The vaginal mucosa epithelium becomes cornified under the influence of estrogens.

The vaginal epithelium is squamous in nature, and until menopause is moist and thick with rugae.

At menopause, the vaginal epithelium thins from declining levels of estrogen.

With menopause, fewer epithelial cells exfoliate into the vagina.

Exfoliated epithelial cells die and release glycogen, which is hydrolyzed to glucose, and in turn glucose is broken down into lactic acid by Lactobacillus, a normal vaginal organism.

If the above process doesn’t occur the pH of the vagina will rise with the loss of lactobacilli andovergrowth of other bacteria, including group B. Streptococcus, staphylococci, coliforms, and diptheroids (Roy S).

Overgrowth of these other bacteria can cause vaginal infections and inflammation.

Progesterone creates thick mucus and epithelium proliferation with infiltration of leukocytes.

Following menopause elasticity of the vagina is reduced and connective tissues increase, vaginal blood flow is decreased, as is vaginal lubrication.

Estrogen receptors in the vagina, vulva, labia, urethra and bladder mediate the effects of endogenous estrogen.

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