Vaginal dryness is a pathological condition that occurs under the influence of hormonal and non–hormonal causes that lead to thinning of the vaginal mucosa. It is manifested by a decrease in vaginal discharge, discomfort, itching and burning in the area of the vagina and vulva, painful sensations during sexual intercourse and blood secretions after it. To make a diagnosis, a gynecological examination, an extended colposcopy, colpocytological and bacteriological examination are carried out, the level of hormones is determined. Hormone replacement therapy, antibacterial and anti-inflammatory drugs are used in complex treatment.
General information
In the vast majority of cases, vaginal dryness occurs in women of menopausal age. According to numerous studies, 5-6 years after the onset of menopause, this pathological condition is detected in every second woman, and 15 years after the last menstruation — in 70-80% of the surveyed. According to experts in the field of gynecology, during postmenopause without replacement correction of estrogen deficiency, atrophic processes in the vaginal mucosa occur in almost all women. In recent years, there has been a tendency to rejuvenate the disease, which is associated with an increase in the frequency of early menopause and the number of radical gynecological operations.
What causes vaginal dryness
The main cause of atrophic changes in the vaginal epithelium is permanent or temporary hypoestrogenemia. The dryness of the vaginal mucosa is most often caused by:
- Age-related decrease in estrogen secretion. Atrophic vaginitis is one of the most common female diseases in the postmenopausal period.
- Radical gynecological operations. Deficiency of female sex hormones occurs after surgical removal of the ovaries or uterus with appendages.
- Radiation therapy. A decrease or loss of the endocrine function of the ovaries and a violation of epithelial regeneration are observed after irradiation of the pelvic organs in the treatment of oncopathology.
- Hormonal imbalance. The secretion of estrogens is disrupted by damage to the ovaries and brain structures that regulate the production of hormones, or drug suppression of the function of these organs.
- Temporary hypoestrogenemia. Signs of dryness of the vaginal mucosa can also be noted during pregnancy, lactation, before menstruation or against the background of oral contraceptives.
Not only hormonal disorders lead to the development of permanent or transient atrophic vaginitis. Epithelial regeneration is also disrupted by factors that directly affect the vaginal mucosa. The cause of local irritation, inflammatory or allergic reactions may be douching solutions, intimate hygiene products, barrier contraceptives, vaginally administered medications, conditionally pathogenic and pathogenic microflora.
Predisposing factors contributing to the pathological thinning of the vaginal mucosa are decreased immunity, low motor activity, obesity, smoking, eating spicy foods, wearing underwear made of low-quality synthetics, promiscuous sex life. Atrophic colpitis is more often diagnosed in patients suffering from diabetes mellitus, HIV, thyroid diseases. As a separate symptom, dryness in the vagina is observed in Sjogren’s disease.
Pathogenesis
With estrogenic insufficiency, regeneration of the multilayered flat vaginal epithelium slows down. The mucous layer gradually thinns, the secretion of epithelial glands decreases, the number of glycogen-containing cells decreases. Glycogen deficiency leads to a decrease in the number of lactobacilli that create a protective acidic environment of the vagina. Against the background of gradual alkalinization, conditionally pathogenic microorganisms that cause local inflammation are activated. An additional link in the pathogenesis is a decrease in the amount of hyaluronic acid, which retains water in the tissues. As a result of these changes, the mucous membrane of the vaginal walls becomes dry, more sensitive to various influences, which forms a typical clinical picture of the disease.
The mechanism of development of inflammatory-atrophic processes under the influence of non-hormonal factors is generally similar to changes in hypoestrogenemia, but in such cases, the leading role is played by a decrease in the number of epithelial cells due to their destruction and delayed regeneration. Atrophy of the vaginal epithelium is often combined with similar processes in the area of the external genitalia.
Vaginal dryness symptoms
In the initial stages, the disease is asymptomatic. Over time, patients note a decrease and complete cessation of vaginal discharge. Subsequently, there is dryness and itching in the vagina, burning in the labia minora during urination, when using soap or hygienic gels. Due to the insufficient amount of lubricant, the patient experiences discomfort and pain during sexual intercourse, at the end of which minor bleeding may occur. The addition of a secondary infection is manifested by an increase in painful sensations in the vagina and the appearance of scanty whites with a specific unpleasant odor.
Complications
The processes leading to vaginal dryness may be complicated by recurrent nonspecific colpitis. The combination of microtraumas of thinned mucosa with a violation of normal vaginal biocenosis creates ideal conditions for the rapid development of opportunistic and pathogenic microorganisms. In the absence of adequate treatment, the disease quickly turns into a chronic phase and is difficult to treat, which significantly worsens the patient’s quality of life. The spread of inflammation to nearby organs leads to the occurrence of urethritis, cystitis, endometritis, oophoritis, adnexitis. When the peritoneal tissue and peritoneum are involved in the process, parametritis, perisalpingitis and even general peritonitis can develop.
Diagnostics
The development of atrophic vaginitis can be suspected on the basis of specific complaints in a climacteric patient or when non-hormonal factors causing vaginal dryness are detected. Confirm the diagnosis allow:
- Examination on the chair. The vaginal mucosa looks thinned, pale, smoothed. It visualizes small red erosions and edematous hyperemic areas of inflammation with serous or serous-purulent plaque. Contact bleeding is observed. The pH of the vagina is increased to 5.5-7.
- Extended colposcopy. When examined under a special microscope, thinning of the mucosa and areas of hemorrhage are revealed. During the Schiller test, the mucosa, in which there is no glycogen, is colored weakly and unevenly.
- Colpocytological examination. The index of maturity of the vaginal epithelium is reduced, parabasal and basal cells predominate.
- A smear on the flora. The white blood cell level is elevated. The content of lactobacilli is sharply reduced, conditionally pathogenic microflora or STI pathogens can be determined.
- Determination of estradiol level . It is usually indicated for women of reproductive age with vaginal dryness and possible violation of the secretory function of the ovaries.
To clarify the condition of the internal genitalia, the patient is additionally prescribed ultrasound and pelvic tomography. To exclude the infectious nature of the pathological process, seeding for flora, PCR diagnostics, ELISA, REEF are used. The disease is differentiated with infectious vaginitis, candidomycosis, neoplasia. In doubtful cases, an oncogynecologist, a dermatovenerologist, a rheumatologist are involved in the diagnosis (if Sjogren’s syndrome is suspected).
Vaginal dryness treatment
The choice of therapeutic tactics is determined by the causes of pathology, the age of the woman, the condition of the mucosa and the presence of complications. In the complex of treatment of vaginal epithelial dryness caused by hypoestrogenemia,
- Hormone replacement therapy is used. Estrogenic or combined estrogen-progestogenic drugs are the most effective. Female sex hormones are taken orally, used as a patch or topically (candles, rings and ointments). In addition to synthetic drugs, phytohormonal agents can be prescribed.
- Antibacterial drugs. Recommended for the development of acute nonspecific colpitis. Before prescribing an antibiotic, the pathogen and its sensitivity are determined.
- Local anti-inflammatory treatment. Emulsions, ointments, creams, candles, baths and douches reduce the inflammatory component of the disease, improve tissue trophism and promote faster mucosal recovery.
- Restoration of normal microflora. Intravaginal use of drugs with lactic acid bacteria culture inhibits the growth of opportunistic flora.
With the development of vaginal dryness due to non-hormonal causes, therapy is aimed at relieving allergic and inflammatory reactions, stimulating tissue regeneration and general immunity. Regardless of the causes of the disease, general tonic agents and physiotherapeutic techniques selected taking into account contraindications are effective in complex therapy. During treatment, it is necessary to correct the diet with the enrichment of the diet with vegetable and lactic acid products, with the exception of pickles, smoked meats, spicy and fatty dishes.
Prognosis and prevention
Timely treatment allows you to completely get rid of vaginal dryness caused by temporary hypoestrogenemia and most non-hormonal causes, as well as significantly improve the quality of life of a woman in all other cases. Preventive measures include regular gynecologist examinations to identify preclinical signs of atrophic colpitis that occurs in postmenopause, after gynecological operations, against the background of hormonal and radiation therapy. It is effective to prescribe HRT for the correction of menopausal and postovariectomy disorders. Taking into account predisposing factors, in order to prevent women over the age of 40, it is recommended to give up smoking, sufficient motor activity, compliance with the rules of intimate hygiene, wearing cotton underwear.
