VULVOVAGINITIS

VULVOVAGINITIS


Other Names : Vaginitis; Vaginal inflammation; Inflammation of the vaginal.

Vulvovaginitis (pronounced:vul-vo-vah-juh-ni-tus) is an inflammation of the vagina. It can that can result in discharge, itching and pain, and is often associated with an irritation or infection of the vulva. It is usually due to infection.

In the pathophysiology of vagina; A normal vaginal discharge consists of 1-4 mL of fluid that is white or transparent, thick, and odorless. This physiologic discharge is formed by sloughing epithelial cells, normal bacteria, and vaginal transudate. The discharge may be noticeable during pregnancy, oral contraceptive pill use, or at mid menstrual cycle, close to the time of ovulation.

The pH of vagina is maintained by lactobacillus, which produces hydrogen peroxide and lactic acid; diphtheroids; and Staphylococcus epidermidis. Lactobacillus is found in 62-88% of women. The normal pH of vaginal secretions is 4.0-4.5. Vaginal pH may increase with age, phase of menstrual cycle, sexual activity, contraception choice, pregnancy, presence of necrotic tissue or foreign bodies, and use of hygienic products or antibiotics.

The normal vaginal epithelium cornifies (develops into a thickened layer of epithelial cells) under the influence of estrogen, protecting women against infection.

Traditionally, the 3 classic entities of vaginitis include bacterial vaginosis, Trichomonas infection, and candidiasis. Other microorganisms may cause vulvovaginitis, or it may be caused by allergic reaction, irritation, injury, low estrogen levels, and certain diseases. Risk factors for bacterial vaginosis include using an intrauterine device (IUD), being of a non-white race, prior pregnancy, first sexual activity at an early age, having multiple sexual partners, and having a history of sexually transmitted diseases. Persons at an increased risk for candida vulvovaginitis include those who have had previous candida infections, frequent sexual intercourse, use birth control pills, have AIDS, are pregnant, are taking antibiotics or corticosteroids, are diabetic, use douches, use perfumed feminine hygiene sprays, wear tight clothing, or use vaginal sponges or an IUD.

Symptoms

• Irritation and itching of the genital area
• Inflammation (irritation, redness, and swelling) of the labia majora, labia minora, or perineal area
• Vaginal discharge
• Foul vaginal odor
• Discomfort or burning when urinating

Causes

Premenarchal; Nonspecific - No defined etiologic agent or poor perineal hygiene, Chemical irritants (eg, bubble baths, lotions),Vaginal foreign bodies, Pinworm infection, GABHS infection, Skin conditions - Eczema, psoriasis, seborrhea, Etiologies usually associated with women of childbearing age - Bacterial vaginosis, Trichomonas species, Candida species, and gonorrhea (Many of these are associated with sexual abuse).

Childbearing age; Sexual contact especially with multiple sexual contacts, No method of birth control, History of STD, Bacterial or fungal infections such as G vaginalis (bacterial vaginosis), Candida species, and Trichomonas species, Chemical irritants, Recent broad-spectrum antibiotics such as tetracycline, ampicillin, and cephalosporins, Pregnancy.

Postmenarchal - Atrophic vaginitis (most common cause of vulvovaginitis in postmenarchal women).

Diagnosis

To diagnose vulvovaginitis, the physician will examine the vagina (using a speculum to keep the vagina open) and take a sample of the vaginal discharge for tests and microscopic analysis. Diagnosis may be difficult because there are many different causes of vulvovaginitis.

Diagnosis is made with microscopy (mostly by vaginal wet mount) and culture of the discharge after a careful history and physical examination have been completed. The color, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent.

Drugs Used to Treat This Disorder

The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications.

Some drugs for example that can used to treat this disorder :

Butoconazole
2% cream; 5 g intravaginally for 3 days,
2% cream; 5 g (Butaconazole1-sustained release), single intravaginal application

Clotrimazole
1% cream; 5 g intravaginally for 7–14 days,
100 mg vaginal tablet for 7 days,
100 mg vaginal tablet; 2 tablets for 3 days)

Miconazole
2% cream 5 g intravaginally for 7 days,
100 mg vaginal suppository; one suppository for 7 days,
200 mg vaginal suppository; one suppository for 3 days,
1,200 mg vaginal suppository, one suppository for 1 day

Nystatin
100,000-unit vaginal tablet, 1 tablet for 14 days

Tioconazole
6.5% ointment 5 g intravaginally in a single application
0.4% cream 5 g intravaginally for 7 days
0.8% cream 5 g intravaginally for 3 days
80 mg vaginal suppository, 1 suppository for 3 days

Fluconazole
150 mg oral tablet, 1 tablet in single dose

Antihistamine drug; if an allergic reaction is involved.

A topical estrogen cream; for women who have irritation and inflammation caused by low levels of estrogen (postmenopausal).

Note : See your physician ! Along with medical treatment, you must be encouraged to avoid etiological agents and to make necessary changes in your habits.

Andi Surya Amal
Independent Author, Pharmacist, to study Medical Pharmacology and formulation