Vaginitis

Clinic

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

The three main causes are infections, specifically bacterial vaginosis, vaginal yeast infection, and trichomoniasis. Other causes include allergies to substances such as spermicides or soaps or as a result of low estrogen levels during breast-feeding or after menopause. More than one cause may exist at a time. The common causes vary by age. Prepubescent girls are often at risk for development of vulvovaginitis because of low amounts of estrogen and an underdeveloped labia minora.

Diagnosis generally include examination, measuring the pH, and culturing the discharge. Other causes of symptoms such as inflammation of the cervix, pelvic inflammatory disease, cancer, foreign bodies, and skin conditions should be ruled out.

Treatment depends on the underlying cause. Infections should be treated. Sitz baths may help with symptoms. Soaps and feminine hygiene products such as sprays should not be used. About a third of women have vaginitis at some point in time. Women of reproductive age are most often affected.

Signs and symptoms

A woman may have vaginal irritation, itching, or burning or may notice a foul-smelling or abnormal discharge that could appear green or yellow.

The following signs or symptoms may indicate the presence of infection:

• Irritation or itching of the genital area
• inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area
• vaginal discharge
• foul vaginal odor
• pain/irritation with sexual intercourse

Complications

Vaginal infections left untreated can lead to further complications, especially for the pregnant woman. For bacterial vaginosis, these include "premature delivery, postpartum infections, clinically apparent and subclinical pelvic inflammatory disease, [as well as] postsurgical complications (after abortion, hysterectomy, caesarian section), increased vulnerability to HIV infection and, possibly, infertility". Studies have also linked trichomoniasis with increased likelihood of acquiring HIV; theories include that "vaginitis increases the number of immune cells at the site of infection, and HIV then infects those immune cells." Other theories suggest that trichomoniasis increases the amount of HIV genital shedding, thereby increasing the risk of transmission to sexual partners. While the exact association between trichomoniasis infection and HIV genital shedding has not been consistently demonstrated, "there is good evidence that TV treatment reduces HIV genital shedding. Five studies were reported in the literature and, of these, four found a decrease in HIV genital shedding after TV treatment."

Further, there are complications which lead to daily discomfort such as:

• persistent discomfort
• superficial skin infection (from scratching)
• complications of the causative condition (such as gonorrhea and candida infection)

Causes

Infection

Vaginitis is often caused by an infection or the disruption of the healthy vaginal flora. The vaginal flora consists of those organisms which generally do not cause symptoms and is dominated mainly by Lactobacillus species. Disruption of the normal flora can cause a vaginal yeast infection. Vaginal yeast infection can affect women of all ages and is very common. The yeast Candida albicans is the most common cause of vaginitis. Specific forms of vaginal inflammation include the following types:

Infectious vaginitis accounts for 90% of all cases in reproductive age women:

• Candidiasis: vaginitis caused by proliferation of Candida albicans, Candida tropicalis, Candida krusei
• Bacterial vaginosis: vaginitis caused by increased growth of Gardnerella (a bacterium).
• Aerobic vaginitis

Other less common infections are caused by gonorrhea, chlamydia, Mycoplasma, herpes, Campylobacter, improper hygiene, and some parasites, notably Trichomonas vaginalis. Rare cases of amebic vaginitis have been reported, primarily in tropical, developing countries. Women who have diabetes develop infectious vaginitis more often than women who do not.

Further, either a change in pH balance or introduction of foreign bacteria in the vagina can lead to infectious vaginitis. Physical factors that have been claimed to contribute to the development of infections include the following: constantly wet vulva due to tight clothing, chemicals coming in contact with the vagina via scented tampons, antibiotics, birth control pills, or a diet favoring refined sugar and yeast.

Hormonal

Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal women.

Irritation/allergy

Irritant vaginitis can be caused by allergies or reactions to vaginal sprays, douches, spermicides, soaps, detergents, or fabric softeners. It can also be caused by hot tubs, abrasion, tissue, tampons, or topical medications.

Foreign body vaginitis (most common foreign bodies are retained tampons or condoms) may cause extremely malodorous vaginal discharges. Treatment consists of removal, for which ring forceps may be useful. Further treatment is generally not necessary.

Remedies

Banerji protocols
First line	Nit-ac C3 two doses daily
Second line	Kreos C200 two doses daily
Third line	Carb-an C200 two doses daily