ESTROGEN & THE VAGINA

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Thanks Luda and for the comments. ; )

To continue with that thread, here's one I'd sent about how Estrogen can help the vagina. It also has an excellent picture as well of estrogen deprivation. I'm sure a lot of us must look like this. ; (

Hi All,

Hope you're all having some pain free days, I have an excellent article and picture, that 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, pelvic disorders, etc. have been ruled out It 'may' still be necessary to rebuild the tissue.

It's main focus is about being menopausal, but if you put that word aside... and keep in mind the 'facts' of what Estrogen can do us, I think you'll find out how important Estrogen can be especially if our receptors have been blocked for instance with the Birth control pills, yeast, soy etc. and why the Estrace (estradiol 17b) just applied topically (small pea size dabs) can help 'us' regardless of age and can be so beneficial for the tissue itself. (sorry I just don't have the URL as I'd saved it a long time ago) My comments are in blue.

Hope you enjoy.

Dee~

Diagnosis and Treatment of Atrophic Vaginitis

(Forget they're mentioning menopause, you'll see why). DT

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 to 40 percent of postmenopausal women have symptoms of atrophic vaginitis, (other studies have a much higher percentage,) 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.

note: when someone has a BV (bacterial vaginosis) the pH levels are higher as well as in menopause (menopausal women rarely get yeast infections because of the declining estrogen) , it's also why some add the lactobacilli or acidophyllis to keep acidic. ) 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, <----------- thought here.... aren't the Mast cells connected with this granulation? DT .. 'fissures,' (think of splits, tears slits) 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 'completely' estrogen dependent and adversely change in an 'estrogen-deprived' environment.

Decreased levels of estrogen is the etiology 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.

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 antiestrogen medications, including medroxyprogesterone (Provera) (Depo Provera), tamoxifen (Nolvadex), danazol (Danocrine), leuprolide (Lupron) and nafarelin (Synarel), are also implicated as causes of atrophic vaginitis.

Note* 'I" would also add 'possibly' excessive Progesterone/progestins here as from the Birth control pills. DT

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

*note* notice they mention PRE-menopausal too as a possibility . DT

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, Painful intercourse.

DOES THIS SOUND LIKE A LOT OF US? DT

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) as in LS.

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, possibly sparsity of pubic hair, dryness of labia, vulvar dermatoses, vulvar lesions and fusion of the labia minora as in Lichen Sclerosus. * see picture*

Introital stenosis (narrowing) 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.

Note*** Now tell me if most of this above doesn't sound like us ?? DT

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 (to me) using the Estrace cream 'topically' alone can restore the tissue whether menopausal or not. (topical use has very little systemic (whole body) absorption in the majority of the cases.) 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 when on estrogen, 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 proven 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 is of 'known' benefit to restoring vaginal tissue, menopausal or not. It's also known thru many studies and tests from Pub Med, Medline, NEJM, BJM, OB/GYN sites, and various other sources I have that Estradiol 17b (as in Estrace) is an 'excellent' healer in wounds for the skin.

I sincerely hope this gives you an overview of how important maintaining Estrogen is for the quality of the Vaginal tissue. ; ) I know it's not 'THE' answer but may be one of the answer for many. ; )

Warmest regards

Dee~ DTroll@...