Atrophic vaginitis and Lichen
sclerosus
Kalpana Navaratnarasah
GPVTS ST2
Atrophic vaginitis
• Atrophic vaginitis is inflammation of the
vagina due to thinning tissue and decreased
lubrication.
• Low oestrogen – Menopause, drugs, RXT/CXT
• Oestrogen – Affects glands that produce fluids and mucus
and keep vagina moist
Causes lining of vagina to be more elastic and
thicker
Stimulates cells to produce glycogen
Lack of oestrogen
• Thinning of tissues around vaginal area
• Reduction in number of glands producing
mucus
• Lose of fat tissue around genital area
• Vagina – less elastic, shorter and more dry
• Changes can take months to years after onset
of menopause
• 50% of women experience some Sx.
Symptoms
• Dyspareunia – smaller, less lubricated and
more sensitive
• Discomfort/pain – vagina or vulva inflamed
• Vaginal discharge – Due to infection
• Itch – Itch/scratch cycle
• Urinary Sx – Due to thinning and weakening of
tissues around the neck of bladder and
urethra e.g. urgency, recurrent UTIs
Treatment
• Lubricating gels – Vaginal dryness and
dyspareunia
• Oestrogen creams – Cream , pessary, vaginal
ring. Every day for 2 weeks and twice weekly
for further 3 months. Localised treatment.
• HRT – If other menopausal symptoms also a
problem.
Lichen sclerosus
• Skin condition that affects the vulva of women
(less commonly affects other areas of skin)
• Affects 1/1,000 women
• In males typically affects the foreskin and end of
penis
• 15% of cases occur in children
• Small ‘pearly white spots’ on the vulva which may
become larger and join together
• Skin around the anus can be affected
• Skin condition – does not extend to vagina or anus
Symptoms
• White irregular spots
• Skin becomes white and thickened
• Inflammation may develop and cause splitting
and cracking of skin. Blistering
• Scar formation – vulva shrinks in size and
tightening of vagina opening
• Itch and irritation
• Painful intercourse
• Susceptibility to infections
Lichen sclerosus
Cause
• Cause not clear
• Genetic susceptibility to an autoimmune
reaction which is triggered by infection
• Possible link with other auto-immune
conditions e.g. thyroid disease, vitiligo
• Possible link with Borrelia infection – 25% of
cases have antibodies to the organism
• Not sexually transmitted
Diagnosis
• Typical appearance
• Vulval biopsy under LA
• Routine blood test for autoimmune conditions
e.g. TFTs
• Associated with small risk of developing vulval
cancer
Treatment
• Topical steroid treatment – Potent steroids
may be used. Initially for 3 months
• Regular Emollients – avoid scented soaps,
bubble baths etc
• Antibiotics/Antifungals – Infection
• Vaginal dilator/surgery – vaginal narrowing
• Circumcision in men
Cancer risk
• Small risk of developing cancer
• Regular follow-up
• Vulva cancer
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Itching soreness, burning of vulva
Lump, swelling or growth like wart
Bleeding or blood stained discharge
Pain in vulva
Ulcerated area
Mole changes shape, size, colour