No desire

Vaginal dryness  - A pathological condition that occurs under the action of hormonal and non-hormonal causes leading to thinning of the mucous membrane of the vagina .Manifested by a decrease in vaginal discharge, discomfort, itching and burning sensation in the vagina and vulva, painful sensations during sexual intercourse and succinic discharge after it.For diagnosis, a gynecological examination, extended colposcopy , colpocytology and bacteriological examination are carried out , and hormone levels are determined.In complex treatment, hormone replacement therapy, antibacterial and anti-inflammatory drugs are used.  

Vaginal dryness

In most cases, vaginal dryness occurs in women of menopausal age.According to numerous studies, 5-6 years after the onset of menopause, this pathological condition is detected in every second woman, and 15- 15 years after the last menstruation - in 70-80% of those examined.According to experts in the field  gynecology , during postmenopause without replacement correction of estrogen deficiency atrophic processes in the vaginal mucosa occur in almost all women.In recent years, there has been a tendency to rejuvenate the disease, which is associated with an increase in the frequency  early menopause  and the number of radical gynecological operations.

Causes of vaginal dryness

The main cause of atrophic changes in the vaginal epithelium is permanent or temporary hypoestrogenemia .To the dryness of the mucous membrane of the vagina most often lead:

• Age-related decrease in estrogen secretion .Atrophic  vaginitis  - One of the most common female diseases in the postmenopausal period.
• Radical gynecological surgery .Deficiency of female sex hormones occurs after surgery.  ovarian removal  or uterus with appendages.
• Radiation therapy .Reduction or loss of endocrine function of the ovaries and impaired regeneration of the epithelium are observed after irradiation of the pelvic organs in the treatment of oncopathology .
• Hormonal imbalance .Estrogen secretion is impaired by damage to the ovaries and brain structures that regulate hormone production, or drug suppression of the function of these organs.
• Temporary hypoestrogenemia .Signs of dryness of the vaginal mucosa can also be observed during pregnancy, lactation, before menstruation, or in the background of oral contraceptives.

Not only hormonal disorders lead to the development of permanent or transient atrophic vaginitis.Regeneration of the epithelium also violate the factors that act directly on the vaginal mucosa.Symptoms for douching, intimate hygiene products, barrier contraceptives, vaginally injected drugs, conditionally pathogenic and pathogenic microflora can be the cause of local irritation, inflammatory or allergic reactions.

Predisposing factors that contribute to the pathological thinning of the vaginal mucosa, are reduced immunity, low motor activity,  obesity , smoking, eating spicy foods, wearing low-quality synthetic linen, promiscuous sex life.  Atrophic colpitis  more commonly diagnosed in patients suffering  diabetes,  HIV , thyroid disease.As a separate symptom, dryness in the vagina is observed when  Sjogren disease .

Pathogenesis

When estrogen deficiency slows the regeneration of stratified squamous vaginal epithelium.The mucous layer gradually becomes thinner, the secretion of secretion by the epithelial glands decreases, the number of glycogen-containing cells decreases.A deficiency of glycogen leads to a decrease in the number of lactobacilli , creating a protective acidic environment of the vagina.Against the background of gradual alkalization, conditionally pathogenic microorganisms are activated, causing local inflammation.An additional link in pathogenesis is the reduction of the amount of hyaluronic acid that retains water in the tissues.As a result of these changes, the mucous walls of the vagina become dry, more sensitive to various influences, which forms the typical clinical picture of the disease.

The mechanism of development of inflammatory and atrophic processes when exposed to non-hormonal factors is generally similar to changes in hypoestrogenaemia , but in such cases, the reduction in the number of epithelial cells due to their destruction and slower regeneration plays a leading role.Atrophy of the vaginal epithelium is often combined with similar processes in the external genitalia.

Symptoms of vaginal dryness

In the initial stages of the disease is asymptomatic.Over time, patients notice a decrease and complete cessation of vaginal discharge.Subsequently, dryness and itching of the vagina, burning in the region of the labia minora when urinating, using soap or hygienic gels.Due to an insufficient amount of lubrication, the patient experiences discomfort and pain during intercourse, at the end of which slight serous discharge can be observed.The attachment of a secondary infection is manifested by increased painful sensations in the vagina and the appearance of scanty whiter with a specific unpleasant odor.

Complications

Processes leading to vaginal dryness may be complicated by recurrent non-specific  colpitis .The combination of microtraumas of a thinned mucous membrane with a disturbance of the normal vaginal biocenosis creates ideal conditions for the rapid development of opportunistic and pathogenic microorganisms.In the absence of adequate treatment, the disease quickly enters the chronic phase and is difficult to treat, which significantly impairs the patient's quality of life.The spread of inflammation to adjacent organs leads to  urethritis,  cystitis,  endometritis ,  oophoritis ,  adnexitis .With the involvement of the circulatory tissue and peritoneum in the process  parametritis , perisalpingitis and even common  peritonitis .

Diagnostics

The development of atrophic vaginitis can be suspected on the basis of specific complaints in a patient of climacteric age or in the detection of non-hormonal factors causing vaginal dryness.Confirm the diagnosis allow:

• Inspection on the chair .Vaginal mucosa looks thinned, pale, smoothed.On it, small red erosion and edematous hyperemic zones of inflammation with serous or serous-purulent bloom are visualized.There is contact bleeding.Vaginal pH increased to 5.5-7.
• Extended colposcopy .In the study under a special microscope revealed thinning of the mucous membranes and areas of hemorrhage.When conducting  Schiller test  mucosa, in which there is no glycogen, stains weakly and unevenly.
• Colpocytological study .The maturity index of the vaginal epithelium is reduced, parabasal and basal cells prevail .
• Smear on the flora .Leukocyte count increased.The content of lactobacilli is sharply reduced , conditionally pathogenic microflora or STI pathogens can be determined.
• Determination of estradiol  .It is usually indicated for women of reproductive age with dry vagina and possible impaired ovarian secretion.

To clarify the condition of the internal genital organs, the patient is additionally prescribed an ultrasound scan and pelvic tomography.To exclude the infectious nature of the pathological process, use is made of seeding for flora, PCR diagnostics, ELISA, and RIF.The disease is differentiated from infectious vaginitis,  Candidomycosis , neoplasia.In doubtful cases, the oncogynecologist is attracted to the diagnosis ,  dermatologist ,  rheumatologist  (for suspected Sjogren syndrome ).

Treatment for vaginal dryness

The choice of therapeutic tactics is determined by the causes of pathology, the age of the woman, the condition of the mucous membrane and the presence of complications.In the complex treatment of vaginal epithelium dryness caused by hypoestrogenemia , apply:

• Hormone replacement therapy .The most effective estrogen or combined estrogen-progestin drugs.Female sex hormones are taken orally, used as a patch ortopically (candles, rings and ointments).In addition to synthetic drugs, phytohormone preparations can be prescribed.
• Antibacterial drugs .Recommended for the development of acute nonspecific colpitis .Before the appointment of the antibiotic is determined by the pathogen and its sensitivity.
• Local anti-inflammatory treatment .Emulsions, ointments, creams, suppositories, baths, and douching reduce the inflammatory component of the disease, improve tissue trophism, and help the mucous membranes to recover more quickly.
• Restoration of normal microflora .Intravaginal use of lactic acid bacteria culture inhibits the growth of conditionally pathogenic flora.

With the development of vaginal dryness due to non-hormonal causes, therapy is aimed at stopping allergic and inflammatory reactions, stimulating tissue regeneration and general immunity.Regardless of the causes of the disease, complex bracing means and physiotherapeutic techniques, selected with consideration of contraindications, are effective in complex therapy.During treatment, correction of the diet with the enrichment of the diet with vegetable and lactic acid products, with the exception of pickles, smoked meats, spicy and fatty foods is necessary.

Prognosis and prevention

Early treatment can completely eliminate the dryness of the vagina caused by temporary hypoestrogenesis and most non-hormonal causes, as well as significantly improve the quality of life for women in all other cases.Preventive measures include regular examinations of the gynecologist to identify preclinical signs of atrophic vaginitis that occurs in postmenopausal women, after gynecological surgeries, on the background of hormonal and radiation therapy.Effectively prescribing HRT for the correction of menopausal andpostovariectomy disorders.Taking into account the predisposing factors, in order to prevent women aged 40 years and over, quitting smoking, sufficient physical activity, compliance with intimate hygiene rules, wearing cotton underwear are recommended.