Vaginitis
From Encyclopedia of Sex and Sexuality
A woman suffering from vaginitis experiences either an increased vaginal discharge or burning or itching in the vaginal area. This is not a trivial problem for women. For one thing, it occurs frequently, accounting for an estimated one-third of women’s out-patient visits to a gynecologist. Patients with these symptoms are hindered in their normal business and social activities. It can also be a sign of more serious disease in some cases, such as genital tract cancer or gonorrhea and chlamydia. Because of this, it is important that women with persistent or recurrent vaginal symptoms seek a medical evaluation and not rely on over-the-counter medications.
There are a wide variety of infectious agents that can cause vaginitis. The three most common are Bacterial vaginosis, Candida vaginitis, and Trichomonas vaginitis. Although the three have some similar symptoms, there are some characteristic clinical findings for each. Patients with Bacterial vaginosis have a persistent, often malodorous discharge that is often most pronounced when they have had intercourse and the vagina has been exposed to the male ejaculate. This overgrowth of a group of bacteria in the vagina calls for treatment with either systemic or local antibiotics. Patients with Candida vaginitis often display increased vaginal discharge and itching after receiving systemic antibiotics for another reason, such as an abscessed tooth or a sore throat. Since the symptoms are caused by an overgrowth of yeast (Candida) in the vagina, treatment is with a topical antifungal preparation. Patients with Trichomonas vaginitis usually have a persistent and uncomfortable vaginal discharge. The symptoms are cause by an overgrowth of the protozoa Trichomonas vaginalis in the vagina, and the antiprotozoal medication, oral metronizadole, is given for cure. Male sexual partners can be asymptomatic carriers of the organism and should be treated as well.
There are other causes of vaginitis. Postmenopausal women can have vaginal discomfort and burning from a lack of estrogen. These symptoms can be alleviated by the use of systemic or vaginal estrogens. Obviously, their use should be preceded by a thorough physical and pelvic examination to be sure that there is no other pelvic pathology. In sexually active young women, an abnormal discharge may be due to an infection of the cervix caused by Neisseria gonorrhea, Chlamydia trachomatis, or the Human Papilloma Virus (HPV). The presence of the first two can be determined by laboratory cultures and all three can be detected by DNA probe techniques. The first two organisms are bacteria and, when present, should be treated with antibiotics. Male sexual partners should be treated as well. HPV is treated with local laser ablation of abnormal tissue, or with trichloracetic acid or 5 fluorouracil.
Another common cause of vaginitis is allergy. The most common sources are vaginal contraceptive gels, vaginal anti-fungal creams, suppositories, and the male ejaculate. In most cases, the cause of the allergic reaction is not determined. For many of these women, antihistamines are quite helpful.
Vaginitis remains a complex medical problem. It requires a physician’s evaluation to insure an accurate diagnosis and appropriate treatment.
