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best course of treatment. For those who have symptoms related to sexual activities, a lubricant may be sufficient. If both urinary and genital symptoms exist, local, low-dose estrogen therapy can be effective. Those individuals who are survivors of hormone-sensitive cancer may need to be treated more cautiously. Some people can have symptoms that are widespread and may be at risk for osteoporosis. Estrogen and adjuvants may be best. Recent research showed a medication called ospemifene can be an alternative oral treatment if vaginal products or hormone therapy is not suitable for patients surviving gynecological cancer. Ospemifene can increase collagen production to improve vaginal tissue, which will help reduce GSM symptoms. Studies have shown this medication has helped increase vaginal pH, elasticity, and moisture to improve vaginal health as well as sexual and emotional well-being.
298:
Estrogen helps maintain a thick, glycogen-rich vaginal lining, which healthy bacteria use to produce lactic acid to keep the vaginal environment acidic, reducing infection risks. In premenopausal women, the main form of estrogen is called estradiol and fluctuates between 40 and 200 pg/mL, rising to 600 pg/mL during ovulation. Postmenopause, estrogen levels drop significantly tp 5-18 pg/mL, leading to gradual changes in the urogenital area. All tissue types such as connective, epithelial, muscular, blood vessels, and nerves are affected and become thinner and less effective, which increases risk of infections, inflammation, injuries, and sores. Blood flow and sensation can decrease, causing pain during sex and the pH level can rise due to decreased lactic acid production, which can allow harmful bacteria and fungi to grow and cause infections.
594:
requirements for inclusion criteria. One of the trials showed that there was a significant impact in helping alleviate GSM symptoms with using 1 mg vitamin E in the experimental group compared to the placebo group. Another trial showed 5 mg vaginal hyaluronic acid had a greater impact than 1 mg vitamin E. Two of the other trials showed there were no difference between using 0.5 g vaginal estrogen and 100 IU of vaginal vitamin E. Since the authors were only able to use four studies, they encountered some limitations such as using a small number of studies and not having as much evidence. In conclusion, the review article found that vaginal vitamin E can be used to helping with GSM symptom but further studies need to be conducted to confirm its efficacy and safety.
503:
improvement in their sex life. If a person cannot tolerate or use estrogen therapy, topical hyaluronic acid can be used as another option which has been shown to be safe and effective. For mild atrophic vaginitis, hyaluronic acid can be used as a treatment first. However, if it is moderate to severe atrophic vaginitis, estrogen therapy is recommended to be used first. Vitamin E vaginal suppositories were also found to be helpful in relieving symptoms of GSM, but further studies need to be done to evaluate how safe and effective this treatment is for this condition. Other studies have discussed using vaginal oxytocin as a treatment, but there has been no significant effect on GSM in either helping alleviate signs and symptoms or improving the condition.
465:
such as before the first menstural cycle, during reproductive years, and after menopause, the distribution of these cell types changes. VMI is determined using a specific formula and provides a more comprehensive view of the hormonal effects on the vagina over time than a single hormone level measurement. VMI is particularly useful in clinical research for evaluating the impact of hormone therapy and changes in sexual function during menopause. VMI is also a better measure of vaginal atrophy than patient-reported symptoms of vaginal dryness.
39:
574:. In a 2021 systematic review, fractionated type CO2 laser therapy used for GSM was shown to be effective and safe in the studies the researchers reviewed. However, there is a lot of evidence still needed to determined how effective this therapy is compared to other treatments for GSM such as hormonal, non-hormonal, and topical treatments. In addition, further studies conducted can also help determine which groups of patients would benefit from CO2 laser therapy.
586:
week, both treatments significantly improved symptoms, including vaginal health index (VHI), maturity valve (MV), and overall symptoms of vaginal atrophy. The Aloe Vera group showed a notable increase in superficial cells and superior results in fluid volume compared to the estrogen group. The study concluded that Aloe Vera cream is as effective as estrogen cream, presenting a viable alternative for women who cannot use estrogen therapy.
582:
group, which received conjugated estrogen vaginal cream. The study measured clinical signs and the
Vaginal Maturation Index (VMI). The results indicated that while fenugreek extract showed some efficacy in treating atrophic vaginitis, it was significantly less effective that ultra-low-dose estrogen as evidenced by higher VMI scores and greater improvement in clinical signs in the control group.
290:
levels drop, this process slows down, leading to thinner vaginal tissue, less moisture, and a less acidic environment. As a result, there's a higher risk of getting vaginal and urinary tract infections. Normal menopause and treatments such as chemotherapy or medications may result in loss of estrogen.
589:
A 2021 systematic review studied the use of hyaluronic acid for those with postmenopausal vaginal atrophy. From the 833 studies identified, the comparisons of hyaluronic acid to vaginal estrogen treatments appear to have similar safety, tolerability, and efficacy based on outcomes such as vaginal pH
585:
A 2021 study examined the effectiveness of aloe vera vaginal cream for the treatment of atrophic vaginitis. This randomized, double-blind, controlled trial compared the effectiveness of Aloe Vera vaginal cream to estrogen vaginal cream in treating vaginal atrophy in 60 postmenopausal women. Over six
511:
Atrophic vaginitis develops in 10-50% of postmenopausal women. Of those who are postmenopausal and have developed atrophic vaginitis, 50-70% develop symptoms. Around 30% of women with atrophic vaginitis discuss their symptoms with their primary healthcare provider. It is likely to be under diagnosed
464:
The
Vaginal Maturation Index (VMI) is a measure used to assess the composition of different types of cells in the vaginal lining. It helps to evaluate the hormonal environment in the vagina by calculating the proportion of different types of cells present in the vagina. During different life stages,
451:
will change from being acidic to a more neutral pH at around 4.5 or higher. This is typically taken by placing Litmus test strip on the wall of the vagina. Papillary and reticular, as well as skin and dermal tissue atrophy are observed via histological examinations. Observed reduced vascularization,
581:
A 12-week randomized controlled clinical trial conducted in
Ardabil, Iran, in 2018 evaluated the effectiveness of fenugreek extract on atrophic vaginitis in 60 postmenopausal women. Research participants were dividied into an intervention group, which received fenugreek vaginal cream, and a control
297:
may be at a higher risk of developing atrophic vaginitis due to chemotherapy and other endocrine treatments. Estrogen is crucial for women's sexual and urinary health. It supports the tissues in the lower vagina and urinary tracts to keep them thick, elastic, and mosit and ensuring good blood flow.
593:
A 2022 systematic review evaluated randomized controlled trials to see if there were evidence to support the effectiveness of using vaginal
Vitamin E and whether it helped alleviate GSM symptoms in postmenopausal individuals. The authors looked into 31 studies and found four of the studies met the
477:
Topical treatment with estrogen is effective when the symptoms are severe and relieves the disruption in pH to restore the microbiome of the vagina. When symptoms include those related to the urinary system, systematic treatment can be used. Recommendations for the use of the lowest effective dose
401:
It can be challenging to diagnose atrophic vaginitis given that the symptoms are mild and nonspecific for many postmenopausal women. Since women can have signs and symptoms that could be attributed to other causes, diagnosis is based upon the symptoms that cannot be better accounted for by another
289:
Atrophic vaginitis may be caused by tissue thinning, loss of elasticity, and loss of vaginal fluids from low estrogen levels. Normally, estrogen helps the vagina shed old cells, which are then converted into lactic acid by good bacteria. This keeps the vagina's pH acidic and healthy. When estrogen
577:
In addition, there were several studies that looked into whether vaginal oxytocin was an alternative hormone treatment for atrophic vaginitis. In 2023, a systematic review found that there was no significant effect using vaginal oxytocin for this condition. The article explored vaginal maturation
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applied to the vagina. The use of estrogen for treatment do come at some risk. Those who are treated with estrogen may be at a higher risk of developing vaginal candidiasis since estrogen allows lactobacilli to increase in levels. Additionally, it is recommended that soaps and other irritants are
473:
Symptoms of genitourinary syndrome of menopause (GSM) will unlikely be resolved without treatment. Some individuals may have many or a few symptoms so treatment is provided that best suits each person. If other health problems are also present, these can be taken into account when determining the
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suggests that the vagina is inflamed or infected. Though this may be true, inflammation and infection are not the major components of postmenopausal changes to the vagina. The former terms do not describe the negative effects on the lower urinary tract which can be the most troubling symptoms of
502:
may be helpful. Since GSM may also cause urinary problems related to pelvic floor dysfunction, the person may benefit from pelvic floor strengthening exercises. The individual and their partners have reported that estrogen therapy resulted in less painful sex, more satisfaction with sex, and an
578:
index, vaginal pH, endometrial thickness, and dyspareunia. Even though there were lack of evidence to support using vaginal oxytocin for atrophic vaginitis, further studies should be conducted to gain a better understanding of oxytocin's effects and its efficacy on this condition.
325:
changes and becomes a few layers thick. Many of the signs and symptoms that accompany menopause occur in atrophic vaginitis. The earliest symptoms of atrophic vaginitis may be decreased vaginal lubrication, while other symptoms may appear later. Genitourinary symptoms include
512:
and under treated due to lack of awareness of those who are affected by atrophic vaginitis and of healthcare providers. Symptoms of genitourinary syndrome of menopause (GSM) are seen in 65% women one year post-menopause versus 87% six years post-menopause.
452:
atrophy of epithelial tissue leading to reduced thickness, and paleness are all apparent in post-menopausal women during histological examinations. Microscopy laboratory tests may be used to rule out symptoms caused by trichomoniasis and other bacteria. A
272:: Chemotherapy, selective estrogen receptor modulators (e.g. Tamoxifen and Raloxifene), or aromatase inhibitors (e.g. Letrozole, Anastrozole, and Exemestane) can lead to decreased estrogen levels and therefore side effects that include atrophic vaginitis.
426:
Lab tests usually do not provide information that will aid in diagnosing. A visual exam is useful. The observations of the following may indicate lower estrogen levels: little pubic hair, loss of the labial fat pad, thinning and resorption of the
431:, and the narrowing of the vaginal opening. An internal exam will reveal the presence of low vaginal muscle tone, the lining of the vagina appears smooth, shiny, pale with loss of folds. The cervical fornices may have disappeared and the
418:, candidiasis, and contact irritation from irritants such as soaps, pantyliners, or tight-fitting clothing. For example, a person who does not feel itching is unlikely to have candidiasis and no odor likely rules out bacterial vaginosis.
232:
In a majority of postmenopausal women, there are risk factors that can contribute to atrophic vaginitis. Specifically, these risk factors are directly related to decreased estrogen levels and vaginal health. Some risk factors include
1559:
Portman DJ, Gass ML (November 2014). "Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the
International Society for the Study of Women's Sexual Health and the North American Menopause Society".
565:
In 2018, the FDA issued a warning that lasers and other high energy devices were not approved for "rejuvenating" the vagina, and it has received many reports of injuries. Such devices are scams and have been shown to only cause
527:
have been the preferred terms for this condition and cluster of symptoms until recently. These terms are now regarded as inaccurate in describing changes to the entire genitourinary system occurring after menopause. The term
223:
Treatment for atrophic vaginitis may involve the use of topical estrogen or other estrogen replacement. To treat the symptoms, patients may use lubricants, but it may not help long term as it does not affect the tissues.
205:. Atrophic vaginitis as well as vulvovaginal atrophy, bladder and urethral dysfunctions are a group of conditions that constitute genitourinary syndrome of menopause (GSM). Diagnosis is typically based on symptoms.
2475:
2460:
1511:
Knörr K, Knörr-Gärtner H, Beller FK, Lauritzen C (2013). "Funktionelle
Anatomie und Histologie der weiblichen Genitalorgane" [Functional anatomy and histology of the female genital organs].
557:. Overall, the current preferred term is Genitourinary syndrome of Menopause (GSM). It is an umbrella term for vulvovaginal atrophy, atrophic vaginitis, urogenital atrophy and vaginal atrophy.
2312:
Safary M, Hakimi S, Mobaraki-Asl N, Amiri P, Tvassoli H, Delazar A (2020-10-27). "Comparison of the
Effects of Fenugreek Vaginal Cream and Ultra Low- Dose Estrogen on Atrophic Vaginitis".
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254:: These treatments involve radiation or embolization of the ovaries and can cause ovarian damage. This leads to decreased estrogen production and symptoms of atrophic vaginitis.
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2568:
313:. Additional risk factors include smokers, those who have not given birth naturally (through the vagina), and increased prolactin levels while lactation.
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2023:"Comparison of the Efficacy of Vaginal Hyaluronic Acid to Estrogen for the Treatment of Vaginal Atrophy in Postmenopausal Women: A Systematic Review"
2246:
2219:
410:
To determine if atrophic vaginitis is the cause for a patient's symptoms, differential diagnosis may be used. Other diagnosis include
257:
Hypothalamic-Pituitary
Disorders: These disorders directly affect the hypothalamus or pituitary gland, disrupting hormone production.
1971:"The effects of various therapies on vulvovaginal atrophy and quality of life in gynecological cancer patients: a systematic review"
1887:"Vaginal maturation index self-sample collection in mid-life women: acceptability and correlation with physician-collected samples"
2077:"Vaginal Vitamin E for Treatment of Genitourinary Syndrome of Menopause: A Systematic Review of Randomized Controlled Trials"
1524:
487:
2129:"The efficacy of oxytocin gel in postmenopausal women with vaginal atrophy: an updated systematic review and meta-analysis"
456:, also known as a pap test, would not be useful as it does not correlate strongly with the symptoms of atrophic vaginitis.
1466:"Practical Aspects in the Management of Vaginal Atrophy and Sexual Dysfunction in Perimenopausal and Postmenopausal Women"
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and cell maturation. Thus, hyaluronic acid may be a suitable treatment for those who cannot tolerate hormonal treatment.
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All of these factors impact estrogen levels and vaginal health, causing an increase in
Atrophic vaginitis development.
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Antiestrogen medications may also contribute to the development of atrophic vaginitis. These medications include
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Vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, estrogen deficient vaginitis
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by two professional societies. The term atrophic vaginitis does not reflect the related changes of the
241:: Women who undergo surgical removal of both ovaries, potentially causing a decline in estrogen levels.
178:
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498:. Other treatments are available without a prescription such as vaginal lubricants and moisturizers.
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2683:
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2347:
Poordast T, Ghaedian L, Ghaedian L, Najib FS, Alipour S, Hosseinzadeh M, et al. (2021-04-24).
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for the shortest duration help to prevent adverse endometrial effects. Treatment is generally with
202:
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247:: Ovaries fail to properly function before 40 years of age, causing a decrease in estrogen levels.
3231:
3181:
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2795:
2349:"Aloe Vera; A new treatment for atrophic vaginitis, A randomized double-blinded controlled trial"
976:"Long-term health consequences of premature or early menopause and considerations for management"
81:
76:
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Postpartum
Breastfeeding: Breastfeeding can cause lower estrogen levels due to hormonal changes.
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491:
198:
134:
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2127:
Farahat RA, Salamah HM, Mahmoud A, Hamouda E, Hashemy M, Hamouda H, et al. (2023-09-16).
610:
International Society for the Study of Women's Sexual Health and the Board of Trustees of The
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158:
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Dos Santos CC, Uggioni ML, Colonetti T, Colonetti L, Grande AJ, Da Rosa MI (January 2021).
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1621:
139:
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Medeiros AG, Cintra MM, dos Reis MA, Rocha LP, do Carmo Neto JR, Machado JR (2024-06-19).
8:
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439:. Inflammation is apparent when the vaginal lining bleeds easily and appears swollen.
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201:. It generally does not resolve without ongoing treatment. Complications may include
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Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S (April 2020).
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1986:
1373:
1260:"Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue"
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942:
895:
842:"Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue"
495:
415:
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1938:
694:"Genitourinary Syndrome of Menopause: Management Strategies for the Clinician"
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238:
2247:"The FDA needs to take another look at laser-based 'vaginal rejuvenation'"
2075:
Porterfield L, Wur N, Delgado ZS, Syed F, Song A, Weller SC (April 2022).
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1658:"The Genitourinary Syndrome of Menopause: An Overview of the Recent Data"
1513:
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2396:"Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review"
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56:
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263:: Medications such as Danazol or Leuprolide can lower estrogen levels.
3246:
3236:
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2512:
2266:"Carbon Dioxide Laser Vulvovaginal Rejuvenation: A Systematic Review"
306:
209:
112:
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3352:
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1829:"A Dermatologist's Approach to Genitourinary Syndrome of Menopause"
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567:
546:
453:
186:
100:
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1510:
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Some treatments have been developed more recently. These include
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182:
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2764:
2464:
436:
432:
2583:
1033:"Current treatment options for postmenopausal vaginal atrophy"
790:"The Recent Review of the Genitourinary Syndrome of Menopause"
2346:
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Hess R, Austin RM, Dillon S, Chang CC, Ness RB (July 2008).
1596:"What causes a woman to bleed after sex? - Health questions"
1121:
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46:
Normal vaginal mucosa (left) versus vaginal atrophy (right)
1258:
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840:
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2442:
1122:
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889:
887:
216:
or using specific medications. Risk factors include
208:
The decrease in estrogen typically occurs following
974:Faubion SS, Kuhle CL, Shuster LT, Rocca WA (2015).
2220:"FDA warning shines light on vaginal rejuvenation"
1463:
1333:
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537:(GSM) was determined to be more accurate than
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2185:
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1619:
1416:
1371:
940:
835:
833:
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669:
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653:
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1826:
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1729:
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1310:
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193:, vaginal itchiness or dryness, and an
3380:
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1936:
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488:selective estrogen receptor modulators
374:increased susceptibility to infections
2606:
2557:
2217:
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2016:
2014:
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1410:
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1406:
1404:
1402:
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435:can appear flush with the top of the
351:malodorous discharge due to infection
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922:
250:Ovarian Failure due to Radiation or
3363:Persistent genital arousal disorder
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535:Genitourinary syndrome of menopause
13:
2340:
2065:
2009:
1957:
1867:
1817:
1613:
1435:10.1097/01.NPR.0000391175.25008.ae
1397:
1358:
442:
14:
3414:
3177:Hypoactive sexual desire disorder
2696:Ovarian hyperstimulation syndrome
2438:
2326:10.2174/1567201817666200708112655
1730:Hum M, Dytoc M (September 2017).
919:
1482:10.1111/j.1743-6109.2005.00131.x
1264:Journal of Personalized Medicine
1213:"Lactational atrophic vaginitis"
846:Journal of Personalized Medicine
612:North American Menopause Society
2387:
2257:
2238:
2211:
2179:
1795:10.1016/j.maturitas.2009.04.009
1770:
1723:
1700:
1588:
1574:10.1016/j.maturitas.2014.07.013
1457:
1251:
1204:
1147:
1115:
1092:"Primary Ovarian Insufficiency"
604:
506:
293:Those with or had a history of
227:
168:Half of women (after menopause)
2791:Dysfunctional uterine bleeding
2400:The Journal of Sexual Medicine
2081:Journal of Menopausal Medicine
1470:The Journal of Sexual Medicine
1090:Sopiarz N, Sparzak PB (2024),
1083:
1024:
967:
794:Journal of Menopausal Medicine
515:
460:Vaginal Maturation Index (VMI)
1:
1779:"Managing urogenital atrophy"
1229:10.1016/s1526-9523(03)00143-0
992:10.3109/13697137.2015.1020484
621:
377:decreased vaginal lubrication
245:Primary Ovarian Insufficiency
189:levels. Symptoms may include
2887:Menorrhagia (hypermenorrhea)
2858:Polymenorrhea (epimenorrhea)
2353:Journal of Ethnopharmacology
2186:Bleibel B, Nguyen H (2024),
1903:10.1097/gme.0b013e31816c5541
1372:Bleibel B, Nguyen H (2024),
1211:Palmer AR, Likis FE (2003).
941:Bleibel B, Nguyen H (2024).
711:10.1016/j.mayocp.2017.08.019
570:and extreme pain to lead to
468:
396:
7:
3304:Pelvic inflammatory disease
894:Flores SA, Hall CA (2024),
560:
368:increased urinary frequency
212:. Other causes may include
10:
3419:
3299:Pelvic congestion syndrome
2729:Fallopian tube obstruction
2412:10.1016/j.jsxm.2020.10.016
2146:10.1186/s12905-023-02645-0
1987:10.1007/s00404-024-07552-9
1937:Kovacs P (15 March 2017).
1172:10.1007/s11154-021-09666-w
358:bleeding after intercourse
354:painful sexual intercourse
179:inflammation of the vagina
3348:Vestibular papillomatosis
3323:
3316:
3291:
3267:
3200:
3158:
3100:
3091:
3047:
2992:
2974:
2951:
2927:
2917:Metropathia haemorrhagica
2819:
2781:
2772:
2763:
2714:
2615:
2599:
2527:
2446:
2365:10.1016/j.jep.2020.113760
2218:Smith J (6 August 2018).
1777:Palacios S (2009-08-20).
1713:American Family Physician
1626:American Family Physician
1476:(Supplement_3): 154–165.
1340:American Family Physician
284:
261:Anti-Estrogen Medications
164:
153:
133:
123:
106:
95:
87:
75:
62:
50:
45:
36:
28:
23:
2684:Follicular cyst of ovary
2283:10.3390/cosmetics8030056
1845:10.1177/1203475417708165
1748:10.1177/1203475417708165
806:10.6118/jmm.2015.21.2.65
597:
380:urinary tract infections
203:urinary tract infections
82:Urinary tract infections
3182:Sexual arousal disorder
3138:Candidal vulvovaginitis
2796:Endometrial hyperplasia
1827:Hum M, Dytoc M (2017).
698:Mayo Clinic Proceedings
270:Breast Cancer Survivors
2625:Endometriosis of ovary
1423:The Nurse Practitioner
492:dehydroepiandrosterone
406:Differential Diagnosis
199:burning with urination
135:Differential diagnosis
3069:Vesicouterine fistula
3012:Cervical incompetence
2937:Recurrent miscarriage
2875:Premenstrual syndrome
2736:Fallopian tube cancer
2314:Current Drug Delivery
1124:"Menopause (Nursing)"
533:menopause for women.
392:thin, clear discharge
252:Arterial Embolization
119:, certain medications
3227:Rectovaginal fistula
2652:Poor ovarian reserve
2040:10.7759/cureus.44191
1050:10.2147/IJWH.S158913
896:"Atrophic Vaginitis"
539:vulvovaginal atrophy
521:Vulvovaginal atrophy
422:Clinical Examination
321:After menopause the
140:Infectious vaginitis
3277:Postcoital bleeding
3205:Urogenital fistulas
3133:Bacterial vaginosis
2786:Asherman's syndrome
1675:10.7759/cureus.7586
412:bacterial vaginosis
311:medroxyprogesterone
3162:Sexual dysfunction
3128:Atrophic vaginitis
3064:Retroverted uterus
3027:Female infertility
3007:Cervical dysplasia
2932:Female infertility
2724:Female infertility
2679:Corpus luteum cyst
2635:Ovulatory disorder
2630:Female infertility
2528:External resources
2133:BMC Women's Health
1277:10.3390/jpm5020050
859:10.3390/jpm5020050
530:atrophic vaginitis
525:atrophic vaginitis
386:difficulty sitting
365:blood in the urine
323:vaginal epithelium
317:Signs and symptoms
175:Atrophic vaginitis
148:contact dermatitis
24:Atrophic vaginitis
3375:
3374:
3371:
3370:
3312:
3311:
3287:
3286:
3220:Obstetric fistula
3118:Vaginal discharge
3087:
3086:
3032:Cervical stenosis
2947:
2946:
2801:Endometrial polyp
2759:
2758:
2689:Theca lutein cyst
2551:
2550:
2188:"Vaginal Atrophy"
2093:10.6118/jmm.21028
1526:978-3-642-95584-6
1374:"Vaginal Atrophy"
1346:(10): 3090–3096.
943:"Vaginal Atrophy"
742:Ferri FF (2016).
704:(12): 1842–1849.
572:suicidal ideation
454:Papanicolaou test
389:difficulty wiping
383:painful urination
362:painful urination
276:Cigarette smoking
172:
171:
129:Based on symptoms
125:Diagnostic method
18:Medical condition
3410:
3403:Vaginal diseases
3343:Kraurosis vulvae
3338:Bartholin's cyst
3321:
3320:
3272:Vaginal bleeding
3165:
3098:
3097:
3074:Uterine prolapse
2902:Menometrorrhagia
2826:
2779:
2778:
2770:
2769:
2669:Ovarian apoplexy
2613:
2612:
2604:
2603:
2578:
2571:
2564:
2555:
2554:
2444:
2443:
2432:
2431:
2391:
2385:
2384:
2344:
2338:
2337:
2309:
2296:
2295:
2285:
2261:
2255:
2254:
2242:
2236:
2235:
2233:
2231:
2215:
2209:
2208:
2207:
2206:
2183:
2177:
2176:
2166:
2148:
2124:
2115:
2114:
2104:
2072:
2063:
2062:
2052:
2042:
2018:
2007:
2006:
1966:
1955:
1954:
1952:
1950:
1934:
1923:
1922:
1882:
1865:
1864:
1824:
1815:
1814:
1774:
1768:
1767:
1727:
1721:
1720:
1704:
1698:
1697:
1687:
1677:
1653:
1642:
1641:
1617:
1611:
1610:
1608:
1607:
1592:
1586:
1585:
1556:
1531:
1530:
1508:
1502:
1501:
1461:
1455:
1454:
1414:
1395:
1394:
1393:
1392:
1369:
1356:
1355:
1331:
1308:
1307:
1297:
1279:
1255:
1249:
1248:
1208:
1202:
1201:
1191:
1151:
1145:
1144:
1143:
1142:
1119:
1113:
1112:
1111:
1110:
1087:
1081:
1080:
1070:
1052:
1028:
1022:
1021:
1011:
971:
965:
964:
962:
961:
938:
917:
916:
915:
914:
891:
882:
881:
871:
861:
837:
828:
827:
817:
785:
760:
759:
739:
724:
723:
713:
689:
615:
608:
500:Vaginal dilators
41:
21:
20:
3418:
3417:
3413:
3412:
3411:
3409:
3408:
3407:
3378:
3377:
3376:
3367:
3308:
3283:
3263:
3196:
3159:
3154:
3150:Vaginal atresia
3083:
3043:
3002:Cervical cancer
2988:
2970:
2966:Uterine fibroid
2943:
2923:
2907:Polymenorrhagia
2848:Oligoamenorrhea
2820:
2815:
2755:
2710:
2706:Ovarian torsion
2595:
2585:Female diseases
2582:
2552:
2547:
2546:
2523:
2522:
2455:
2441:
2436:
2435:
2392:
2388:
2345:
2341:
2310:
2299:
2262:
2258:
2243:
2239:
2229:
2227:
2216:
2212:
2204:
2202:
2184:
2180:
2125:
2118:
2073:
2066:
2019:
2010:
1967:
1958:
1948:
1946:
1935:
1926:
1883:
1868:
1825:
1818:
1775:
1771:
1728:
1724:
1705:
1701:
1654:
1645:
1618:
1614:
1605:
1603:
1594:
1593:
1589:
1557:
1534:
1527:
1509:
1505:
1462:
1458:
1415:
1398:
1390:
1388:
1370:
1359:
1332:
1311:
1256:
1252:
1209:
1205:
1152:
1148:
1140:
1138:
1120:
1116:
1108:
1106:
1088:
1084:
1029:
1025:
972:
968:
959:
957:
939:
920:
912:
910:
892:
885:
838:
831:
786:
763:
756:
740:
727:
690:
629:
624:
619:
618:
609:
605:
600:
563:
518:
509:
471:
462:
445:
443:Lab Examination
424:
408:
399:
348:white discharge
319:
287:
230:
195:urge to urinate
183:tissue thinning
181:as a result of
19:
12:
11:
5:
3416:
3406:
3405:
3400:
3395:
3390:
3373:
3372:
3369:
3368:
3366:
3365:
3360:
3355:
3350:
3345:
3340:
3335:
3329:
3327:
3318:
3314:
3313:
3310:
3309:
3307:
3306:
3301:
3295:
3293:
3289:
3288:
3285:
3284:
3282:
3281:
3280:
3279:
3268:
3265:
3264:
3262:
3261:
3260:
3259:
3254:
3249:
3244:
3239:
3229:
3224:
3223:
3222:
3217:
3212:
3210:Ureterovaginal
3201:
3198:
3197:
3195:
3194:
3189:
3187:Vaginal cancer
3184:
3179:
3174:
3168:
3166:
3156:
3155:
3153:
3152:
3147:
3142:
3141:
3140:
3135:
3130:
3120:
3111:
3101:
3095:
3089:
3088:
3085:
3084:
3082:
3081:
3079:Uterine cancer
3076:
3071:
3066:
3061:
3051:
3049:
3045:
3044:
3042:
3041:
3039:Nabothian cyst
3036:
3035:
3034:
3024:
3019:
3017:Cervical polyp
3014:
3009:
3004:
2998:
2996:
2990:
2989:
2987:
2986:
2980:
2978:
2972:
2971:
2969:
2968:
2963:
2957:
2955:
2949:
2948:
2945:
2944:
2942:
2941:
2940:
2939:
2928:
2925:
2924:
2922:
2921:
2920:
2919:
2911:
2910:
2909:
2904:
2896:
2895:
2894:
2889:
2879:
2878:
2877:
2872:
2862:
2861:
2860:
2855:
2853:Oligomenorrhea
2850:
2845:
2840:
2829:
2827:
2817:
2816:
2814:
2813:
2808:
2803:
2798:
2793:
2788:
2782:
2776:
2767:
2761:
2760:
2757:
2756:
2754:
2753:
2748:
2743:
2738:
2733:
2732:
2731:
2720:
2718:
2716:Fallopian tube
2712:
2711:
2709:
2708:
2703:
2701:Ovarian cancer
2698:
2693:
2692:
2691:
2686:
2681:
2671:
2666:
2661:
2656:
2655:
2654:
2649:
2648:
2647:
2645:Oligoovulation
2642:
2627:
2621:
2619:
2610:
2601:
2597:
2596:
2581:
2580:
2573:
2566:
2558:
2549:
2548:
2545:
2544:
2532:
2531:
2529:
2525:
2524:
2521:
2520:
2509:
2498:
2487:
2472:
2456:
2451:
2450:
2448:
2447:Classification
2440:
2439:External links
2437:
2434:
2433:
2406:(1): 156–166.
2386:
2339:
2320:(9): 815–822.
2297:
2256:
2237:
2210:
2178:
2116:
2064:
2008:
1981:(2): 631–641.
1956:
1924:
1897:(4): 726–729.
1866:
1839:(5): 418–424.
1816:
1789:(4): 315–318.
1769:
1742:(5): 418–424.
1722:
1699:
1643:
1632:(5): 321–329.
1612:
1587:
1568:(3): 349–354.
1532:
1525:
1503:
1456:
1396:
1357:
1309:
1250:
1223:(4): 282–284.
1203:
1166:(3): 333–355.
1146:
1114:
1082:
1023:
986:(4): 483–491.
966:
918:
883:
829:
761:
754:
725:
626:
625:
623:
620:
617:
616:
602:
601:
599:
596:
562:
559:
517:
514:
508:
505:
480:estrogen cream
470:
467:
461:
458:
444:
441:
423:
420:
416:trichomoniasis
407:
404:
398:
395:
394:
393:
390:
387:
384:
381:
378:
375:
372:
369:
366:
363:
360:
355:
352:
349:
346:
343:
340:
337:
334:
331:
318:
315:
286:
283:
279:
278:
273:
267:
264:
258:
255:
248:
242:
229:
226:
170:
169:
166:
162:
161:
155:
151:
150:
137:
131:
130:
127:
121:
120:
110:
104:
103:
97:
93:
92:
89:
85:
84:
79:
73:
72:
66:
60:
59:
54:
48:
47:
43:
42:
34:
33:
30:
26:
25:
17:
9:
6:
4:
3:
2:
3415:
3404:
3401:
3399:
3396:
3394:
3393:Inflammations
3391:
3389:
3386:
3385:
3383:
3364:
3361:
3359:
3356:
3354:
3351:
3349:
3346:
3344:
3341:
3339:
3336:
3334:
3333:Vulvar cancer
3331:
3330:
3328:
3326:
3322:
3319:
3315:
3305:
3302:
3300:
3297:
3296:
3294:
3290:
3278:
3275:
3274:
3273:
3270:
3269:
3266:
3258:
3255:
3253:
3250:
3248:
3245:
3243:
3240:
3238:
3235:
3234:
3233:
3230:
3228:
3225:
3221:
3218:
3216:
3215:Vesicovaginal
3213:
3211:
3208:
3207:
3206:
3203:
3202:
3199:
3193:
3190:
3188:
3185:
3183:
3180:
3178:
3175:
3173:
3170:
3169:
3167:
3164:
3163:
3157:
3151:
3148:
3146:
3143:
3139:
3136:
3134:
3131:
3129:
3126:
3125:
3124:
3121:
3119:
3115:
3112:
3110:
3106:
3103:
3102:
3099:
3096:
3094:
3090:
3080:
3077:
3075:
3072:
3070:
3067:
3065:
3062:
3060:
3056:
3053:
3052:
3050:
3046:
3040:
3037:
3033:
3030:
3029:
3028:
3025:
3023:
3020:
3018:
3015:
3013:
3010:
3008:
3005:
3003:
3000:
2999:
2997:
2995:
2991:
2985:
2982:
2981:
2979:
2977:
2973:
2967:
2964:
2962:
2959:
2958:
2956:
2954:
2950:
2938:
2935:
2934:
2933:
2930:
2929:
2926:
2918:
2915:
2914:
2912:
2908:
2905:
2903:
2900:
2899:
2897:
2893:
2890:
2888:
2885:
2884:
2883:
2880:
2876:
2873:
2871:
2868:
2867:
2866:
2863:
2859:
2856:
2854:
2851:
2849:
2846:
2844:
2843:Hypomenorrhea
2841:
2839:
2836:
2835:
2834:
2831:
2830:
2828:
2825:
2824:
2818:
2812:
2809:
2807:
2806:Endometriosis
2804:
2802:
2799:
2797:
2794:
2792:
2789:
2787:
2784:
2783:
2780:
2777:
2775:
2771:
2768:
2766:
2762:
2752:
2749:
2747:
2744:
2742:
2741:Hematosalpinx
2739:
2737:
2734:
2730:
2727:
2726:
2725:
2722:
2721:
2719:
2717:
2713:
2707:
2704:
2702:
2699:
2697:
2694:
2690:
2687:
2685:
2682:
2680:
2677:
2676:
2675:
2672:
2670:
2667:
2665:
2662:
2660:
2659:Mittelschmerz
2657:
2653:
2650:
2646:
2643:
2641:
2638:
2637:
2636:
2633:
2632:
2631:
2628:
2626:
2623:
2622:
2620:
2618:
2614:
2611:
2609:
2605:
2602:
2598:
2594:
2590:
2586:
2579:
2574:
2572:
2567:
2565:
2560:
2559:
2556:
2543:
2539:
2538:
2534:
2533:
2530:
2526:
2519:
2515:
2514:
2510:
2508:
2504:
2503:
2499:
2497:
2493:
2492:
2488:
2486:
2482:
2481:
2477:
2473:
2471:
2467:
2466:
2462:
2458:
2457:
2454:
2449:
2445:
2429:
2425:
2421:
2417:
2413:
2409:
2405:
2401:
2397:
2390:
2382:
2378:
2374:
2370:
2366:
2362:
2358:
2354:
2350:
2343:
2335:
2331:
2327:
2323:
2319:
2315:
2308:
2306:
2304:
2302:
2293:
2289:
2284:
2279:
2275:
2271:
2267:
2260:
2252:
2248:
2241:
2225:
2221:
2214:
2201:
2197:
2193:
2189:
2182:
2174:
2170:
2165:
2160:
2156:
2152:
2147:
2142:
2138:
2134:
2130:
2123:
2121:
2112:
2108:
2103:
2098:
2094:
2090:
2086:
2082:
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2071:
2069:
2060:
2056:
2051:
2046:
2041:
2036:
2033:(8): e44191.
2032:
2028:
2024:
2017:
2015:
2013:
2004:
2000:
1996:
1992:
1988:
1984:
1980:
1976:
1972:
1965:
1963:
1961:
1944:
1940:
1933:
1931:
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1737:
1733:
1726:
1719:(7): 807–815.
1718:
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1218:
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1207:
1199:
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1034:
1027:
1019:
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1005:
1001:
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989:
985:
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977:
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948:
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935:
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927:
925:
923:
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905:
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890:
888:
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875:
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865:
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855:
851:
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836:
834:
825:
821:
816:
811:
807:
803:
799:
795:
791:
784:
782:
780:
778:
776:
774:
772:
770:
768:
766:
757:
755:9780323448383
751:
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746:
738:
736:
734:
732:
730:
721:
717:
712:
707:
703:
699:
695:
688:
686:
684:
682:
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678:
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674:
672:
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668:
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664:
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650:
648:
646:
644:
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640:
638:
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634:
632:
627:
613:
607:
603:
595:
591:
587:
583:
579:
575:
573:
569:
558:
556:
552:
549:, vestibule,
548:
544:
540:
536:
531:
526:
522:
513:
504:
501:
497:
496:laser therapy
493:
489:
484:
481:
475:
466:
457:
455:
450:
440:
438:
434:
430:
419:
417:
413:
403:
391:
388:
385:
382:
379:
376:
373:
370:
367:
364:
361:
359:
356:
353:
350:
347:
344:
341:
338:
335:
332:
329:
328:
327:
324:
314:
312:
308:
304:
299:
296:
295:breast cancer
291:
282:
277:
274:
271:
268:
265:
262:
259:
256:
253:
249:
246:
243:
240:
236:
235:
234:
225:
221:
219:
215:
214:breastfeeding
211:
206:
204:
200:
196:
192:
191:pain with sex
188:
184:
180:
176:
167:
163:
160:
156:
152:
149:
145:
144:vulvar cancer
141:
138:
136:
132:
128:
126:
122:
118:
117:breastfeeding
114:
111:
109:
105:
102:
98:
94:
90:
86:
83:
80:
78:
77:Complications
74:
70:
69:Pain with sex
67:
65:
61:
58:
55:
53:
49:
44:
40:
35:
31:
27:
22:
16:
3252:Sigmoidocele
3160:
3127:
3105:Hematocolpos
2984:Parametritis
2892:Metrorrhagia
2870:Dysmenorrhea
2823:Menstruation
2821:
2811:Endometritis
2746:Hydrosalpinx
2674:Ovarian cyst
2535:
2511:
2500:
2489:
2474:
2459:
2403:
2399:
2389:
2356:
2352:
2342:
2317:
2313:
2273:
2269:
2259:
2250:
2240:
2228:. Retrieved
2223:
2213:
2203:, retrieved
2191:
2181:
2136:
2132:
2084:
2080:
2030:
2026:
1978:
1974:
1947:. Retrieved
1942:
1894:
1890:
1836:
1832:
1786:
1782:
1772:
1739:
1735:
1725:
1716:
1712:
1702:
1668:(4): e7586.
1665:
1661:
1629:
1625:
1615:
1604:. Retrieved
1599:
1590:
1565:
1561:
1516:
1512:
1506:
1473:
1469:
1459:
1429:(1): 22–28.
1426:
1422:
1389:, retrieved
1377:
1343:
1339:
1270:(2): 50–66.
1267:
1263:
1253:
1220:
1216:
1206:
1163:
1159:
1149:
1139:, retrieved
1127:
1117:
1107:, retrieved
1095:
1085:
1040:
1036:
1026:
983:
979:
969:
958:. Retrieved
946:
911:, retrieved
899:
852:(2): 50–66.
849:
845:
800:(2): 65–71.
797:
793:
744:
701:
697:
606:
592:
588:
584:
580:
576:
564:
538:
529:
524:
520:
519:
510:
507:Epidemiology
485:
476:
472:
463:
447:The vaginal
446:
429:labia minora
425:
409:
400:
371:incontinence
320:
300:
292:
288:
280:
239:Oophorectomy
231:
228:Risk Factors
222:
207:
174:
173:
108:Risk factors
15:
3257:Urethrocele
3172:Dyspareunia
3145:Hydrocolpos
3109:Hydrocolpos
3055:Hematometra
2976:Parametrium
2961:Adenomyosis
2774:Endometrium
2751:Salpingitis
2640:Anovulation
2537:MedlinePlus
2087:(1): 9–16.
1945:. WebMD LLC
1600:NHS Choices
1043:: 387–395.
980:Climacteric
516:Terminology
402:diagnosis.
185:due to low
29:Other names
3382:Categories
3358:Vulvodynia
3242:Enterocele
3192:Vaginismus
3114:Leukorrhea
3022:Cervicitis
2953:Myometrium
2838:Amenorrhea
2664:Oophoritis
2502:DiseasesDB
2359:: 113760.
2230:21 October
2205:2024-07-26
2192:StatPearls
2139:(1): 494.
1949:7 February
1606:2018-02-07
1391:2024-08-01
1378:StatPearls
1141:2024-07-30
1128:StatPearls
1109:2024-07-30
1096:StatPearls
960:2024-07-25
947:StatPearls
913:2024-07-26
900:StatPearls
622:References
490:, vaginal
237:Bilateral
57:Gynecology
3388:Menopause
3247:Rectocele
3237:Cystocele
3123:Vaginitis
2513:SNOMED CT
2420:1743-6109
2373:0378-8741
2292:2079-9284
2276:(3): 56.
2270:Cosmetics
2251:STAT News
2155:1472-6874
1995:1432-0711
1911:1072-3714
1891:Menopause
1853:1615-7109
1803:0378-5122
1783:Maturitas
1756:1203-4754
1562:Maturitas
1490:1743-6109
1443:0361-1817
1286:2075-4426
1237:1526-9523
1180:1389-9155
1059:1179-1411
1000:1369-7137
483:avoided.
469:Treatment
397:Diagnosis
307:nafarelin
210:menopause
165:Frequency
154:Treatment
113:Menopause
91:Long term
52:Specialty
3353:Vulvitis
3317:External
3232:Prolapse
3059:Pyometra
2600:Internal
2593:genitals
2518:52441000
2428:33293236
2381:33383112
2334:32640956
2200:32644723
2173:37716966
2164:10505316
2111:35534426
2059:37767255
2050:10520994
2003:38898186
1943:Medscape
1919:18427354
1861:28453946
1811:19493638
1764:28453946
1694:32399320
1638:29671516
1582:25179577
1498:16422792
1451:21150811
1386:32644723
1352:10839558
1304:25815692
1245:12867914
1198:34405378
1136:33760453
1104:36943992
1077:30104904
1018:25845383
955:32644723
908:33232011
878:25815692
824:26357643
720:29202940
568:necrosis
561:Research
547:clitoris
345:pressure
342:soreness
187:estrogen
159:estrogen
157:Vaginal
101:estrogen
99:Lack of
88:Duration
64:Symptoms
3048:General
2587:of the
2496:D059268
2102:9086347
1685:7212735
1295:4493485
1189:9156507
1068:6074805
1009:4581591
869:4493485
815:4561742
555:bladder
551:urethra
339:burning
336:itching
330:dryness
303:danazol
218:smoking
3093:Vagina
2994:Cervix
2913:Other
2898:Mixed
2882:Timing
2765:Uterus
2608:Adnexa
2589:pelvis
2542:000892
2426:
2418:
2379:
2371:
2332:
2290:
2224:MDedge
2198:
2171:
2161:
2153:
2109:
2099:
2057:
2047:
2027:Cureus
2001:
1993:
1917:
1909:
1859:
1851:
1809:
1801:
1762:
1754:
1692:
1682:
1662:Cureus
1636:
1580:
1523:
1496:
1488:
1449:
1441:
1384:
1350:
1302:
1292:
1284:
1243:
1235:
1196:
1186:
1178:
1134:
1102:
1075:
1065:
1057:
1016:
1006:
998:
953:
906:
876:
866:
822:
812:
752:
718:
494:, and
437:vagina
433:cervix
309:, and
285:Causes
96:Causes
3325:Vulva
3292:Other
2617:Ovary
2507:32516
2485:627.3
2470:N95.2
1515:[
598:Notes
543:labia
2865:Pain
2833:Flow
2591:and
2491:MeSH
2480:9-CM
2424:PMID
2416:ISSN
2377:PMID
2369:ISSN
2330:PMID
2288:ISSN
2232:2019
2196:PMID
2169:PMID
2151:ISSN
2107:PMID
2055:PMID
1999:PMID
1991:ISSN
1951:2018
1915:PMID
1907:ISSN
1857:PMID
1849:ISSN
1807:PMID
1799:ISSN
1760:PMID
1752:ISSN
1690:PMID
1634:PMID
1578:PMID
1521:ISBN
1494:PMID
1486:ISSN
1447:PMID
1439:ISSN
1382:PMID
1348:PMID
1300:PMID
1282:ISSN
1241:PMID
1233:ISSN
1194:PMID
1176:ISSN
1132:PMID
1100:PMID
1073:PMID
1055:ISSN
1014:PMID
996:ISSN
951:PMID
904:PMID
874:PMID
820:PMID
750:ISBN
716:PMID
553:and
523:and
333:pain
2476:ICD
2461:ICD
2408:doi
2361:doi
2357:270
2322:doi
2278:doi
2159:PMC
2141:doi
2097:PMC
2089:doi
2045:PMC
2035:doi
1983:doi
1979:310
1899:doi
1841:doi
1791:doi
1744:doi
1680:PMC
1670:doi
1570:doi
1478:doi
1431:doi
1290:PMC
1272:doi
1225:doi
1184:PMC
1168:doi
1063:PMC
1045:doi
1004:PMC
988:doi
864:PMC
854:doi
810:PMC
802:doi
706:doi
197:or
177:is
3384::
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3057:/
2540::
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