Decline of Vaginal Wall in Menopause

DECLINE OF VAGINAL WALL IN MENOPAUSE 7

Declineof Vaginal Wall in Menopause

Declineof Vaginal Wall in Menopause

Themenopause is perhaps one of the most dreaded stages in the life of anindividual. This is particularly because it seems to mark thebeginning of an end of the productive capacity or life of anindividual. Indeed, the stage comes with a number of changes,particularly in the physical aspects of individuals. Of course, thereare variations in the changes that different genders experience atcertain age. Nevertheless, it is evident that there is always amodification in the levels and types of hormones that are availableor produced in the body. Indeed, not only do some tissues become wornout, but some hormones are depreciably produced. It is, therefore,common for individuals in menopause to suffer from some ailments orconditions that they previously never suffered from. One of these isthe vaginal atrophy, or vulvovaginal atrophy, which entails thereduction of the vaginal lining and elimination of the folds thatallow it to stretch during childbirth and intercourse. (Nappi et l,2013) As noted earlier, this comes during perimenopause as lessestrogen is produced, thereby causing the vulva tissues, as well asthe vaginal lining to become less flexible or elastic, drier and eventhinner. In addition, the vaginal secretions would be reduced therebycausing a reduction of lubrication (Nappi Kokot-Kierepa, 2010).Further, the lower levels of estrogen produced in the body wouldcause the heightening of the pH of the vaginal, thereby making itless acidic as it was prior to the setting of puberty. Volumes ofliterature have been written examining the varied aspects of thisailment or condition, not only with a view to comprehending itsoccurrence and symptoms but also coming up with appropriate ways ofdiagnosing it and treating it effectively.

Scholarsnote that the condition is quite prevalent among menopausal women.Indeed, Lehman, (2009) noted that between 10% and 50% of menopausalwomen across the globe encounter the condition. Of particular note isthe fact that severe vaginal symptoms accompany the vaginal atrophyincluding pain and bleeding in the course of or after intercourse,tenderness, burning, itching and dryness of the vulva. It goeswithout saying that the painful intercourse as a result of thedecrease in lubrication and the dryness may cause women to completelylack interest in intercourse (Nappi Kokot-Kierepa, 2012). Close to57% of menopausal women who are sexually active experiencevulvo-vaginal atrophy, while 55% have some form of sexualdysfunction. Even worse is the fact that it is pretty common forwomen suffering from vaginal atrophy to exhibit urinary symptoms, asclose to 20% of the elderly postmenopausal women experience symptomssuch as hematuria, stress incontinence, urgency, increased frequency,urethral discomfort and bacterium (Lehman, 2009). According toMattsson et al, (2013), in spite of the high prevalence of thecondition, few women seek assistance or are provided with the same bythe healthcare professionals. Unfortunately, unlike vasomotorsymptoms that, more often than not, improve as time goes by even whenno treatment has been sought, vulvovaginal atrophy is progressive andhas less potential for being resolved without appropriateintervention or treatment (Archer, 2010). Of course, the interest ofscholars has been piqued towards the relationship between menopauseand the occurrence of the condition (Levine et al, 2008). Researchersacknowledge that estrogen plays a crucial role in the maintenance ofthe function and structure of the vulva, and enhances the vaginalsurface are in the course of intercourse (Simon et al, 2013). Inaddition, it enhances the content of glycogen in epithelia cells,which would then be metabolized by lactobacilli into lactic acid,which comes in handy in the maintenance of the vaginal pH at 4.0 orless (Barner &amp Branvold, 2005). The combination of thick vaginalepithelium, acidic pH, cervical mucus secretions and local bacteriaflora functions as a barrier to pathogens. Upon the onset ofmenopause, the estrogen would be produced in less capacity, with thepH turning to basic. Indeed, the postmenopausal vagina would haveless vaginal capillary blood flow, as well as less smooth musclerelaxation, in which case it would not attain the level ofengorgement that an estrogen-primed vaginal would achieve in thecourse of intercourse or sexual arousal (Parish et al, 2013). Theurinary tract epithelium would undergo atrophic modifications as aresult of estrogen deprivation, resulting to bladder and urethralmucosal thinning, shortening of the urethral reduced bladdercapacity, weakening sphincter, uninhibited detrusor musclecontractions, as well as an increase in the postvoid volume ofresidual urine (Nappi Kokot-Kierepa, 2012). The modifications wouldresult in enhanced susceptibility to pathogens, dysuria, as well asincreased urinary frequency.

Inclusionand exclusion criteria

Anexploratory study would be undertaken to determine the efficacy ofthe notion that the vaginal wall becomes thinner at the onset ofmenopause. Eligible participants would be women aged 45 years andabove, who had at least 2 years since the last menstrual cycle oreven the bilateral oophorectomy (Pastore et al, 2004). They must alsohave reported a minimum of three urogenital symptoms such as vaginalbleeding in the course of intercourse, dyspareunia, dysuria,soreness, irritation, itching and dryness of the vagina (Al-Baghdadi &amp Ewies, 2009). The participants would be excluded in instanceswhere they have a history of thromophlebitis or hormone-dependentcancers, vaginal infections that necessitate treatment or any seriousailment that may interfere with their compliance in the study (Barner&amp Branvold, 2005) (Minkin et al, 2013). Essentially, the patientswould have the vaginal wall trimmings, with the tissue being analysesfor historical and morphological assessment.

Questionnaire

Thereare certain questions that would have to be incorporated so as todetermine whether the vaginal wall becomes thinner at the onset ofmenopause.

  1. How old are you?

  2. When was your last menstrual cycle if you can remember?

  3. What vaginal discomfort have you been experiencing?

  4. When did the discomfort set in?

  5. Have you ever experienced such symptoms in the past? If so, when was it?

  6. How active is your sex life? (regular sex keeps the muscles healthy)

  7. Have you ever suffered from vaginismus, vaginitis or other urinary tract conditions? (Vaginitis underlines the vaginal inflammation, which may result from estrogen-related vaginal atrophy, bacterial or yeast infection, or even irritation as a result of the usage of hygiene products and soaps (Botsis et al, 1997). Vaginismus underlines involuntary contractions and spasms at the perineum or rather the area between the anus and vagina, or at the vaginal opening (Al-Baghdadi &amp Ewies, 2009). Other urinary tract conditions may include urethritis, sensitivity to latex condoms, prolapsed bladder, irritation and bladder inflammation).

  8. Are you suffering from any cancer that requires radiation therapy, chemotherapy or hormonal therapy/

  9. When was the last time you were breastfeeding?

References

ArcherDF (2010). Efficacy and tolerability of local estrogen therapy forurogenital atrophy. Menopause.17(1):194–203.

ParishSJ, Nappi RE, Krychman ML (2013). Impact of vulvovaginal health onpostmenopausal women: a review of surveys on symptoms of vulvovaginalatrophy. IntJ Womens Health.20135:437–447.

PastoreLM, Carter RA, Hulka BS, Wells E (2004). Self-reported urogenitalsymptoms in postmenopausal women: Women’s Health Initiative.Maturitas.49(4):292–303

LevineKB, Williams RE, Hartmann KE (2008) Vulvovaginal atrophy is stronglyassociated with female sexual dysfunction among sexu&shyally activepostmenopausal women. Menopause.15(4 Pt 1):661–666.

NappiRE, Kingsberg S, Maamari R, Simon J (2013). The CLOSER (ClarifyingVaginal Atrophy’s Impact On SEx and Relationships) survey:implications of vaginal discomfort in postmenopausal women and inmale partners. JSex Med.10(9):2232–2241.

NappiRE, Kokot-Kierepa M (2010). Women’s voices in the menopause:results from an international survey on vaginal atrophy. Maturitas.67(3):233–238.

NappiRE, Kokot-Kierepa M (2012). Vaginal Health: Insights, Views andAttitudes (VIVA) – results from an international survey.Climacteric.15(1):36–44.

Al-BaghdadiO, Ewies AA (2009). Topical estrogen therapy in the management ofpostmenopausal vaginal atrophy: an up-to-date overview. Climacteric.12(2):91–105

BotsisD, Kassanos D, Kalogirou D, Antoniou G,Vitoratos N, Karakitsos P(1997). Vaginal ultrasound of the endometrium in postmenopausal womenwith symptoms of urogenital atrophy on low-dose estrogen or tibilonetreatment: a comparison. Maturitas26:57–62..

Lehman,R (2009). ClinicalApproach to Recognizing and Managing a Patient With Vaginal Atrophy:A Guide for Physician Assistants.The Internet Journal of Academic Physician Assistants. 2009 Volume 8Number 1.

MattssonLA, Ericsson A, Bøgelund M, Maamari R (2013). Women’s prefer&shyencestoward attributes of local estrogen therapy for the treatment ofvaginal atrophy. Maturitas.74:259–263.

BarnerJC, Branvold A (2005). Patients’ willingness to pay forpharmacist-provided menopause and hormone replacement therapyconsultations. ResSocial Adm Pharm.1(1):77–100.

MinkinMJ, Maamari R, Reiter S (2013). Improved compliance and patientsatisfaction with estradiol vaginal tablets in postmenopausal womenpreviously treated with another local estrogen therapy. IntJ Womens Health.5:133–139.

SucklingJ, Lethaby A, Kennedy R (2006). Local oestrogen for vaginal atrophyin postmenopausal women. CochraneDatabase Syst Rev.(4):CD001500.

SimonJA, Kokot-Kierepa M, Goldstein J, Nappi RE (2013). Vaginal health inthe United States: results from the Vaginal Health: Insights, Viewsand Attitudes survey. Menopause.20(10):1043–1048.

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