Senile vulvar atrophy is an atrophic change caused by skin nutritional disorders, resulting in partial or complete reduction of skin tissue and functional impairment in the vulvar skin and mucosa.Senile vulvar atrophy may result from aging, endocrine disorders, malnutrition, chronic infections, poisoning, congenital abnormalities, or neurotrophic dysfunction. It can also stem from prolonged mechanical pressure, traction, or physical factors like radiation damage or chemical irritation.Although primarily affecting elderly women, middle-aged women over 40 experience declining ovarian function, reduced estrogen secretion, and diminished vaginal self-cleansing capacity. Consequently, the risk of external vaginal infections increases annually after middle age. This underscores the importance of initiating preventive measures against vaginitis from middle age onwards.So, how should senile vulvar atrophy be treated?
Most experts advocate non-surgical approaches, with medication often yielding satisfactory results. However, follow-up monitoring remains essential post-treatment to prevent malignant transformation.
1. General Management
Maintain vulvar skin cleanliness and dryness. Avoid washing with soap or irritating agents. Refrain from scratching with hands or tools. Eliminate spicy foods from the diet.Wear loose-fitting clothing and avoid non-breathable synthetic underwear to prevent exacerbating the condition.
2. Oral Medications
Supplement with multivitamins to regulate bodily functions and improve local nutrition. For those experiencing significant mental tension, itching, or insomnia, sedatives, hypnotics, and desensitizing medications may be prescribed.
3. Topical Medications
Apply topical anti-itch agents. For sclerotic lichen planus with atrophy, use 10%–20% cod liver oil ointment or add 1%–2% testosterone propionate ointment. Apply 3–4 times daily until skin softens, adhesions resolve, and itching subsides.For chronic localized lichen planus, apply 5%–10% salicylic acid ointment topically. For thickened skin, use 0.1% tretinoin ointment.
4. Laser Therapy
Carbon dioxide or helium-neon laser treatment effectively relieves itching and reduces secretions in lichen sclerosus, while decreasing skin hyperkeratosis and improving blood perfusion.
5. Surgical Treatment
If severe vulvar atrophy persists despite medication, surgical intervention may be considered. For vulvar leukoplakia lesions classified as Grade II–III, vulvectomy with pathological examination of the specimen is recommended for safety. Postoperative follow-up is essential. If malignancy is present, treatment should follow vulvar carcinoma protocols.