What is Atrophic Vaginitis?
Atrophic Vaginitis is a skin condition of the vulva and vagina. It occurs when a hormone called estrogen is lacking in the body. Atrophic vaginitis can occur at any age. It most commonly occurs in women who are menopausal and in women whose ovaries have stopped making estrogen. It can also be seen in women who are breast feeding, using Depo-Provera, or have had their ovaries removed. Decreasing estrogen levels can cause skin changes in the vulvar and vaginal areas as well as the urethra and bladder. With these changes, the skin becomes thin and more easily damaged. Atrophic vaginitis does not affect all women.

What are the signs and symptoms of Atrophic vaginitis?

• Problems with urination, such as: burning, frequency, urgency, loss of urine, and pain.
• Vulvar itching and/or burning.
• Bleeding/Spotting.
• Pain with intercourse.

How is Atrophic vaginitis diagnosed (identified)?
Your doctor or health care provider will examine the vulva and vaginal skin. A sample of vaginal discharge may be obtained and examined to determine if you have the changes seen with atrophic vaginitis.

What is the cause of Atrophic vaginitis?
A lack or decrease in estrogen in the vulvar and vaginal areas causes atrophic vaginitis. This decrease of estrogen affects women differently. When a woman's estrogen begins to decrease, some women will develop atrophic vaginitis.

What is the treatment of Atrophic vaginitis?
Treatment may include any of the following:

• Follow Guidelines for Vaginal Skin Care  (see attached sheet for details)
• Estrogen Replacement Therapy helps to restore the body's estrogen levels. There are two ways to do this:
• Systemic Estrogen Replacement provides estrogen to the whole body.
• Oral Estrogen - This involves taking an estrogen pill as prescribed by your health care provider. Some of the most commonly used forms include Estrace, Ogen, Orthoest, and Premarin.
• A Transdermal Patch  - This is a patch that is applied one or two times a week and gives the estrogen hormone through the skin. It is applied on the upper parts of the body. Some commonly used brands are Climara and Estraderm.
  NOTE: If you still have your uterus you will need a combination of estrogen and progesterone called Combipatch.   
• Dietary-based phytoestrogens  - In a few patients, plant-derived phytoestrogens can be used. Food sources of phytoestrogens can be found in soy milk or tofu

Topical Estrogen Replacement provides estrogen to the area where it is applied. Topical Estrogen is the other way to restore the decreased estrogen levels in your vulvar vaginal skin. The topical cream is inserted into the vagina with a vaginal applicator or applied directly to the vulvar skin. Commonly used brands are Estrace, Ogen, and Premarin cream.  There is also a convenient and easy to use tablet form called Vagifem and it is placed in the vagina with a simple to use applicator.                                                                                                                                                                 

                                                            Guidelines for Vaginal Skin Care

The goal is to promote healthy vulvar/vaginal skin. This is done by decreasing and/or removing any chemicals, moisture, or rubbing (friction). Any products listed below have been suggested for use because of their past success in helping to decrease or relieve itching, irritation and burning. The term vulva refers to the external skin around your vagina.

Laundry Products

• Use a detergent free of dyes, enzymes, and perfumes (such as Dreft, All Free and Clear) on any clothing that comes in contact with your vulva such as: underwear, exercise clothes, towels, or pajama bottoms. Use 1/3 to 1/2 the suggested amount per load. Other clothing may be washed in the laundry soap of your choice.
• Do not use fabric softener or dryer sheets in the washer or dryer on these articles of clothing. If you do use dryer sheets with the rest of your clothes, you must hang dry your underwear, towels, and any other clothing that comes in contact with your vulva.
• Stain Removing Products  - Soak and rinse in clear water all underwear and towels on which you have used a stain removing product. Then wash in your regular washing cycle. This removes as much of the product as possible.

Clothing

• Wear white, all cotton underwear - not nylon with a cotton crotch. Cotton allows air in and moisture out.
• Avoid pantyhose. If you must wear them either cut out the diamond crotch (leave about 1/4 to 1/2 inch of fabric from the seam to prevent running) or wear thigh high hose. Many stores now carry thigh high nylons.
• Avoid tight clothing, especially clothing made of synthetic fabrics. Remove wet bathing and exercise clothing as soon as you can.

Bathing and Hygiene

• Avoid bath soaps, lotions, gels, etc. which contain perfumes. These may smell nice but can be irritating. This includes many baby products and feminine hygiene products marked "gentle" or "mild". Dove-Hypoallergenic, Neutrogena, Ivory, and Basis and Pears are the soaps we suggest. Do not use soap directly on the vulvar skin, just warm water and your hand will keep the vulvar area clean without irritating the skin.
• Avoid all bubble baths, bath salts and scented oils. You may apply a neutral (unscented, non-perfumed) oil such as Vitamin E oil or Keri Oil to damp skin after getting out of the tub or shower.
• Do not scrub vulvar skin with a washcloth - washing with your hand and warm water is enough for good cleaning.
• Pat dry rather than rubbing with a towel or use a hairdryer on a cool setting to dry the vulva.
• Baking soda soaks. Soak in lukewarm (not hot) bathwater with 4-5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 1-3 times a day for 10-15 minutes.
• Use white, unscented toilet paper. If paper has a perfumed scent or lotion, avoid using it.
• Avoid all feminine hygiene sprays, perfumes, adult or baby wipes. Pour lukewarm water over the vulva after urinating if urine causes burning of the skin. Pat dry rather than rubbing with a towel.
• Avoid the use of deodorized pads and tampons. Tampons should only be used when the blood flow is heavy enough to soak one tampon in four hours or less. Tampons are safe for most women, but wearing them too long, or when the blood flow is light may result in vaginal irritation, increased discharge, odor or toxic shock syndrome.
• Avoid all over the counter creams or ointments, except A and D Ointment. Ask your health care provider first.
• Small amounts of A and D Ointment may be applied to your vulva as often as needed to protect the skin. It may also help to decrease skin irritation during your period and when you urinate.
• Do Not Douche.   Douching can take away the healthy skin cells in your vagina and will increase your dryness.
• Do Not Shave the Vulvar Area.
• Dryness and irritation during intercourse may be helped by using a lubricant. Use a small amount of Vitamin E oil because it contains no chemicals to irritate vulvar/vaginal skin. Vitamin E oils will rinse away with water and will not increase your chances of infection. Water based products like K-Y Jelly or Astroglide work well for most people, but may tend to dry before intercourse is over and also contain chemicals that can irritate your vulvar skin. It may help to use a non-lubricated, non-spermicidal condom and use vitamin E oil as the lubricant.
• Some women may have problems with chronic dampness. Keeping dry is important so choose cotton fabrics whenever you can and keep an extra pair of underwear with you in a small bag and change if you become damp during the day at work/school.