VVA-Vulvovaginal Atrophy

by Dr. Thisara Weerasamai
Dr. Thisara Weerasamai

Since vaginal dryness has been commonly linked to a decline in oestrogen levels, we tend to think that it only happens during the postmenopausal phase. According to medical studies Vulvovaginal atrophy (VVA) is a common and underreported condition associated with decreased oestrogenisation of the vaginal tissue. The symptom can occur at any time in a woman’s life cycle, although it is more common in 50% of menopausal or postmenopausal women.

Symptoms of Vulvovaginal Atrophy
  • Vaginal dryness, burning and genital itching
  • Decreased vaginal lubrication during sexual activity, light bleeding after intercourse
  • Burning with urination, urgency with urination, frequent urination and urinary incontinence
  • Recurrent urinary tract infections
Symptoms of Vulvovaginal Atrophy
Diagnosis of VVA
  1. Pelvic exam
  2. Vaginal PH or acid balance test
Causes of Vulvovaginal Atrophy (VVA)
  • Decrease in oestrogen level in ageing process: level in premenopausal state is around 10-800pg/ml. When women have reached menopause, oestrogen levels decrease to 30pg/ml or lower
  • Decrease in oestrogen level as side effects of medication
  • After chemotherapy, some patients experience sudden decrease of oestrogen production in the ovaries. This can lead to symptoms of menopause.
  • Anti-oestrogen medications for treatment of some diseases, such as endometriosis and ovarian cyst (abnormal growth in the ovaries) and injections to reduce the size of tumours before surgery.
ovarian cyst

Differential diagnosis for other diseases with vaginal dryness should always be considered before giving treatment because some conditions would need different treatment methods.

  1. Vaginal inflammation from infection e.g. Bacterial infection, protozoan infection, fungal infection.
  2. Vaginal irritation from feminine hygiene, underwear or sanitary pads allergy.
  3. Skin rash around vulva and/or vagina.
  4. Vaginal cancer may have signs and symptoms of vaginal dryness, itching, and discomfort. If you notice any of these symptoms, talk to your healthcare provider about which treatment is right for you.
How is vaginal dryness treated?

1. Oestrogen Hormone Therapy Oestrogen hormone therapy which comes in oral pills are sometimes used to treat common menopausal symptoms, such as hot flushes, flu-like symptoms, clinical results show it reduces cholesterol levels and prevents osteoporosis. Oestrogen Hormone therapy which comes in vaginal suppositories is a low dose oestrogen vaginal suppository which according to The North American Menopause Society (NAMS) 2007, can effectively treat vaginal dryness whether in cream, tablet or ring form. Applying low-dose medication directly to the vaginal area has been researched to potentially increase the level of oestrogen in the blood.

the laser increasing vaginal lubrication

2. Treatment with moisturiser comes in gels, creams and vaginal suppositories, which can be used for long term with no harmful effects on the body due to its non-hormonal composition.

3. Treatment with lubricant: To reduce discomfort during intercourse.

4. Treatment with supplementary vitamins; though not clinically proven taking Vitamins E and D some report it can help alleviate vaginal dryness.

5. Fractional CO2 laser: Tremendous advances in rejuvenation have been made in the use of the laser increasing vaginal lubrication and moist layers are produced. This procedure needs no anaesthesia, causes no pain and you can perform normal daily activities right after the procedure.

PHYATHAI 1 HOSPITAL
364/1 Sri Ayutdhaya ., Ratchatevee., Bangkok 10400  Thailand
Tel: +66 2201 4600 Ext.2148 Email: ircp1@phyathai.com

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