Symptoms
Possible symptoms include vulvovaginal dryness, itching, inflammation, burning, feeling of pressure, discharge, light bleeding, pain during sexual intercourse, and local infectious disease. The urinary tract may be involved, manifested, for example, by frequent and painful urination, cystitis, blood in the urine, and urinary incontinence.
Causes
A common cause of symptoms is vaginal atrophy in women during and after menopause, which is due to the natural lack of estrogen and the regression of the mucosa. Estrogens are produced by the ovary and are important for normal tissue structure, blood flow, moisturization and elasticity. The hormones stimulate the formation of glycogen, which is converted to lactic acid by lactobacilli and provides a locally acidic environment. However, vaginal dryness can occur at any age. In addition to the natural aging process, other causes may be responsible:
- Drugs such as estrogen antagonists, cytostatics, contraceptives, antidepressants, parasympatholytics.
- Radiotherapy, breast cancer therapy
- Sjögren’s syndrome
- Pregnancy and lactation
- Surgical procedures: removal of the ovaries before menopause.
- Systemic diseases, local infectious diseases
- Smoking
- Excessive intimate hygiene
Diagnosis
The diagnosis is made at the gynecologist. This must exclude other diseases that cause similar symptoms. These include vaginal fungus and sexually transmitted diseases such as genital chlamydial infection and trichomoniasis.
Nonpharmacologic treatment
- Avoid irritants such as soaps, deodorants and spermicides.
- Sexual activity is recommended.
- Use of a lubricant.
- Quitting smoking.
Drug treatment
Estrogens:
- Such as estradiol, estriol, and promestriene are used systemically in the form of tablets, transdermal preparations, as well as locally in the form of vaginal suppositories, vaginal tablets, vaginal rings, and vaginal creams for treatment. They substitute the reduced amount of hormone and are considered to be well effective. Systemic treatment has the advantage that other symptoms such as hot flushes can be positively influenced at the same time, but it carries the risk of undesirable effects, especially if the treatment is prolonged. Used are also related agents such as tibolone.
Moisturizing and nourishing products:
- With substances such as hyaluronic acid and cellulose derivatives such as hydroxyethylcellulose, for example, are applied locally as vaginal gels, nourishing oils or vaginal suppositories and have hydrating and nourishing properties. They are usually cosmetics or medical devices.
Probiotics:
- Lactobacilli, lactic acid and glycogen, among others, are used to strengthen and substitute the vaginal environment.
Anti-infectives:
- Such as antifungals, antiseptics, antibiotics, antiviralia, and antiparasitics are used when a concurrent infection is present.
Other agents:
- Whether herbal medicines and alternative medicines such as black cohosh, red clover, wild yam, phytoestrogens, vitamin E, vitamin D and DHEA are effective for treatment is controversial.
