Atrophic vaginitis or vaginal dryness may affect up to 40 per cent of postmenopausal women.1 It is thought that most women with atrophic vaginitis do not present with their symptoms and atrophic vaginitis is often under-diagnosed. Atrophic vaginitis is related to oestrogen deficiency.1
A reduction in oestrogen levels results in thinning of the endometrial and vaginal lining with an increase in vaginal pH. These changes can predispose women to urogenital infections.1 Menopause is the commonest cause of oestrogen deficiency. Atrophic vaginitis may occur in younger women with oestrogen deficiency, for example those women who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy who subsequently have a surgically induced menopause. Other causes also include hyperprolactinaemia, chemotherapy and radiation therapy, as well as medications such as tamoxifen and danazol.2 Lack of sexual intercourse, smoking and nulliparity can also cause the condition.1
Oestrogen stimulates the vaginal epithelium to produce glycogen which acts as a substrate for lactobacilli, which in turn produce lactic acid.1 Furthermore, oestrogen deficiency results in connective tissue proliferation and elastin breakdown, which may cause fissuring and ecchymoses.1 These tissue changes might affect the urogenital system.