Vulvovaginal atrophy is a common symptom of atrophic vaginitis (also referred to as the genitourinary syndrome of menopause or GSM) and can occur in both perimenopausal and postmenopausal women. If a patient reports vaginal dryness consider the following:
Prasterone is an approved, steroid-based FDA treatment for postmenopausal vaginal atrophy. Use is appropriate for women who complain of dyspareunia, or general discomfort due to dryness and thinning of the vaginal mucosa.
FDA approves Intrarosa for postmenopausal women experiencing pain during sex
FDA: Prescribing information for Intrarosa (prasterone)
ACOG Committee Opinion No. 659: The Use of Vaginal Estrogen in Women With a History of Estrogen Dependent Breast Cancer
Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management
A patient presents with vaginal inflammation with discharge, pain and/or itching. Next steps should include
Perform “Whiff Test” with 10% KOH and Microscopy with Saline
Determine Vaginal pH
If pH is Elevated (>4.7) Consider the Following
Vaginitis is a general term for disorders of the vagina, but does not indicate the underlying cause. Vaginitis may result from infection, inflammation, or may reflect changes in the normal vaginal microbiome. The disorder is termed vulvovaginosis when the vulva is involved. When patients present with symptoms of itching/burning/irritation/dyspareunia/discharge consider a broad range of possibilities including but not limited to the triad of bacterial vaginosis (BV), trichomoniasis and vulvovaginal candidiasis. Office based tests such as those above also have a low sensitivity. Accurate diagnosis may require a combination of a careful history, vulvar or vaginal biopsy and appropriate culture.
ACOG Practice Bulletin 215: Vaginitis in Nonpregnant Patients
Vaginitis: Diagnosis and Treatment
Advances in Diagnosing Vaginitis: Development of a New Algorithm
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