Vaginal and Vulvovaginal Disorders (copy)

What is the Environment of the Vagina?

acidic (pH = 4-4.5)

What is Vaginitis?

inflammation of the vagina that can result in discharge, itching, and pain

What are the Causes of Vaginitis?

1. bacterial vaginosis (BV)

2. vulvovaginal candidiasis (VVC)

3. trichomoniasis

What Cause of Vaginitis is Self Treatable?

vulvovaginal candidiasis (VVC)

How Does VVC Change Vaginal pH?

no change

What are the Symptoms of VVC?

itch, discomfort, dysuria (painful urination) ,thick discharge

What are the Sympotoms of BV?

odor, itch, discharge

What are the Symptoms of Trichomoniasis?

itch, discharge, possible vaginal irritation; ~50% asymptomatic

What are the Characteristics of VVC Discharge?

thick, white (“cottage-cheese”-like), without odor

What are the Characteristics of BV Discharge?

thin (watery), white or gray, sometimes foamy, unpleasant “fishy” odor that increases after intercourse

What are the Characteristics of Trichomoniasis Discharge?

frothy, malodorous, yellow-green (or discolored)

What are the 3 Key Factors in Identifying VVC?

1. no change in vaginal pH

2. thick, white vaginal discharge

3. odorless vaginal discharge

What are the Limitations to Vaginal pH Testing Kits?

• cannot test until 72 hours after the use of any vaginal preparations (spermicides, inserts, etc.)

• must wait 48 hours after douching

• must wait 5 days after menstrual period

What is the Common Name for VVC?

yeast infection or moniliasis

What are the Risk Factors for VVC?

• pregnancy

• high-dose combined oral contraceptives

• estrogen therapy

• uncontrolled diabetes

• antibiotic use

• onset of first regular intercourse activity

• receptive oral sex

• intrauterine or vaginal sponge contraceptive

What is the Pharmacological Therapy for VVC?

vaginal antifungals (class: imidazoles)

How Does the Dose of Imidazole Treatment Relate to Duration of Therapy?

higher dose = shorter treatment duration

How Do Imidazoles Differ in Effectiveness?

all are equally effectives regardless of drug or strength/duration of treatment

What is a Drug Interaction with Imidazoles?

miconazole vaginal suppositories + warfarin = increased bleeding risk

What are Common Adverse Effects of Imidazole Treatment?

• vulvovaginal burning

• itching

• irritation

uncommon; occurs in 3-7% of pts

How Long Does VVC Take to Treat?

relief of symptoms should occur within 3 days but may take up to a week for complete resolution

• it is importatnt to complete the full course of treatment even if symptom relief is sooner

When Should the Pt Seek Medical Attention for VVC?

• if symptoms persist more than 1 week after treatment

• if symptoms recur within 2 months

• if vaginal symptoms worsen or change

What are Nonpharmacological Treatments for VVC?

• not standard therapy

• may try dietary measures (consumption of yogurt containing live cultures)

• avoidance of nonabsorbant clothing

What Pts are Excluded from Self-Treatment of VVC?

1. girls under 12 years old

   • VVC is rare in premenarchal girls

2. recurrent VVC infections

   • more than 4 per year

3. severe symptoms

What is Atrophic Vaginitis?

inflammation of the vagina related to atrophy of the vaginal mucosa secondary to decreased estrogen levels

What is a Common Symptom of Atrophic Vaginitis?

dyspareunia (painful intercourse)

What Leads to Atrophic Vaginitis?

decreased estrogen levels occur during:

• menopause

• postpartum period

• breastfeeding

What is the Treatment for Atrophic Vaginitis?

vaginal lubricants may be used in mild-moderate cases to alleviate symptoms by moistening vaginal tissues

What are Counseling Points for Vaginal Lubricants?

• provides short-term improvement of symptoms such as burning or itching

• should not use petrolatum jelly

• only use water-soluble products with latex condoms or diaphragm

• water-soluble lubricants may be used both internally and externally

What is Vaginal Douching?

washing or cleaning the vagina with water or other mixtures of fluids

Is Douching Recommended?

No

• vagina is a self-cleaning organ

• douching leads to increased risk of pelvic inflammatory disease (PID), infection (BV), ectopic pregnancy, and preterm delivery