ABSTRACT
Patients with vaginal atrophy sometimes develop urinary tract infections (UTI) as well as urinary in continence 5-7. The postmenopausal woman with urinary incontinence should not be subjected to a comprehensive evaluation of the urinary tract as the initial step in the work-up. The evaluation should begin by obtaining a clean catch urine specimen. If the patient has a copious discharge an evaluation of the vagina should be performed, i.e. physician inspection, determination of the vaginal pH, and microscopic examination of the vaginal discharge. Following completion of the pelvic examination, a lubricated tampon (place estrogen cream on the surface of the tampon) should be inserted into the vagina and the patient asked to provide a clean catch urine specimen. If the patient has atrophic vaginitis, and has copious discharge, the urine specimen will be contaminated by a variety of bacteria from the vagina. Once the specimen has been obtained the tampon should be removed. When evaluating the patient with urinary incontinence the presence of a UTI should be ruled out. If the patient exhibits signs of vaginal atrophy and vaginitis, a trial of estrogen therapy should be administered. If the patient continues to complain of urinary incontinence once the vagina has been restored to a healthy state, a comprehensive evaluation of the lower urinary tract should be conducted.
