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Atrophic vulvovaginitis

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. Reviewed by Dr Jennifer Bradford, Gynaecologist, Sydney, Australia. Updated by Dr Oakley, February 2014.


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Atrophic vulvovaginitis — codes and concepts
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What is萎缩vulvovaginitis?

Atrophic vulvovaginitis means thinnedgenitaltissues in women. Often it is shortened to atrophic vaginitis, as it is阴道ltissue that is most often symptomatic. Due its患病率in older women, it is also known as senile vulvovaginitis.

是什么引起萎缩性外阴毒素炎?

Atrophic vulvovaginitis is associated withoestrogendeficiency due to:

  • Menopause
  • Lactation
  • 高细胞菌血症
  • High-dose孕酮medicines
  • 胸部cancermedication, such as tamoxifen and aromatase抑制剂

What are the symptoms of atrophic vulvovaginitis?

雌激素的不足也可能导致dysuria(通过尿液时燃烧的感觉),尿液紧急,频率和尿失禁(泌尿生殖综合征更年期)。

细菌in the vagina

Lack of oestrogen causes changes in the normal vaginal有机体。那些在年轻女性中看到的那些(尤其是乳杆菌) disappear and are replaced by gram negative organisms such as Escherichia coli or those associated withbacterial阴道病。Urinary or bladder感染s在绝经后妇女中比在年轻女性中更常见。

What does an atrophicvulvaand vagina look like?

Atrophic vulvovaginitis changes the appearance of the female生殖器:

  • 外阴看起来更苍白
  • 阴唇are thinner and smaller
  • 阴蒂引擎盖不太明显
  • A red membrane or polyp may be visible at尿道开口(尿道旋律)
  • 阴道皮肤看起来薄干燥,很小血管在它的下导致发红
  • Stretching the vulva may cause splitting of the skin at the bottom of the vagina or elsewhere.

Should any tests be done to confirm the diagnosis?

Tests may be performed in atrophic vulvovaginitis if any symptoms are present. These may include:

  • 皮肤拭子 /wet mountexamination – this may revealepithelial可能会报告绝经后阴道的典型细胞,并可以帮助识别感染
  • Biopsy- 这可能是为了确保没有inflammatoryskin disease or肿瘤疾病导致症状
  • 膀胱的膀胱镜检查和尿症状的研究
  • Colposcopyof the vagina and宫颈和妇科症状的调查。

General measures to improve atrophic vulvovaginitis

建议采取以下措施。

  • 使用非肥皂cleanser或单独用温水轻轻洗涤,每天不超过一次或两次
  • Applyemollient奶油suitable for sensitive skin or petroleum jelly if the vulva feels dry or itchy
  • 使用润滑剂进行性交 - 如果刺痛,请尝试其他或使用石油或石油果冻
  • 阴道保湿剂的试验
  • 抗胆碱能,antihistamine,充血或抗抑郁药可能导致干燥;如果服用这些,请考虑停止
  • Short-term use of局部类固醇may be necessary for皮炎caused byirritantssuch as urine, panty liner or tight clothing

雌激素治疗

Atrophic vulvovaginitis is treated with topical oestrogen, a prescription medicine. This can be provided as vaginal cream, pessaries or vaginal ring. In New Zealand, Ovestin™, which contains oestriol, is used in a dose of 0.5 mg/day for 1–2 weeks then once or twice weekly. It can be inserted with an applicator or on a fingertip. Vagifem™ pessaries (containing oestrodiol) can also be used but are not currently funded by PHARMAC in New Zealand.

雌激素治疗results in:

  • 阴道壁细胞的归一化
  • 改善阴道血流
  • Decreased vaginalph
  • 乳酸杆菌重新化
  • 改善阴道厚度和弹性
  • Reduction invulvovaginalsymptoms
  • 改善性功能
  • 减少尿感染。

局部雌激素被认为是安全的,因为很少有系统地吸收。但是,它通常不给患有严重肝病,雌激素的女性开具依赖癌症或血栓栓塞疾病,以防这些疾病的风险。

有时建议使用其他形式的雌激素,包括片剂,透皮斑块,凝胶,喷雾和乳液。Systemicoestrogen is usually mixed with progestogens. There are important risks and side effects so they are not usually used if atrophic vaginitis is the only problem.

阴道雌激素治疗的副作用和风险

Topical oestrogen may cause side effects, including:

  • Vaginal itching and burning
  • Increased risk of vaginal Candida albicans infection (阴道l thrush)
  • 胸部discomfort (uncommon)
  • Vaginal bleeding (rare).

当每周一次或两次使用一次时,不会出现雌激素的较高剂量或递送方式所描述的其他副作用。

其他治疗萎缩性外阴毒素炎的治疗方法

Experimental options for vulvovaginal rejuvenation in symptomatic women that are unsuitable for or intolerant of local or systemic oestrogen therapy include:

Optimum regimens, effectiveness and safety of these procedures are as yet undetermined.

参考

  • 雌激素替代疗法用于治疗绝经后的泌尿生殖道功能障碍Smith A L, Wein A J. Discovery Medicine
  • Arunkalaivanan A, Kaur H, Onuma O. Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int Urogynecol J. 2017 May;28(5):681-685. doi: 10.1007/s00192-017-3282-y. Epub 2017 Feb 2.PubMed
  • Vanaman M,Bolton J,Placik O,Guillen FabiS。非手术女性生殖器复兴的新兴趋势。皮肤手术。2016年9月; 42(9):1019–29。doi:10.1097/dss.0000000000000697。PubMed PMID:27153040。PubMed
  • Arroyo C. Fractional CO(2) laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Womens Health. 2017 Aug 28;9:591–595. doi: 10.2147/IJWH.S136857. eCollection 2017. PubMed PMID: 28894392; PubMed Central PMCID: PMC5584900.杂志

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