Vaginitis definition:
Inflammatory reaction affecting vaginal mucosa.
Vaginitis aetiology:
Primary vaginitis
♦♦♦ During childhood: vulvovaginitis of children.
♦♦♦ During childbearing period:
Common causes:
a) Bacterial vaginosis (40 – 50 %).
b) Monilial vaginitis (30 %).
c) Trichomonas vaginitis (20 %).
Rare causes:
a) Acute puerperal infection: infected lacerations.
b) Chronic specific & non specific.
c) Vaginitis emphysematosa.
d) Cytolytic vaginitis.
♦♦♦ After menopause: senile vaginitis.
Secondary vaginitis
♦♦♦ Exogenous causes:
– Neglected pessary causing mechanical irritation.
– Concentrated vaginal douches causing chemical burn.
♦♦♦ Genital causes:
– Continuous pouring of irritant discharge:
Salpingitis, endometritis, & Cervicitis.
♦♦♦ Neighboring structures:
– Urinary: vesico-vaginal fistula.
– Rectal: recto-vaginal fistula.
Vulvo-vaginitis of children
Aetiology:
♦♦♦ Causative organism:
– Streptococcal infection is the commonest cause.
– Oxyrius infestation.
♦♦♦ Route of infection:
– Exogenous: infected towels & toilet seats.
– Autogenous: autoinfection by oxyrius.
♦♦♦ Predisposing factors:
– Foreign bodies.
– Lack of estrogen (thin epithelium with weak vaginal acidity).
– Lack of local hygiene.
Diagnosis:
Symptoms:
– Purulent discharge.
– Pruritus vulvae.
– Pain & soreness.
– Frequency & burning micturition.
Signs:
– Local redness, tenderness & edema.
– Enlarged tender inguinal L.Ns.
– Vulva is bathed in discharge.
– PR: detects foreign bodies
Investigations:
– Culture & sensitivity of the discharge.
– X-ray to detect FB.
– Stool analysis: exclude oxyrius infestation.
Treatment:
1. General: antibiotics according to culture & sensitivity.
2. Local:
a) Estrogen cream (EE): 0.025 mg Х 1 Х 14 then ½ the dose Х 1 Х 14.
b) Remove FB if present.
c) Local measures to prevent labial adhesions: castor oil or vasline.
Senile vaginitis
Definition:
Inflammation of the vulva & vagina in postmenopausal female.
Aetiology:
* Causative organism: any pathogenic organism as strept. & staph.
* Route of infection: exogenous, endogenous & autogenous.
* Predisposing factors: neglected pessary, lack of estrogen & lack of local hygiene.
Diagnosis:
Symptoms:
– Purulent discharge especially blood stained.
– Pruritus vulvae.
– Pain & soreness.
– Frequency & burning micturition.
Signs:
– Local redness, tenderness & edema.
– Enlarged tender inguinal L.Ns.
– Vulva is pathed in discharge.
– Tender atrophic vagina with areas of
superficial ulcerations.
Investigations:
– Culture & sensitivity of discharge.
– Cytological smear to exclude malignancy (very important).
Treatment:
♦♦♦ General:
*Oral antibiotic to prevent secondary infection. *oral estrogen.
♦♦♦ Local:
* Estrogen cream (EE): 0.05 mg Х 2 Х 3 weeks (treatment of choice).
* Lactic acid vaginal douches.
Non specific vaginitis
Definition: vaginal infection in the absence of specific organism.
Incidence: mostly before puberty or after menopause.
Treatment: local estrogen is the best treatment.
Vaginitis emphysematosa
Definition: Inflammation of vaginal mucosa associated with;
– Numerous small bullae in the vaginal epithelium filled with CO2,
– Hard indurated surrounding tissues,
– Excessive vaginal discharge.
Incidence: rare, mostly seen in pregnant females.
Aetiology: may be trichomonas & Gardnerella.
Treatment: metronidazole (used empirically).
Cytolytic vaginitis
Pathogenesis: overproduction of Doderlein bacilli overproduction of H2O2 vaginal
irritation cytolysis of vaginal cells.
Diagnosis:
– Vaginal discharge: white or paste like.
– Pruritus vulvae.
– Pain & soreness of the vulva: leads to 2ry vulvitis.
– Dyspareunia: due to tender vagina.
– Frequency & burning micturition.
Investigations:
– Smear: ↑ number of Doderlein bacilli, vaginal cells shows cytolysis & specific
organisms are absent.
– PH: < 4.5
Treatment:
– Alkaline vaginal douches by NaHCO3 (30 – 60 gm / liter) given 3 times/week till
symptoms disappear.
Vaginitis PPT (power point presentations):
Vaginitis Prof. Aboubakr Elnashar Benha University Hospital, Egypt ABOUBAKR ELNASHAR