Menopause changes infection, disease landscape. (STDs are Less Likely).

WASHINGTON -- The spectrum of gynecologic infection and disease in peri- and postmenopausal women differs dramatically from that of younger women, according to Dr. David A. Eschenbach.

Sexually transmitted infections become less common as women age, while gynecologic disease is more likely to result from changes in estrogen levels and decreased immunity Loss of skin thickness increases the risk of trauma, making it far more likely that symptoms such as irritation or discharge in an older women arise from the skin or vulva than from the vagina or cervix, he said at an update on sexually transmitted infections sponsored by OB. GYN. NEWS and Boston University.

Vulvar disease in peri- and postmenopausal women can be divided into four useful categories:

* Flat, white lesions (lichen sclerosis).

* Inflammatory lesions (candidiasis, lichen planus, and vestibulitis).

* Raised lesions (carcinoma in situ, squamous cell carcinoma, or other cancers).

Candidiasis is less common in older women, and when it occurs, it is much more likely to be associated with predisposing factors such as diabetes, said Dr. Eschenbach, professor and chair of obstetrics and gynecology at the University of Washington, Seattle.