Without the presence of oestrogen, the ability of the vagina’s cells to store glycogen is compromised, changing the pH of the vaginal secretions and losing its ability to sustain the growth of the guardian of the vaginal ecosystem – the lactobacillus.
WITH the onset of menopause, a woman’s reproductive phase comes to a close. She moves on to the next phase of her life, referred to as the climacteric.
Simply put, it is a critical period in a person’s life in which some bodily change occurs. It comes from the Greek word “klimakter”, meaning ladder. Her general wellbeing changes, her sexual drive declines, her skin loses its elasticity, the breasts are no more proud and protruding, ailments such as osteoporosis and heart diseases, once held at bay by oestrogen, now make their entry. But it is the reproductive system that takes the greatest toll.
Disrupted vaginal ecosystem
The ovaries shrink in size and produce oestrogen in its bare minimum. The uterus ceases to function and the monthly periods disappear.
The vagina too takes its share of the toll. Without the support of the monthly oestrogen, the lining begins to thin out – referred in medical parlance as atrophy.
Furthermore, without the presence of oestrogen, the ability of its cells to store glycogen is compromised. This has an impact on the pH of the vaginal secretions. It loses its acidity and the ability to sustain the growth of the guardians of the vaginal ecosystem – the lactobacillus.
These bacteria perpetuate an acidic environment that to some extent prevents the growth of abnormal bacteria or fungus.
Atrophic vaginitis
The vaginal lining becomes susceptible to infections, a condition referred to as atrophic vaginitis. A discharge is the commonest presentation. The patient describes it as staining and it forces her to use a panty-liner.
Occasionally, it can be blood stained. It sends alarm bells and an appointment with her gynaecologist is invariably made. He will usually exclude other infections, and having done so, the treatment is simple. A daily application of oestrogen cream into the vagina over a few weeks will deal with it.
Skin disorder
The skin of the area around her “private parts”, referred to as the vulva, is not spared. For some strange reason, hitherto not clear, it becomes prone to develop certain skin disorders.
The first indication that something is not right is an itch. The hand mirror once used to admire her hair is now used to view the genitalia in the privacy of her bedroom.
All she may see is a pale or white patch. Some women pass it off as “nothing to be too concerned about”. Part of the reason I suspect, is their reluctance to see a gynaecologist.
Just as the dictum that “any breast lump must be biopsied” holds true, the same applies to any “funny-looking” patches of skin of the vulva. Seeing a gynaecologist is a must.
In most instances, it is a condition called “lichen sclerosis”, sometimes referred to as “white-spot disease”. Its symptoms are varied. On the one hand, it may not give any symptoms at all. On the other hand, it may give rise to an intense itch.
Furthermore, if the affected area is fairly wide, the whole vulva appears shrunken because of the scarring.
Sexual intercourse is painful and her whole morale is down in the dumps. It may become a source of depression. But what is most worrying is that it has a between 1% and 4% chance of turning malignant.
The actual reason it occurs is unknown but there are many theories. A genetic predisposition is one. Unfortunately most of these cases go undiagnosed and seldom treated by the unwary doctor.
It is only when she consults someone who knows about it that attention is paid. In most instances, a biopsy is done and sent to the pathologist for a confirmation of the diagnosis.
A word of caution: If it turns to an ulcer and occasionally bleeds, one must seek an opinion as soon as possible. It is a cancer of the skin until proven otherwise.
Special hygiene needs
Feminine hygiene usually takes a back seat in the pantheon of worries that inflict a post-menopausal woman. Any changes in the genitalia are taken as part of the ageing process and complacency is the rule.
I hope this article has changed that mindset. Remember, an itch, a patch or a bleed must be taken seriously.
This article is courtesy of sanofi-aventis. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
WITH the onset of menopause, a woman’s reproductive phase comes to a close. She moves on to the next phase of her life, referred to as the climacteric.
Simply put, it is a critical period in a person’s life in which some bodily change occurs. It comes from the Greek word “klimakter”, meaning ladder. Her general wellbeing changes, her sexual drive declines, her skin loses its elasticity, the breasts are no more proud and protruding, ailments such as osteoporosis and heart diseases, once held at bay by oestrogen, now make their entry. But it is the reproductive system that takes the greatest toll.
Disrupted vaginal ecosystem
The ovaries shrink in size and produce oestrogen in its bare minimum. The uterus ceases to function and the monthly periods disappear.
The vagina too takes its share of the toll. Without the support of the monthly oestrogen, the lining begins to thin out – referred in medical parlance as atrophy.
Furthermore, without the presence of oestrogen, the ability of its cells to store glycogen is compromised. This has an impact on the pH of the vaginal secretions. It loses its acidity and the ability to sustain the growth of the guardians of the vaginal ecosystem – the lactobacillus.
These bacteria perpetuate an acidic environment that to some extent prevents the growth of abnormal bacteria or fungus.
Atrophic vaginitis
The vaginal lining becomes susceptible to infections, a condition referred to as atrophic vaginitis. A discharge is the commonest presentation. The patient describes it as staining and it forces her to use a panty-liner.
Occasionally, it can be blood stained. It sends alarm bells and an appointment with her gynaecologist is invariably made. He will usually exclude other infections, and having done so, the treatment is simple. A daily application of oestrogen cream into the vagina over a few weeks will deal with it.
Skin disorder
The skin of the area around her “private parts”, referred to as the vulva, is not spared. For some strange reason, hitherto not clear, it becomes prone to develop certain skin disorders.
The first indication that something is not right is an itch. The hand mirror once used to admire her hair is now used to view the genitalia in the privacy of her bedroom.
All she may see is a pale or white patch. Some women pass it off as “nothing to be too concerned about”. Part of the reason I suspect, is their reluctance to see a gynaecologist.
Just as the dictum that “any breast lump must be biopsied” holds true, the same applies to any “funny-looking” patches of skin of the vulva. Seeing a gynaecologist is a must.
In most instances, it is a condition called “lichen sclerosis”, sometimes referred to as “white-spot disease”. Its symptoms are varied. On the one hand, it may not give any symptoms at all. On the other hand, it may give rise to an intense itch.
Furthermore, if the affected area is fairly wide, the whole vulva appears shrunken because of the scarring.
Sexual intercourse is painful and her whole morale is down in the dumps. It may become a source of depression. But what is most worrying is that it has a between 1% and 4% chance of turning malignant.
The actual reason it occurs is unknown but there are many theories. A genetic predisposition is one. Unfortunately most of these cases go undiagnosed and seldom treated by the unwary doctor.
It is only when she consults someone who knows about it that attention is paid. In most instances, a biopsy is done and sent to the pathologist for a confirmation of the diagnosis.
A word of caution: If it turns to an ulcer and occasionally bleeds, one must seek an opinion as soon as possible. It is a cancer of the skin until proven otherwise.
Special hygiene needs
Feminine hygiene usually takes a back seat in the pantheon of worries that inflict a post-menopausal woman. Any changes in the genitalia are taken as part of the ageing process and complacency is the rule.
I hope this article has changed that mindset. Remember, an itch, a patch or a bleed must be taken seriously.
This article is courtesy of sanofi-aventis. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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