Vaginitis

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Overview
Vaginitis is an inflammation of the vaginal mucosa and often associated with an irritation or infection of the vulva leading to vulvovaginitis. It is a common problem.

Significance
Vaginitis may be asymptomatic, but usually leads to significant vaginal itching and irritation so that the patient self-medicates or seeks professional help. If it is caused by an infectious organism such as chlamydia, the infection progress throughout the uterus into the fallopian tubes and ovaries and could lead to infertility. An infection via human papillomavirus (HPV) can eventually increase the risk of cervical carcinoma.

Symptoms
A woman with this condition may have itching or burning and may notice a discharge. In general, these are symptoms of vaginitis:
 * irritation and/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
 * discomfort or burning when urinating
 * pain/irritation with sexual intercourse

Causes
Vulvovaginitis can affect women of all ages and is very common. Specific forms of vaginitis are:

Infection
Infectious vaginitis accounts for 90% of all cases in reproductive age women and is represented by the triad:
 * Candidiasis: vaginitis caused by Candida albicans (a yeast),
 * Trichomoniasis: vaginitis caused by Trichomonas vaginalis (a protozoan),
 * Bacterial vaginosis: vaginitis caused by Gardnerella (a bacterium).

Other less common infections are caused by gonorrhea, chlamydia, mycoplasma, herpes, campylobacter and some parasites.

Hormonal
Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal or postpartum women. Sometimes it can occur in young girls before puberty. In these situations the estrogen support of the vagina is poor.

Irritation/allergy
Irritant vaginitis can be caused by allergies to condoms, spermicides, soaps, perfumes, douches, lubricants and semen. It can also be caused by hot tubs, abrasion, tissue, tampons or topical medications.

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

Role of STI's
Sexually Transmitted Infections (STIs) can be a cause of vaginal discharge. Chlamydia and gonorrhea testing should be done whenever a sexually active adolescent complains of vaginal discharge even when the cervix appears normal.

Discharge
The color of the discharge may be predictive of the causative agent. (ICD-10 codes for causative agents listed below.)


 * Candida Vaginitis Candidiasis usually causes a watery, white, cottage cheese like vaginal discharge. The discharge is irritating to the vagina and the surrounding skin.


 * Atrophic vaginitis (or "Senile Vaginitis") usually causes scant vaginal discharge with no odour, dry vagina and painful intercourse. These symptoms are usually due to decreased hormones usually occurring during and after menopause.


 * Bacterial Vaginitis Gardnerella usually causes a discharge with a fish-like odour. It is associated with itching and irritation, but not pain during intercourse.


 * Trichonomas Vaginitis Trichomonas vaginalis can cause a profuse discharge with a fish-like odour, pain upon urination, painful intercourse, and inflammation of the external genitals.


 * Herpes usually occurs as water blisters on the genital region, about one week after infection. There is tenderness, swollen glands, and fever.  The water blisters are extremely painful and heal in about three weeks.  However, herpes is usually an external infection and does not fall under the category of vaginitis.

Women who have diabetes frequently develop vaginitis, often Candida Candida albicans more often than women who do not.

Diagnosis
It may be useful to measure the PH value as with infections vaginal pH increases. Diagnosis is made with microscopy and culture of the discharge after a careful history and physical examination have been completed.

Complications

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

Treatment
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. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed.