QuestionSBA
QuestionChoice
Pelvic muscle retraining is a first-line management strategy for uncomplicated stress urinary incontinence. Whilst this woman has an element of stress incontinence (urine leakage on coughing), she predominantly has symptoms of urge incontinence, likely caused by vulvovaginal atrophy.
49790
d
Refer for pelvic muscle retraining
QuestionChoice
This postmenopausal woman likely has urge incontinence due to atrophic vulvovaginitis/urethritis caused by oestrogen deficiency. Atrophic vulvovaginitis often results in urinary frequency, urge incontinence and dysuria. Vulval atrophy is evidenced by pallor, and vaginal atrophy is evidenced by the narrowed introitus and inability to insert more than one digit. The treatment of choice is topical oestrogen therapy for at least 14 days. Symptoms can be reassessed at this point.
49787
a
Topical oestrogen therapy for at least 14 days
QuestionChoice
Post-void residual urine volume should be measured in people with unexplained urge incontinence to assess for incomplete bladder emptying. This woman has features of vulvovaginal atrophy, so it would be prudent to treat this and reassess. If her symptoms were not resolved with topical oestrogen, an ultrasound scan might be used next.
49789
c
Bladder ultrasound scan for post-void residual urine volume
QuestionChoice
An urgent spinal MRI would be indicated in a patient with recent-onset urinary incontinence accompanied by lower limb weakness, altered perineal sensation or back pain to exclude cauda equina syndrome. This woman does not have an acute onset of urinary incontinence and does not have any other features of cauda equina.
49791
e
Urgent magnetic resonance imaging (MRI) of the spine
QuestionChoice
Whilst this woman has features of urinary tract infection (frequency, dysuria and incontinence), her urine dipstick is clear. She also has no fever, and it is unlikely she has had a urinary tract infection for six months.
49788
b
Urine culture and sensitivity
QuestionComment
Lol
25586
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Body Gastro
QuestionComment
Let's gooooooooo
27829
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Axillary Lung
QuestionComment
wait what? urge incontinence can be caused by vulvovaginal atrophy?
28620
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anon
QuestionComment
i'd never have gotten this 
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Intubation Hypertension
Concept
Chapter
# Summary
  
 
Atrophic vaginitis, also known as vulvovaginal atrophy, is a condition characterised by inflammation and thinning of genital tissues due to reduced oestrogen levels, most commonly seen after menopause. Key signs and symptoms include thinning of vaginal mucosa, loss of pubic hair, narrowed introitus, and vaginal dryness, among others. Key investigations include clinical examination, transvaginal ultrasound, endometrial biopsy if required, and an infection screen. Management strategies primarily involve hormonal treatments, non-hormonal treatments, and in some cases, transvaginal laser therapy.
  
 
# Definition
  
 
Atrophic vaginitis, also known as vulvovaginal atrophy, is characterised by inflammation and thinning of the genital tissues due to a decrease in oestrogen levels. This condition is most common after menopause.
  
 
  

# Aetiology
  
 
The primary cause of atrophic vaginitis is a decline in oestrogen levels, which typically occurs post-menopause.
  
 
# Signs and Symptoms
 
 
  - Thinning of the vaginal mucosa
  - Loss of pubic hair
  - Narrowed introitus
  - Loss of vaginal rugae (folds)
  - Vaginal dryness and itching
  - Dyspareunia
  - Post-coital bleeding
  - Vaginal discharge from inflammation
  - Urinary symptoms such as dysuria and recurrent UTI
  
 
# Differential Diagnosis
  
 
- **Endometrial cancer and endometrial hyperplasia:** presents with post-menopausal bleeding. Ruled out with transvaginal USS and possible biopsy.
- **Sexually transmitted infection:** presents with itching and abnormal discharge. Would have cervical tenderness on bimanual examination and can be diagnosed using vaginal swabs. 
- **Lichen planus:** can cause itchiness and dyspareunia. Would present with pale, dry patches which may be cracked and cause bleeding. 
- **Vaginismus:** also presents with dyspareunia but would not show signs of atrophy on speculum examination. 

  
 
# Investigations
  
 **Bedside:**
 
* Clinical examination, including speculum examination if tolerated, to look for vaginal signs of atrophy. This is usually enough for diagnosis. 
* Vaginal swabs for infection screening if itching of discharge is present.  
 
No bloods, imaging or invasive tests are required. 
  

# Management
  
 
Hormonal treatment:
  
  - Topical oestrogen preparations
  - Systemic hormone-replacement therapy (oral or transdermal)

  
Non-hormonal treatments:

  - Lubricants, which provide short-term improvement to vaginal dryness, alleviating symptoms such as dyspareunia
  - Moisturisers, which should be used regularly

  
 
# References
  
 
  [Patient Info](https://patient.info/doctor/atrophic-vaginitis)
935
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Atrophic vaginitis
Topic
26
Gynaecology
9994
A 58-year-old woman presents to her general practitioner with a six-month history of incontinence.

She feels she needs to pass urine more often and cannot make it to the toilet in time. She often feels a burning sensation when voiding.

Her observations are normal, and a urine dipstick is clear.

She has a past medical history of well-controlled hypertension, osteoporosis and hypothyroidism. She has had a previous hysterectomy for menorrhagia. She is not sexually active.

On examination, her abdomen is soft and non-tender. Her vulval skin is pale, and there is a narrowing of the introitus. A single-digit vaginal examination does not reveal any significant pelvic organ prolapse. On coughing, there is a minor leakage of urine.

What is the most appropriate management?
a