ESTROGEN & THE VAGINA W. PICTURE (Atrophic Vaginitis & More)

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I found this one in my files and thought it might be helpful... Hugs, Chelle

Hi Everyone

I have a good article and picture that's excellent as it talks about Vaginal atrophy and what happens with a lack of enough Estrogen (estradiol 17b) I also want to stress that's after all other infections, allergies, irritations etc. have been ruled out It may still be necessary to rebuild the tissue.

It's main talk is about being menopausal, but if you put that word aside... and keep in mind the 'facts' of what Estrogen can do for all of us, I think you'll find out how important Estrogen can be and why the Estrace (estradiol 17b) and not Premarin) just applied topically (small pea size dabs) can help 'us' regardless of age and can be so beneficial for the tissue itself. It's one I'd saved and clipped and pasted and recently sent on to someone else. (sorry I just don't have the URL as I'd saved it a while ago) *sigh*.

Hope you enjoy.

Dee~

Diagnosis and Treatment of Atrophic Vaginitis

GLORIA A. BACHMANN, M.D., andNICOLE S. NEVADUNSKY Wood Medical School, New Brunswick, New Jersey

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Because of declining estrogen levels, an estimated 10-40 percent of postmenopausal women have symptoms of atrophic vaginitis, also referred to as urogenital atrophy. Despite the prevalence of symptoms, only 20 to 25 percent of symptomatic women seek medical attention.

Changes affect the urinary tract as well as the genital tract in estrogen-deprived women.

Estrogen stimulation produces copious amounts of glycogen. Döderlein's lactobacilli depend on glycogen from sloughed vaginal cells. Lactic acid produced by these bacteria lowers vaginal pH levels to 3.5 to 4.5; this is 'essential' for the body's natural defense 'against' vaginal and urinary tract infections.

Increased vaginal pH levels predispose the vagina to infection by streptococci, staphylococci, coliforms and diphtheroid.

My note: when someone has a BV (bacterial vaginosis) the pH levels are higher as well as in menopause) dt.

Numerous cytologic transformations follow estrogen reduction, including proliferation of connective tissue, fragmentation of elastin and hyalinization of collagen. These changes may result in granulation, fissures, (think of splits, cuts, tears, DT) ecchymoses, telangiectases and ulcerations.

Changes in tissue composition are not limited to the genital tract but also include the urinary tract because of the shared common embryologic origin. Vaginal and urethral epithelia are estrogen dependent and adversely change in an 'estrogen-deprived' environment.

'Decreased' levels of estrogen is the etiology (cause) in almost all cases of atrophic vaginitis. In nonmenopausal women, production of ovarian estrogen can be interrupted by radiation therapy, chemotherapy, immunologic disorders and oophorectomy.

*my note* Also Birth control pills containing High Progestins which is countering or opposing or antagonistic towards Estrogen can lower the E in the vag. area)

The postpartum (after birth) decline in estrogen levels accompanies the loss of placental estrogen and the antagonistic action of prolactin on estrogen production during lactation. (nursing)

Side effects of 'anti-estrogen' medications, including medroxyprogesterone (Provera) (Depo Provera), tamoxifen (Nolvadex), danazol (Danocrine), leuprolide (Lupron) and nafarelin (Synarel), are also implicated as causes of atrophic vaginitis.

An increase in the severity of symptoms occurs in women who are naturally 'premenopausally' estrogen deficient, smoke cigarettes, have not given birth vaginally or exhibit nonfluctuating levels of estrogen.

Symptoms of Atrophic Vaginitis:

Genital Dryness, Itching, Burning, Dyspareunia, Burning, leukorrhea,Vulvar pruritus Feeling of pressure, Yellow malodorous discharge, Urinary Dysuria,(painful urination) Hematuria (blood in urine) Urinary frequency, Urinary tract infection ,Stress incontinence. Presenting Signs and Symptoms PICTURE

.. Note loss of labial and vulvar fullness, pallor of urethral and vaginal epithelium, and decreased vaginal moisture, as well as decrease of smaller labial lips. (fusion)

A long-term decrease in estrogen stimulation is generally required before symptoms of atrophic vaginitis arise.

All atrophic vaginitis symptoms can be exacerbated by a simultaneous infection of candidiasis, trichomoniasis or bacterial vaginosis.

Over time, the lack of vaginal lubrication often results in sexual dysfunction and associated emotional distress.

Physical ExaminationIt is important not to assume a diagnosis of atrophic vaginitis (or solely a diagnosis of atrophic vaginitis) in the patient who presents with urogenital complaints. A patient history should include attention to exogenous agents that may cause or further aggravate symptoms.

Perfumes, powders, soaps, deodorants, panty liners, spermicides and lubricants often contain irritant compounds. In addition, tight-fitting clothing and long-term use of perineal pads or synthetic materials can worsen atrophic symptoms

On examination, several signs of vaginal atrophy will be evident. Atrophic epithelium appears pale, smooth and shiny. Often, inflammation with patchy erythema, petechiae and increased friability may be present.

External genitalia should be examined for diminished elasticity, turgor of skin, sparsity of pubic hair, dryness of labia, vulvar dermatoses, vulvar lesions and fusion or adhesions of the labia minora* see picture*

Introital stenosis to a width 'less then two fingers' and decreased vaginal 'depth' will be apparent; if these conditions are not diagnosed before insertion of the speculum, the pelvic examination will cause considerable pain. Friable and poorly rugated vaginal epithelium is more prone to traumatic damage.

Minor lacerations at peri-introital and posterior fourchette (6 o*clock position) may also recur after coitus or during a speculum examination. Vaginal examination or sexual activity can result in vaginal bleeding or spotting.

Treatment

Estrogen Replacement

Hormone replacement therapy is the most logical choice of treatment and has proved to be effective in the restoration of anatomy and the resolution of symptoms.

My note* this is why using the Estrace cream 'topically' alone can restore the tissue whether menopausal or not. (topical use has very little systemic (whole body) absorption.) DT.

Adequate estrogen therapy increases the number of superficial cells. Estrogen therapy may alleviate existing symptoms or even prevent development of urogenital symptoms.

Other treatment options include transvaginal delivery of estrogen in the form of creams, pessaries or a hormone-releasing ring (Estring). Treatment with a low-dose transvaginal estrogen has proved effective in relieving symptoms without causing significant proliferation of the vaginal epithelium.

My note: internal usage of creams would be suggested for menopausal women, topical use for non-menopausal women DT.

The genitourinary pH level is also lowered, leading to a 'decreased' incidence of urinary tract infections as well as 'restoration' of the vaginal tissue, urethra, and bladder.

Sexual Activity

Sexual activity is a healthful prescription for women who have a substantially estrogenized vaginal epithelium. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation.

Women who participate in sexual activity report fewer symptoms of atrophic vaginitis and, on vaginal examination, have less evidence of stenosis and shrinkage in comparison with sexually inactive women.

END.

The only thing I can add is that Estradiol 17 b (as in Estrace cream) is of 'known' benefit to restoring vaginal tissue. I've also thru experience and research learned that even if the blood serum levels are fine and normal that for some reason many with vulvar pain have diminished capabilities in the E. "receptors' themselves (we do have 'proven' with studies for Testosterone receptors loss with LS) and why using the Estrace cream 'directly' on top (where the pain is) can saturate those receptors externally and give us back our elasticity, tone and stretchability.

I don't mean 'saturate' the tissues at all with the creams, but a term that's used when the E 'receptors' are full. It's why usually you need more initially and then can taper even using it topically.

It's also known thru studies and tests from Pub Med, Medline, NEJM, BJM, OB/GYN sites, and various other sources that Estradiol 17b is an 'excellent' healer in wounds for the skin.

One simple and easy to understand link for the patient I'd suggest reading is by Dr. J. Willems: (though I'd NEVER suggest the large amt. he uses, he forgets the extreme pain we can be in)

http://www.vulvarpainfoundation.org/topical_estrogen_treatment.htm Or AOLers <a href="http://www.vulvarpainfoundation.org/topical_estrogen_treatment.htm"</a>

also this one suggesting it's use by Dr. S. Omoigui.

http://www.medicinehouse.com/guidepages/PRvulvodynia.html OR

<a href="http://www.medicinehouse.com/guidepages/PRvulvodynia.html"</a>

There are many others out there so those are just a few.

I sincerely hope this gives you an overview of how important maintaining Estrogen is for the quality of the Vaginal tissue.

Warmest regards and big hugs

Dee~