Brief Answer:
ATROPHIC VAGINITIS LIKELY
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us with your health concern.
I assume you are menopausal at 57.
Any kind of vaginal bleeding / spotting after
menopause qualifies as post menopausal bleeding , and warrants investigation.
The most probable diagnosis in your case is - Atrophic Vaginitis.
This occurs in almost half of all menopausal women.
Due to lower circulating levels of estrogen in the system, the vaginal epithelium dries up, becoming more fragile and delicate.
The dryness and lack of vascularity predisposes easily to infections.
Also, the vaginal mucosa breaks down easily, leading to intermittent spotting and vaginal bleeding, particularly after intercourse.
The burning and itching is also characteristic of the dried up fragile epithelium.
The classical treatment is estrogen provided locally.
It is essential to have a gynaecological check up to confirm the diagnosis, before starting treatment.
You should have the following work up at a minimum -
1. Internal check up - per vaginum and per speculum. THis is sufficient to establish the diagnosis, as the vagina has the characteristic look of atrophy
2. Pelvic
transvaginal ultrasound scan
3.
Pap smear
4. Hormonal levels to confirm menopause if you are bleeding still ( less likely at 57 )
Once the diagnosis is confirmed, you would be started on
Estrogen replacement treatment locally - in the form of creams, pessaries or a vaginal ring ( Estring ) .
As you are on vacation, it would be unwise to start the hormonal creams without having a gynec check up and proper diagnosis.
WOmen who do not accept hormonal treatment for any reason / are not able to use it due to risk factors - can be managed with vaginal moisturizers and lubricants as well.
THese are short term measures.
Sexual activity is a big stimulant to the vaginal mucosa, and improves vaginal wall elasticity and pliability.
It is best to indulge in regular coitus to help keep the symptom at bay.
Right now , on vacation, you might choose from a variety of moisturizers and vaginal lubricants ( depends on the location where you are based and local availability of the products ).
Common products are - K-Y Jelly, K-Y Ultragel, K-Y Liquid , K-Y Silk-e Liquid , K-Y Long Lasting ,
Astroglide Silken Secret , Lubrin , Replens , Finally etc.
Once you get back to base, I strongly recommend a checkup and treatment accordingly if the symptoms persist / recur.
The consultation would also rule out other causes of your symptoms - such as a
vaginal infection ( not primarily due to atrophic vaginitis ) or a local cause of bleeding such as a polyp, cervical lesion etc.
Take care.
Please feel free to discuss further.
Hope the answer helped you.