Vulvovaginal atrophy is also known as atrophic vaginitis and menopausal genitourinary syndrome due to estrogen deficiency. The bladder trigone, urethra, pelvic floor muscles, and endopelvic fascia possess estrogen receptors and are maintained by adequate estrogen levels. Hypoestrogenemia results in atrophy of the superficial and intermediate layers of the vagina and urethral mucosal epithelium. Diminished urethral closure pressure and loss of urethral compliance contribute to urgency, frequency, urinary tract infections, and incontinence (stress and urge).
This patient's urinary symptoms in the setting of vulvovaginal atrophy are consistent with either urgency incontinence or a recurrent urinary tract infection. A urinalysis and urine culture should be ordered to distinguish between these 2 conditions. Use of moisturizers and lubricants is the first step in management of mild atrophic vaginitis. For moderate to severe cases with predominant urinary symptoms, as in this patient, treatment is low-dose vaginal estrogen therapy.
