Vaginitis and vulvitis, inflammation of the vagina and vulva respectively, are common conditions often encountered in clinical practice. They can be uncomfortable and distressing, but are usually treatable.
Causes
- Infectious Causes:
- Bacterial Vaginosis (BV): Overgrowth of bacteria normally present in the vagina.
- Candidiasis (Yeast Infection): Overgrowth of Candida, a yeast-like fungus.
- Trichomoniasis: Sexually transmitted infection caused by a parasite.
- Viral Infections: Such as herpes simplex virus.
- Non-Infectious Causes:
- Allergic Reactions: To products like soaps, douches, or spermicides.
- Irritants: Such as laundry detergents, fabric softeners, or tight clothing.
- Hormonal Changes: Especially during menopause (atrophic vaginitis).
- Skin Conditions: Such as lichen sclerosus or eczema.
Diagnosis
- History:
- Symptoms like itching, burning, discharge, odor, pain during intercourse, or urination.
- Recent use of new products, medications, or sexual activity.
- Menstrual history and hormonal changes.
- Examination:
- External genital exam for redness, swelling, lesions, or discharge.
- Vaginal examination to assess discharge, signs of atrophy, or inflammation.
- Pelvic exam to rule out other gynecological conditions.
- Investigations:
- Wet Mount: Vaginal discharge sample examined under a microscope.
- pH Testing: Vaginal pH; elevated in bacterial vaginosis and trichomoniasis.
- Cultures: For yeast, bacteria, or Trichomonas.
- Pap Smear: To rule out cervical dysplasia or cancer if indicated.
- STI Screening: Especially if trichomoniasis or herpes is suspected.
Differential Diagnosis
- Sexually Transmitted Infections (STIs): Gonorrhea, chlamydia.
- Urinary Tract Infections (UTIs): Especially if dysuria is a primary symptom.
- Dermatological Conditions: Psoriasis, lichen planus.
- Foreign Body: In children, a retained foreign body can cause similar symptoms.
Management
- Infectious Vaginitis:
- Bacterial Vaginosis: Antibiotics like metronidazole 2g oral stat
- Candidiasis: Antifungal medications, either topical (clotrimazole) or oral (fluconazole 150mg oral stat)
- Trichomoniasis: Metronidazole 2g oral stat
- Atrophic Vaginitis:
- Hormonal therapy, such as topical oestrodiol.
- Allergic/Irritant Vulvitis:
- Avoidance of the offending agent.
- Topical corticosteroids for severe irritation.
- Emollients for symptomatic relief.
- General Measures:
- Good genital hygiene practices.
- Avoid douching and the use of scented products.
- Loose-fitting cotton underwear.
- Education and Counseling:
- Understanding the cause of symptoms.
- Safe sexual practices, if STIs are a concern.
- Follow-Up:
- To assess response to treatment.
- Repeat testing if symptoms persist.
Conclusion
Effective management of vaginitis and vulvitis requires a comprehensive approach, including accurate diagnosis, appropriate treatment, patient education, and addressing underlying causes or contributing factors. Regular follow-up is essential to ensure resolution of symptoms and to manage any recurrent episodes.