Vaginitis
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| ICD-10 | N76.0-N76.1 |
|---|---|
| ICD-9 | 616.1 |
Vaginitis is an inflammation of the vaginal mucosa and usually falls into one of three categories: hormonal, irritant or infectious.
- Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal, or postpartum women. Sometimes it can occur in young girls before puberty.
- Irritant vaginitis can be caused by allergies to condoms, spermicides, soaps, perfumes, douches and semen. It can also be caused by hot tubs, abrasion, tissue, tampons or topical medications.
- Infectious vaginitis accounts for 90% of all cases in reproductive age women and is usually caused by Candida albicans (a yeast), Trichomonas vaginalis (a protozoan) or by Gardnerella (a bacterium). Other less common infections are caused by gonorrhea, chlamydia, mycoplasma, herpes, campylobacter and some parasites.[1]
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[edit] Significance
Vaginitis can be initially harmless. However, if it is caused by an infectious organism (e.g. chlamydia) it may progress throughout the uterus into the fallopian tubes and ovaries. An advanced infection of this type can lead to infertility. Therefore the PH value is measured regularly at gynecological screenings, and a microbiological unstained preparation is applied, in order to recognize vaginitis. An infection via human papillomavirus (HPV) can eventually increase the risk of cervical carcinoma.
[edit] Symptoms
A woman with this condition may have itching or burning and may notice a discharge.
- irritation and/or itching of the genital area
- inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area
- vaginal discharge
- foul vaginal odor
- discomfort or burning when urinating
- bloody diarrhoea
(*to look for redness or irritation, a small section could be shaved to see any difference)
[edit] Causes
Vulvovaginitis can affect women of all ages and is extremely common. It can be caused by bacteria, yeasts, viruses, and other parasites. Some sexually transmitted diseases can also cause vulvovaginitis, as can various chemicals found in bubble baths, soaps, and perfumes. Environmental factors such as poor hygiene and allergens may also cause this condition.
Candida albicans, which causes yeast infections, is one of the most common causes of vulvovaginitis in women of all ages. Antibiotic use can lead to yeast infections by killing the normal antifungal bacteria that live in the vagina. Yeast infections typically cause genital itching and a thick, white vaginal discharge.
Another cause of vulvovaginitis is bacterial vaginosis, an overgrowth of certain types of bacteria in the vagina. Bacterial vaginosis may cause a thin, grey vaginal discharge and a fishy odor.
[edit] Other Causes Of Vulvovaginitis
Sexually Transmitted Infections
STIs are a common cause of vaginal discharge in adolescents. Chlamydia and gonorrhea testing should be done whenever a sexually active adolescent complains of vaginal discharge even when the cervix appears normal.
A sexually transmitted disease called Trichomonas vaginalis infection is another common cause. This infection leads to genital itching, a vaginal odor, and a heavy vaginal discharge, which may be yellow-grey or green in color.
Foreign Body Vaginitis
Foreign bodies (most commonly retained tampons or condoms) cause extremely malodorous vaginal discharges. Treatment consists of removal, for which ring forceps may be useful. Further treatment is generally not necessary.
Allergic or Contact Vaginitis
Bubble baths, feminine hygiene sprays, or vaginal contraceptive foams or suppositories may cause chemical irritation of the vaginal mucosa. Discontinuing use of the offending agent is indicated.
The color may be predictive of the causative agent. (ICD-10 codes for causative agents listed below.)
- (B37.) Candida Vaginitis Candidiasis usually causes a watery, white, cottage cheese like vaginal discharge. The discharge is irritating to the vagina and the surrounding skin.
- (N95.2) Atrophic vaginitis (or "Senile Vaginitis") usually causes scant vaginal discharge with no odour, dry vagina and painful intercourse. These symptoms are usually due to decreased hormones usually occurring during and after menopause.
- (B96.3) Bacterial Vaginitis Gardnerella usually causes a discharge with a fish-like odour. It is associated with itching and irritation, but not pain during intercourse.
- (A59.0) Trichonomas Vaginitis Trichomonas vaginalis can cause a profuse discharge with a fish-like odour, pain upon urination, painful intercourse, and inflammation of the external genitals.
- (A60.0) Herpes usually occurs as water blisters on the genital region, about one week after infection. There is tenderness, swollen glands, and fever. The water blisters are extremely painful and heal in about three weeks.
Women who have diabetes frequently develop vaginitis, often Candida Candida albicans more often than women who do not.
[edit] Diagnosis
Diagnosis is with microscopy and culture of the discharge, and appropriate antibiotic or antifungal treatment.
[edit] Complications
- persistent discomfort
- superficial skin infection (from scratching)
- complications of the causative condition (such as gonorrhea and candida infection)
[edit] Treatment
The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed.
[edit] References
- Egan ME: Diagnosis of vaginitis. Am Fam Physician 2000;62:1095.
- Jaquiery A, Stylianopoulos A, Hogg G, et al: Clinical features, aetiology, and microbiology of the genital tract. Arch Dis Child 81:64, 1999.
- Brook I: Microbiology and management of polymicrobial female genital tract infections in adolescents. J Pediatr Adolesc Gynecol 2002;15(4):217. PMID 12459228.
- Joesoef MR, Schmid GP, Hillier SL. Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. 1999;28(suppl 1):S57-S65.
- Reed B, Slatery M, French T. Diet and vaginitis. Fam Pract 1989;29:509-15.
- Rodgers CA, Beardall AJ: Recurrent vulvovaginal candidiasis: Why does it occur? Int J STD AIDS 10:435; quiz 440, 1999.
[edit] See also
[edit] External links
- eMedicine emerg/631
- DDB 14017
- Vulvovaginitis - Overview, Causes, & Risk Factors | Symptoms & Signs | Diagnosis & Tests | Prevention & Expectations | Treatment & Monitoring
