagina, not the posterior fornix).
2. The result is more alkaline in atrophic vaginitis.
3. Vaginal cytology - can show lack of maturation of the epithelial tissue of the vagina, normally present in atrophic vaginitis.
The principles of treatment are:
1. Restoration of urogenital physiology
2. Relief of symptoms
The effectiveness of lubricants and moisturizers is normally thought to be less than that with using topical estrogens.

TABLE OF CONTENT
Introduction
Chapter 1 Vaginal Atrophy
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Dyspareunia
Chapter 8 Vaginismus
Epilogue