Vaginal and Vulvovaginal Disorders

Douching

-race and education important predictors

-more AA and Hispanic women douche

-common in teens

-increased risk of PID, reduced fertility, ectopic pregnancy, vaginal infections, STIs, preterm delivery, cervical cancer

-irritation or sensitization to vinegar, iodine, or povidone

-disruption of normal flora and pH

-allergic reactions

-tactfully discourage

Vaginitis

-disorders of the vagina caused by infection, inflammation, changes in normal flora

-change in vaginal discharge, pruritus, burning, irritation, erythema, dyspareunia, spotting, dysuria

Vaginal Atrophy Pathophys.

after less estrogen:

- lining becomes then and dry

- decreased blood flow

Atrophic Vaginitis

-inflammation of vagina related to atrophy of mucosa secondary to decreased estrogen levels

-Sx: dyspareunia, itching, irritation, changes to leukorrhea (thin, watery, malodorous, burning)

-Tx: water based moisturizers and lubricants, sexual activity, estrogen replacement therapy

Atrophic Vaginitis Exclusions to Self Care

-sx of severe vaginal dryness, dyspareunia or bleeding

-sx that are not localized

-vaginal dryness or dyspareunia not relieved by use of personal lubricants

Bacterial Vaginosis

-Sx: incr amount, thin, watery discharge, off white, fishy smell, worse post intercourse, vag. irritation, dysuria, itch

-Etiol/Epi: polymicrobial, imbalance in flora

-risk factors: new partner, IUD, smoking, condoms may reduce

-RX: clindamycin, metronidazole

Trichomoniasis

-Sx: copious, malodors, yellow, green, frothy discharge, pruritis, erythema, edema, men asymptomatic reservoirs

-Etiol: Trichomonas vaginalis (protozoa)

-Risk Factors: multiple sex partners, STI, new partner

-Rx: metronidazole, trinidazole, Rx partner

Vulvovaginal Candidiasis (Yeast Infection)

-Sx: thick, white discharge, no odor, normal pH, pruritus, vaginal soreness, dyspareunia

-Etiol: C. albicans, C. glabrata, C. tropicalis, Saccharomyces

-Risk Factors: pregnancy, OCs, diabetes, antibiotics, immunosuppressants, no cause

-Rx: azole antifungals, nystatin, no Rx partner

Exclusion for Self Treatment of VVC

-pregnancy unless indicated by doctor, 7 day treatment

-girls under 12: worried about sexual assult

-concurrent sx: fever or pain in pelvic area, lower abdomen, back or shoulder

-medications that can predispose: corticosteroids, antineoplastics

-medical disorders that can predispose: diabetes, HIV

-recurrent VVC

-first VVC

Nonpharm Therapy

-decrease sucrose and carbs

-increase yogurt with live cultures

-discontinue offending meds if possible

-wear cotton underwear

-reduce or avoid tight fitting clothes

Pharm Therapy

Imidazole antifungals:

- clotrimazole 1%: 1, 3, 7 day options

-miconazole 2%: 1, 3, 7 day options

-tioconazole 6.5%: 1 day treatment

-creams, suppositories, tablets

-MOA: alters membrane permeability of fungi resulting in loss of normal membrane function

-S/E: burning, itching. irritation

-all same efficacy (80%) so up to patient preferences