Because the vagina and urethra share a common embryologic origin, it is believed that estrogen deficiency causes atrophy of both structures. Atrophy of the vaginal epithelium may cause vaginal itching, dryness, and dys-pareunia, with resulting inflammation. One effect of estrogen deficiency is to cause changes in the vaginal pH, which predispose women to urinary tract infections that cause urgency, incontinence, frequency, nocturia, and dysuria. The loss of estrogen on periurethral tissues will contribute to pelvic laxity and stress incontinence. Recurrent urinary tract infections can be prevented with systemic estrogen therapy, and low-dose topical estrogen is effective in managing atrophic vaginitis. Estrogen provides relief of these symptoms and may protect against recurrent urinary tract infections.
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