What is Vaginitis?

Vaginitis, or vaginal inflammation, is a group of conditions that cause vulvovaginal symptoms such as itching, burning, irritation, and abnormal fluid flow. Normal healthy women's vagina has a natural defense function against pathogen invasion due to the characteristics of anatomical tissue. For example, the vaginal opening is closed, the front and back of the vagina are tightly attached, the proliferation of vaginal epithelial cells under the influence of estrogen and the keratinization of the surface cells, the vaginal pH is kept balanced, the reproduction of pathogens that adapt to alkaline is suppressed, and the cervical mucus presents Alkaline, when the natural defense function of the vagina is destroyed, pathogens easily invade, leading to vaginal inflammation.

Basic Information

nickname

Vaginal inflammation

English name

vaginitis

Visiting department

Gynecology

Common locations

vaginal

Common causes

infection

Common symptoms

Increased vaginal discharge, itching of the vulva, frequent urination, and dysuria

Causes of vaginitis

Bacterial vaginosis

Lactobacillus producing hydrogen peroxide is predominant in normal vagina. In bacterial vaginosis, an endogenous mixed infection caused by a decrease in vaginal lactobacilli and an increase in Gardnerella and anaerobic bacteria.

2. Candidal vaginitis

(1) 80% to 90% of the pathogens are Candida albicans, which are easy to grow in an acidic environment and are biphasic (yeast phase, mycelium phase).

(2) The patient's vaginal pH is 4.0-4.7, and the normal pH is <4.5.

(3) Conditional pathogenic bacteria (yeast phase mycelium phase).

(4) Common causes: pregnancy, diabetes, extensive use of immunosuppressants and broad-spectrum antibiotics.

(5) Other incentives: Candida gastrointestinal tract, tight chemical fiber underwear, obese people.

3. Trichomonas vaginitis

(1) Trichomonas vaginalis is suitable for growth in a humid environment at a temperature of 25 ° C to 40 ° C and a pH of 5.2 to 6.6.

(2) The vaginal pH changes before and after menstruation. It is nearly neutral after menstruation, and trichomoniasis is easy to reproduce.

(3) The vaginal pH of patients is generally between 5.0 and 6.5, and most of them are> 6.0.

(4) Parasitic in the vagina, urethra or paraurethral glands, bladder, renal pelvis, male foreskin folds, urethra, prostate.

(5) often coexist with other vaginitis.

4. Senile vaginitis

Postmenopausal women suffer from a decline in ovarian function, decreased estrogen levels, atrophy of the vaginal wall, thinning of the mucous membranes, increased pH in the vagina, and reduced local resistance. Other pathogenic bacteria overproduce or easily invade and cause inflammation, mainly aerobic bacteria.

5. Vaginitis in young women

Infants and young children develop due to poor vulvar development, low levels of estrogen, and vaginal foreign bodies, which cause provocation infections. Common pathogens include Escherichia coli, Staphylococcus, and Streptococcus.

Clinical manifestations of vaginitis

Bacterial vaginitis

10% to 40% of patients are asymptomatic, and those with symptoms are mainly increased vaginal secretions, fishy smell, especially after sexual intercourse, and may be accompanied by mild vulvar itching or burning sensation. Examination revealed no vaginal inflammation of the vaginal mucosa. The secretion was grayish white, uniform, thin, and often adhered to the vaginal wall, which was easy to wipe away from the vaginal wall.

2. Candidal vaginitis

(1) Vulvar itching, burning pain, pain during intercourse.

(2) Frequent urination and pain. Urinary pain is characterized by urinary irritation of the vulva and vestibule that cause pain during urination.

(3) Characteristic secretions: white and thick like curd or bean dregs.

(4) Vulvitis shows map-like erythema, edema, and scratches.

(5) Edema, erythema, and white membrane can be seen in vaginitis.

3. Trichomonas vaginitis

(1) Features of increased vaginal discharge: thin purulent, yellowish green, foamy, and odorous.

(2) Itching parts of vulva: vaginal opening and vulva.

(3) If combined with urinary tract infections: frequent urination, urgency, dysuria, and sometimes hematuria.

(4) Infertility: Trichomonas vaginalis can swallow sperm, hinder lactic acid production, and affect its survival in the vagina.

(5) Examination: hyperemia of the vaginal mucosa, scattered bleeding spots, "strawberry-like" cervix dorsal vaginal discharge, a grayish yellow, yellow-white thin liquid or yellow-green purulent discharge, often foamy. There was no abnormal change in the vaginal mucosa of the carrier.

4. Senile vaginitis

Increased vaginal discharge, vulvar itching, etc., often accompanied by sexual intercourse pain.

5. Young children with vaginitis

Mainly vaginal purulent discharge and vulvar itching.

Vaginitis diagnosis

Bacterial vaginosis

(1) Milky vaginal discharge is homogeneous and smelly.

(2) The vaginal pH is> 4.5.

(3) Positive amine test.

(4) Cue cells are positive (> 20%).

A clinical diagnosis can be made if 3 of the above 4 are positive, of which 4 is the diagnostic gold standard.

2. Candidal vaginitis

Women with symptoms or signs of vaginal inflammation can be diagnosed by finding sporozoites or pseudohyphae of Candida albicans in vaginal secretions. The pH measurement is of differentiating significance: pH4.5 is a mixed infection, especially a mixed infection of bacterial vaginosis.

3. Trichomonas vaginitis

(1) Trichomonas can be diagnosed when found in vaginal secretions. Hanging drop method (80% -90% accuracy); culture method (98% accuracy).

(2) Avoid washing, medicine and checking 24-48 hours before taking the material, keep it warm after taking the material, and send it for inspection in time.

4. Senile vaginitis

According to menopause, a history of ovarian surgery, a history of pelvic radiation therapy, or a history of drug-induced amenorrhea and clinical manifestations, diagnosis is generally not difficult, but other diseases should be excluded before diagnosis.

5. Vaginitis in young women

Infants and young children have poor language expression skills. Collecting a medical history often requires inquiring the girl's mother in detail. At the same time, the mother is asked if she has a history of vaginitis. Combined with symptoms and physical findings, a preliminary diagnosis can usually be made.

Vaginitis treatment

General vaginitis is mainly used for drug treatment. Combining pelvic inflammatory disease or recurrent vaginitis can be combined with oral medication. If necessary, the husband and wife should be treated together. Note that regular oral antibiotics may inhibit the normal flora and secondary mold infection.

Bacterial vaginosis

The treatment principle is to choose anti-anaerobic drugs, mainly metronidazole, tinidazole, clindamycin. Note: Disulfiram-like reactions can occur with both oral and topical metronidazole.

(1) Oral drugs: Metronidazole is preferred.

(2) Local drug treatment.

(3) Sexual partners do not require routine treatment.

2. Candidal vaginitis

(1) Elimination of incentives: If there is diabetes, active treatment should be given, and broad-spectrum antibiotics, estrogen and cortisol should be stopped in time. Change your underwear frequently. Used underwear, basins, and towels should be scalded with boiling water.

(2) Topical application: miconazole suppository, clotrimazole suppository, nystatin suppository.

(3) Systemic medication (for patients with recurrent or inability to vaginal administration): fluconazole, itraconazole. Fluconazole has a lower risk of liver toxicity and can be used in place of ketoconazole.

(4) Sexual partners should be examined and treated for Candida.

(5) Local treatment for pregnancy with Candida vaginitis, oral azoles are prohibited

3. Trichomonas vaginitis

(1) Local vaginal medication: metronidazole vaginal effervescent tablets or 0.75% metronidazole gel, 1% lactic acid or 0.5% acetic acid rinse can reduce symptoms.

(2) Systemic medication: Metronidazole is optional for the first treatment, and should be discontinued if side effects are found. Alcohol is forbidden during metronidazole treatment and within 24 hours of discontinuation, and within 72 hours of discontinuation of metronidazole. Metronidazole and tinidazole have similar efficacy and side effects, including possible disulfiram-like reactions. Breastfeeding should not be used during lactation.

(3) Sex partners should be treated at the same time, and unprotected sex should be avoided before cure.

4. Senile vaginitis

The principle of treatment is to supplement estrogen, enhance vaginal immunity and inhibit bacterial growth.

5. Vaginitis in young women

Treatment principles are to keep the vulva clean, treat it symptomatically, and choose antibiotics for the pathogen.