Vaginal discharge
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vaginitis

Causes of Vaginitis

The causes of vaginitis vary depending on the age of the patient. Some causes of vulvitis and vulvovaginitis are the same.

children

Vaginitis in children often involves infection of the gastrointestinal tract flora (non-specific vulvovaginitis). One common contributing factor in girls ages 2 to 6 is poor perineal hygiene (e.g., wiping from back to front after defecation; not washing hands after defecation; frequent touching of the perineum or vagina, especially in response to itching).

Chemicals in bubble baths or soaps can cause vulvovaginal inflammation.

Sometimes children insert small objects into their body cavities, including the vagina. Such foreign objects (e.g., tissue) can cause nonspecific vaginitis with bloody discharge.

Sometimes childhood vulvovaginitis is caused by infection with a specific pathogen (e.g., streptococcus, staphylococcus, candida species; sometimes pinworms).

Sexual abuse in children trichomonal vaginitis included sexually transmitted infections may be why.

Women of Reproductive Age

Vaginitis in women of reproductive age is often contagious. The most common types are:

• Bacterial Vaginosis

• Candidal Vaginitis

• Sexually Transmitted TRicosomal Vaginitis

Normally, in women of reproductive age, nonpathogenic species are the predominant component of the normal vaginal flora. Colonization of these bacteria maintains the vaginal pH within the normal range (3.8 to 4.2), thus preventing the overgrowth of pathogenic bacteria. In addition, high serum estrogen levels strengthen local defense by maintaining vaginal epithelial thickness.

Factors that predispose to the overgrowth of bacterial vaginal pathogens include the following:

• Alkaline vaginal pH due to decrease in menstrual blood, semen, or lactobacilli

• poor hygiene

• Shower

Vaginitis can be caused by foreign objects (for example, forgotten tampons). Non-infectious inflammatory vaginitis is rare.

Postmenopausal Women

A significant decrease in estrogen in postmenopausal women often causes thinning of the vaginal epithelium, increasing susceptibility to infection and inflammation. Some treatments (e.g., oophorectomy, pelvic radiation, some chemotherapy agents) are associated with a decrease in serum estrogen yuto ovarian failure why does it happen? Decreasing estrogen predisposes to inflammatory (especially atrophic) vaginitis.

Hypoestrogenism may result in a more alkaline vaginal pH, which may predispose to overgrowth of vaginal pathogenic bacteria.

Poor hygiene (e.g., in incontinent or bedridden patients) can lead to chronic vulvar inflammation due to chemical irritation in urine or feces, or nonspecific infection.

Bacterial vaginosis and candidal vaginitis are rare in postmenopausal women but can occur in those with risk factors. Sexually transmitted infections, including trichomonal vaginitis, are less common in older women.

Women of All Agesin;

Non-infectious vulvitis accounts for 30% of vulvovaginitis cases. It may be caused by hypersensitivity or irritating reactions to hygiene sprays or perfumes, menstrual pads, laundry soaps, bleaches, fabric softeners, fabric dyes, synthetic fibers, bath water additives, toilet paper or sometimes spermicides, vaginal lubricants or creams, latex condoms. , vaginal contraceptive rings or diaphragms.

At any age, conditions that cause damage to the vaginal epithelium or increased exposure to pathogens predispose to vaginal or vulvar infection, including:

• Fistulas between the intestine and genital tract that allow contamination of the intestinal flora into the genital tract

• Pelvic radiation or tumors that damage tissue and thus compromise normal host defenses

vaginitisSymptoms

Vaginitis causes vaginal discharge, which must be distinguished from normal (physiological) discharge.

Normal discharge is common in children when estrogen levels are high; for example, in the first 2 weeks of life. Because estrogen from the mother increases during pregnancy.It crosses the placenta. Babies often experience light vaginal bleeding as estrogen levels drop suddenly as exposure to the mother's estrogen ceases.

Discharge is also common during the few months before menarche, when estrogen production increases.

Normal vaginal discharge is usually milky white or mucoid, odorless, and non-irritating. The overall volume is small but may cause vaginal wetness, which moistens underwear. Normal vaginal discharge may occur daily or intermittently. In many women, during ovulation,  There is a sticky discharge. Discharge due to vaginitis is accompanied by itching, redness and sometimes burning, pain or slight bleeding. The volume may be small or increased or even abundant. Itching can be severe and even interfere with sleep. Dysuria or dyspareunia may occur.

In atrophic vaginitis in postmenopausal women or other patients with inflammatory vaginitis, discharge is scant, dyspareunia is common, and vaginal tissue appears thin and dry.

Although symptoms vary between specific types of vaginitis, there is a lot of overlap.

Vulvitis can cause redness, itching, and sometimes tenderness and discharge from the vulva.

Vaginitis Diagnosis

• History and pelvic examination

• Vaginal pH can be measured

• Sometimes molecular diagnostic tests or discharge culture

Vaginitis is diagnosed using clinical criteria and office or laboratory tests.

A pelvic examination is performed using a speculum (gel lubricants can be bacteriostatic) and vaginal secretions are collected with a swab.

A sample of vaginal discharge is tested with pH paper; pH is measured in 0.2 increments from 4.0 to 6.0 (normal vaginal pH is 3.8 to 4.2). Then the secretions are placed into 2 slides:

• Prepared with 0.9% sodium chloride 

• Potassium hydroxide (KOH) prepared with 10% potassium hydroxide 

 The slide is examined microscopically as soon as possible to detect trichomonads, which may become immobile within minutes of preparation and become more difficult to recognize. 

KOH  Check for fishy odor (Whiff test) caused by amines produced in trichomonal vaginitis or bacterial vaginosis. Potassium hydroxide is also used to test for Candida; KOH dissolves most cellular material other than yeast hyphae, making identification easier.

Clinical criteria and in-office testing are the most cost-effective way to diagnose bacterial vaginosis or vaginal candidiasis. For candida infection, culture may be performed if microscopy is inconclusive or if symptoms recur or persist after treatment; Antimicrobial susceptibility should be tested to detect fluconazole-resistant Candida. Additionally, some molecular diagnostic tests are commercially available for clinical use.

If women have bacterial vaginosis or trichomonal vaginitis (and are therefore at high risk of contracting sexually transmitted infections), cervical tests are performed for Neisseria gonorrhoeae and Chlamydia trachomatis, common causes of sexually transmitted pelvic inflammatory disease (PID).

If contact irritant or allergic vulvitis is suspected, the patient should systematically eliminate potential irritants or allergens to determine the cause. Severe dermatitis or allergic reactions require evaluation by an allergist or dermatologist.

Other causes of discharge should be ruled out, including:

• Foreign Body:If children have vaginal discharge, a vaginal foreign body may be present.

• cervicitis : Cervical discharge due to cervicitis may resemble vaginitis.

• PID :Upper genital tract infection can also cause cervical discharge. Abdominal pain, cervical motion tenderness, or cervical inflammation suggest PID.

• Cancer : Discharge that is watery, bloody, or both may be caused by vulvar, vaginal, or cervical cancer; Cancers can be distinguished from vaginitis by examination, Papanicolaou (Pap) tests, and biopsy.

• Skin Disorders: Vaginal itching and/or discharge are symptoms of vulvar dermatoses (e.g.  ), which can often be distinguished from infectious vaginitis by history and skin findings.lichen planus , lichen sclerosus ) or other vulvar skin disorders (e.g. psoriasis , tinea versicolor ). 

 If children have trichomonal vaginitis, an evaluation for sexual abuse is required. Abuse should also be considered if there is unexplained vaginal discharge that may be due to a sexually transmitted infection.

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Vaginitis Treatment

• Treatment of the Cause

• Symptomatic Treatment

Infectious vaginitis (e.g. bacterial vaginosis , candidal vaginitis , trichomoniasis ) or any other cause is treated.

If there is a foreign body, it is removed.

For contact irritant or allergic vulvitis, any identified irritant or allergen should be avoided. In general, vaginal douching and unnecessary topical preparations (e.g. feminine hygiene sprays) should be avoided.

If chronic vulva inflammation is caused by bedriddenness or incontinence, vulvar hygiene and skin care measures may be helpful. Prepubescent girls should be taught vulvar hygiene (e.g., wiping from front to back after defecation and urination, washing hands, avoiding frequent touching of the vulvovaginal area).

Infectious, irritant, or allergic vulvovaginitis can cause significant discomfort until adequately treated. Intermittent use of ice packs or hot sitz baths with or without baking soda can reduce pain and itching.

If symptoms of noninfectious conditions are moderate or severe or do not respond to other measures, topical corticosteroids (e.g., topical 1% hydrocortisone twice daily as needed) can be applied to the vulva but not to the vagina. Oral antihistamines may be recommended to reduce itching.

• Common age-related causes of vaginitis include: nonspecific (mostly hygiene-related) vaginitis and chemical irritation in children and bedridden or incontinent elderly patients; bacterial vaginosis and candidal and trichomonal vaginitis in women of reproductive age; and atrophic vaginitis in postmenopausal women.