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Author: Dr Amanda Oakley, Dermatologist, Waikato Hospital, Hamilton New Zealand, 2009.
Vaginitis is the term used to describe inflammatory conditions affecting the female vagina. It is sometimes called vaginal mucositis. Vaginitis may be associated with vulval conditions.
Vaginitis may result in vaginal soreness, itching, discharge, malodour, fissuring and bleeding. It may hurt to pass urine (dysuria). It may prevent sexual intercourse (apareunia) or result in painful or uncomfortable sexual intercourse (dyspareunia).
Although most often due to infection, vaginitis may be due to one or more causes. These include:
Note that bacterial vaginosis does not cause vaginitis; bacterial vaginosis causes non-inflammatory and malodorous vaginal discharge.
Menstrual bleeding usually occurs for a few days at regular monthly intervals. Intermenstrual spotting can be quite normal. However, vaginal bleeding after established menopause may be serious and requires investigation as it may be an important sign of early cervical or endometrial cancer.
Vaginal dryness is a common problem that significantly reduces women's enjoyment of sex. It is due to reduced vaginal natural lubrication, and it can also be a sign of vaginitis.
Normal vaginal discharge is produced by mucous glands in the cervix and vagina, which mix with desquamating cells from the lining of the vagina. During arousal (orgasm), additional musk-smelling fluid is produced by the Bartholin glands at the entrance to vagina to reduce friction caused by penetration of a penis.
Lack of oestrogen due to menopause or infancy reduces vaginal mucus production. This may cause atrophic vaginitis, resulting in postmenopausal dryness, burning and lack of sexual desire (decreased libido).
Vaginal dryness in premenopausal women may be caused by menstrual cycle hormonal fluctuations, pregnancy or Sjögren syndrome. Certain medications may dry up normal vaginal fluids, such as some oral contraceptive pills, depot progesterone injections, sedatives, heart pills, cold or allergy medicines.
Vaginitis is evaluated by speculum examination of the vagina and cervix, as well as an examination of the abdomen, groin and vulva. In some cases, examination under anaesthetic (EUA) is necessary, including hysteroscopy (examination of the inside of the womb). Other investigations may include:
Microscopy of a wet smear evaluates epithelial cells and patterns of micro-organisms. The results may be difficult to interpret, as bacteria and yeasts may be found in the normal vaginal flora.
Measurement of pH can help determine the likelihood of a particular cause of vaginitis.
Normal or acidic pH is associated with candida vulvovaginitis, Group A streptococcal vaginitis (rare), and normal microbiome. Symptoms may be due to vulval and external conditions, such as contact allergic or irritant dermatitis, seborrhoeic dermatitis, and flexural psoriasis.
Treatment of vaginitis depends on the underlying cause. It may include:
In general, the vagina does not need to be washed (douched), as it regularly cleans itself. Gently cleanse the outside skin with water. A non-soap cleanser may be used.
Water-based vaginal lubricant before and during sex, or a vaginal moisturiser inserted several times each week, can make intercourse easier and less uncomfortable.
Vulvovaginal Disorders: an algorithm for basic adult diagnosis and treatment — ISSVD
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