Senile vaginitis, also known as atrophic vaginitis, is a non-specific vaginitis. It mostly occurs in postmenopausal women, but it can also appear in women who have had bilateral oophorectomy or are in the lactation period.

bubble_chart Etiology

The main reason is the decline in ovarian function, leading to low or deficient estrogen levels in the body, reduced glycogen in vaginal epithelial cells, and an alkaline pH in the vagina, which diminishes the ability to kill pathogens. At the same time, due to the atrophy of the vaginal mucosa, thinning of the epithelium, and insufficient blood supply, the vagina's resistance decreases, making it easier for bacteria to invade and multiply, causing inflammatory lesions. Additionally, poor personal hygiene habits, nutritional deficiencies, especially a lack of B-group vitamins, may be related to the onset of the condition.

bubble_chart Clinical Manifestations

The main symptoms include increased leucorrhea, which is yellowish or purulent with a foul odor. In severe infections, there may be spotting vaginal bleeding, accompanied by a sensation of heaviness and vaginal burning. If the vestibule and the mucous membrane around the urethral orifice are affected, frequent urination and dysuria often occur.

bubble_chart Diagnosis

Based on the age of onset, medical history, and local examination findings such as redness and moisture of the vulva, congestion of the vaginal walls with scattered bleeding points—most prominent in the posterior fornix and cervix—and the formation of ulcers after vaginal mucosal peeling, the diagnosis is generally straightforward. When chronic inflammation develops, two outcomes may occur: one is fibrosis of the connective tissue beneath the vaginal mucosa, leading to loss of vaginal elasticity and eventual vaginal stenosis and scarring; the other is the formation of vaginal adhesions resulting in vaginal atresia, or even pyocolpos above the atresia. Although rare, this condition is severe.

The treatment principles for senile vaginitis are to enhance the resistance of the vaginal mucosa and inhibit bacterial growth. For systemic medication, oral administration of diethylstilbestrol 0.25–0.5 mg once daily for 7 days may be used. This medication may sometimes cause withdrawal uterine bleeding. For local treatment, improving vaginal pH can be achieved by washing the vagina with 1% lactic acid or a 1:5000 potassium permanganate solution. A vaginal suppository containing 0.25–0.5 mg of diethylstilbestrol can be inserted nightly for 7 days. If necessary, topical application of antibiotic powder or ointment may also be used.

bubble_chart Differentiation

To differentiate from specific vaginitis, vaginal secretions should be examined to rule out pathogens such as trichomonads and fungi. Bloody leucorrhea should be distinguished from malignant tumors of the uterus. During gynecological examination, attention should be paid to the size and shape of the uterus, the source of bleeding, and vaginal cytology tests. If necessary, cervical or endometrial biopsies should be performed during the seasonal epidemic.