What is the pathophysiology of atrophic vaginitis?

Updated: Jan 19, 2018
  • Author: Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD  more...
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Extremely low estrogen production, as found after menopause or bilateral oophorectomy, can lead to atrophy of the vaginal and vulvar epithelium. Vulvovaginal atrophy is considered a natural process after estrogen withdrawal. Although menopause is the leading cause of decreased levels of circulating estrogen, atrophy of the vagina can occur in nonmenopausal women due to diminished ovarian estrogen production, as can result from cancer treatments, such as radiation therapy and chemotherapy, and immunologic disorders.

Furthermore, in postpartum women, the decline in estrogen levels in conjunction with the loss of placental estrogen and the antagonistic action of prolactin on estrogen production during lactation can lead to atrophy.

Among its many effects, estrogen helps to maintain the collagen content of the epithelium and thus affects its thickness and elasticity. It also helps to maintain acid mucopolysaccharides and hyaluronic acid, which keep epithelial surfaces moist. During the reproductive years, estrogen stimulation is responsible for maintenance of a well-epithelialized vaginal vault. It causes the nonkeratinized stratified squamous epithelium of the vagina to be thick, rugated, and rich in glycogen. Glycogen is necessary for rapid multiplication and maintenance of lactobacilli.

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