Other Causes of Vulvovaginitis

OTHER CAUSES OF VULVOVAGINITIS

Atrophic vaginitis is defined as atrophy of the vaginal ep-ithelium due to diminished estrogen levels. Although more common in postmenopausal women, atrophic vaginitis can be observed in younger premenopausal women. Estrogen status plays a crucial role in determining the normal state of the vagina. When estrogen levels decrease, there is loss of cellular glycogen with resulting loss of lactic acid. In the prepubertal and postmenopausal states, the vaginal epithe-lium is thinned, and the pH of the vagina usually is elevated (4.7 or greater). Loss of elasticity in the connective tissue may also occur, resulting in shortening and narrowing of the vagina. The urinary tract may also be affected and may demonstrate atrophic changes. Patients with atrophic vaginitis may have an abnormal vaginal discharge, dryness, itching, burning, or dyspareunia. Typical urinary symp-toms include urgency, frequency, recurrent urinary tract infections, and incontinence. Atrophic vaginitis is treated with topical or oral estrogen therapy.

Desquamative inflammatory vaginitis is generallyseen in perimenopausal and postmenopausal women, and is characterized by purulent discharge, exfoliation of epithe-lial cells with vulvovaginal burning and erythema, relatively little lactobacilli and overgrowth of gram-positive cocci; usually streptococci are seen. Vaginal pH is greater than 4.5. Initial therapy is clindamycin cream 2%, applied daily for 14 days.