Vulvovaginal Atrophy, Genital Menopause Syndrome: Test and Diagnosis

Depending on the symptomatology, examinations concerning the bladder, vulva, and vagina and, to clarify menopausal symptoms, hormone status are useful and necessary. Laboratory parameters of the 1st order – obligatory laboratory examinations

Bladder/urethra

  • Urinalysis by test strip:
    • A rapid test for nitrite detects nitrite-forming bacteria in the urine, if necessary. [Nitrate detection in urinary tract infection (UTI): 95% with a positive nitrate test have positive cultures, although 45% with a negative test]Leukocyturia may also be detectable. [according to German S3 guidelines, a HWI is considered likely if nitrite or leukocyte esterase test positive].
    • Urine pH values > 7.0 in the pH daily profile = indication of a urinary tract infection with urease-forming bacteria (risk of infection stone formation).
  • Urine sediment
  • Urine culture (pathogen detection and resistogram) from midstream urine possibly catheter urine in acute chronic recurrent cystitis (recurrent cystitis.

Note: further details on the clarification of urinary tract infection or chronic recurrent infections see chapter cystitis (cystitis).

Vulva / vagina

  • Amine test (Whiff test) – by sprinkling the vaginal secretion (vaginal secretion) with a 10% potassium hydroxide solution typical fishy smell (= amine colpitis).
  • Measurement of the pH of the vaginal secretion [alkaline?]
  • Phase contrast microscopy of vaginal secretion – live, unstained cells appear extremely low contrast in a normal brightfield microscope, these are clearly visualized by the phase contrast technique

Hormone parameters

  • FSH (follicle-stimulating hormone).
  • LH (luteinizing hormone)
  • 17-beta estradiol

Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.

Bladder/Urethra

  • Small blood count
  • Inflammatory parameters – CRP (C-reactive protein) or PCT (procalcitonin).
  • Fasting glucose (fasting plasma glucose).
  • If necessary, exclusion of venereal disease – in cystitis with adnexitis, colpitis.
  • Urine cytology
  • BK (polyoma) virus DNA detection – in immunocompromised individuals, BK virus can lead to hemorrhagic cystitis.

Vulva/Vagina

  • Bacteriological/mycological/virological culture – cultivation of bacteria/fungi from the vulva and/or from vaginal secretions in recurrent colpitids.
  • Virus detection
    • Molecular genetic diagnostics (DNA or PCR): HIV (AIDS), herpes simplex virus type 1/2 (genital herpes), human papilloma virus (HPV; condylomata acuminata).
    • Other detection: herpes viruses:
      • From vesicle smear applied to a microscope slide. Determination of the virus type by fluorescence test using type-specific immune sera if necessary direct antigen test (fluorescence test).
      • Histologically after biopsy
      • Colposcopic: dabbing with 3% acetic acid (affected skin areas turn white).
      • Cytological smear
  • Parasite detection (microscopic): crabs (pediculosis pubis), mites, oxyuras, scabies, Trichomonas vaginalis (trichomoniasis).
  • Antibodies against Chlamydia trachomatis, HSV type 1 u. 2, HIV, Treponema pallidum (TPHA, VDRL etc.) – due toexclusion of sexually transmitted infections.
  • Biopsy for histological examination
  • Cytology

Hormone parameters

  • TSH
  • Prolactin
  • Estrone

If necessary, further (as far as not yet determined).