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Atrophic Vaginitis

One-third of patients with vaginal symptoms will not have laboratory evidence of bacterial vaginosis, Candida, or Trichomonas.

Other causes of the vaginal symptoms include cervicitis, allergic reactions, and vulvodynia.

Atrophic vaginitis should be considered in postmenopausal patients if the mucosa appears pale and thin and wet-mount findings are negative.

Oral estrogen (Premarin) 0.625 mg qd should provide relief.

Estradiol vaginal cream 0.01% may be effective as 2-4 g daily for 1-2 weeks, then decreasing by 50% for 1-2 weeks; maintenance dosage is 1 g one to three times weekly.

Conjugated estrogen vaginal cream may be effective as 2-4 g daily (3 weeks on, 1 week off) for 3-6 months.

Allergy and chemical irritation atrophic vaginitis, vaginal allergy, irritation, atropic, atrofic

Patients with a short history of vulvar irritation should be questioned about use of substances that cause allergic or chemical irritation, such as deodorant soaps, laundry detergent, vaginal contraceptives, bath oils, perfumed or dyed toilet paper, hot tub or swimming pool chemicals, and synthetic clothing.

Topical steroids and systemic antihistamines can help alleviate the symptoms until the irritant can be identified.