1. Atrophic vaginitis and Lichen sclerosus Kalpana Navaratnarasah GPVTS ST2

2. 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

3. 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.

4. 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

5. 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.

6. 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

7. 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

8. Lichen sclerosus

9. 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

10. Diagnosis Typical appearance Vulval biopsy under LA Routine blood test for autoimmune conditions e.g. TFTs Associated with small risk of developing vulval cancer

11. 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

12. Cancer risk Small risk of developing cancer Regular follow-up Vulva cancer – 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