Abstract
Atrophic changes of the vulva, vagina, and lower urinary tract can detract from the quality of life of menopausal women. Vulvovaginal symptoms, in contrast to vasomotor disturbances, are usually progressive in nature and do not ameliorate with time from the menopausal transition. The patient may initially attribute the symptoms of atrophy to other vulvovaginal conditions. Embarrassment arising from cultural or religious beliefs can prevent the patient from openly discussing problems related to sexual function. Sensitive questioning and thorough evaluation will correctly identify the pattern of changes as those caused by the loss of estrogen. Hormonal and nonhormonal treatments can provide patients with relief and a return to their previous level of function. Because these atrophic changes respond favorably to estrogen therapy, no reason exists for older women to suffer from urogenital atrophy symptoms. In addition to vulvar dystrophies, vulvovaginal complaints in postmenopausal women not related directly to estrogen loss also include a variety of systemic and chronic conditions such as diabetes, autoimmune diseases, and urinary incontinence.