Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy

Abstract

Introduction

It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this clinical problem while receiving various pharmacological or endocrine treatments or radiotherapy.

Aim

To determine clinical and diagnostic exams required to confirm the presence of VVA (also referred to as atrophic vaginitis, urogenital atrophy, or genitourinary syndrome of menopause) and rule out other genital or pelvic clinical conditions.

Materials and methods

Literature review searches were carried out on the main scientific article search engines (PubMed, SciELO, Cochrane) using different clinical terms, treatments or interventions and comorbidity related to VVA.

Results

The development and severity of VVA depend mainly on the duration of hypoestrogenism. Hypoestrogenism causes changes in the urogenital tissue, generating signs and symptoms, such as dryness, burning, soreness, itching, and irritation of the genital skin. The diagnosis can be made through anamnesis (patient history), questionnaires, physical exam, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be completed with the Vaginal Health Index, the Vaginal Maturation Index, or vaginal pH in the absence of infection or semen. The exclusion of other vulvovaginal organic pathology is essential to reach an accurate diagnosis and provide adequate treatment.

Conclusions

The specialist should be able to identify VVA, rule out other pathologies that make a differential diagnosis and conduct proper management.

绝经后外阴阴道萎缩的临床表现及评价 摘要

简介：据估计, 50% 的女性会遭受与更年期相关的严重外阴阴道萎缩 (VVA)。同样, 年轻女性在接受各种药物或内分泌治疗或放射治疗时可能会暂时出现这种临床问题。

目的：确认 VVA（也称为萎缩性阴道炎、泌尿生殖道萎缩或更年期泌尿生殖系统综合征）存在所需的临床和诊断检查, 并排除其他生殖器或盆腔临床疾病。

材料与方法：对主要科学文献检索进行文献综述检索, 引擎（PubMed、SciELO、Cochrane）使用不同的临床术语、治疗或干预以及与 VVA 相关的共病。

结果：VVA 的发展和严重程度主要取决于雌激素不足的持续时间。雌激素不足会导致泌尿生殖组织发生变化, 产生体征和症状, 例如生殖器皮肤干燥、灼热、酸痛、瘙痒和刺激。诊断可以通过病史（患者病史）、问卷调查、体检, 有时还包括补充检查。客观的阴道评估是必不可少的, 可以通过阴道健康指数、阴道成熟指数或在没有感染或精液的情况下阴道 pH 值来完成。排除其他外阴阴道器质性病变对于准确诊断和提供充分治疗至关重要。

结论：专家应该能够识别 VVA, 排除其他可进行鉴别诊断的病理并进行适当的管理。

Keywords:

• Menopause
• vulvovaginal atrophy
• genitourinary syndrome of menopause
• dyspareunia
• diagnosis
• women’s sexual health
• atrophic vaginitis

Disclosure statement

PVB received travel and speaker fees from Seegene^®, Roche^®, and Merck^®. The other authors have declared they have no conflicts of interest.