Vulvovaginitis

Inflammation of the vagina and vulva are most often caused by a bacterial, fungal, or parasitic infection.

Vulvovaginitis, vulvitis, and vaginitis are general terms that refer to the inflammation of the vagina and/or vulva (the external genital organs of a woman).These conditions can be caused by bacterial, fungal, or parasitic infections. Also, vulvovaginitis can be caused by low estrogen levels (called "atrophic vaginitis") or any type of allergic or irritation response from things such as spermicidal products, condoms, soaps, and bubble bath.

In general, vulvovaginitis causes vaginal discharge, irritation, and itching.One of the most common reasons why women visit their doctor is because therehas been a change in vaginal discharge. It is completely normal for a womanto have a vaginal discharge, the amount and consistency of which varies during the course of the menstrual cycle. Each of the three most common types of vulvovaginitis will be described separately.

Bacterial vaginosis is the most common cause of vaginitis during the childbearing years. Forty percent to 50% of vaginitis cases are caused by bacterial vaginosis. The occurrence of bacterial vaginosis is difficult to determine butstudies have proposed that 10% to 41% of women have had it at least once. The occurrence of bacterial vaginosis in the United States is highest among African-American women and women who have had multiple sexual partners and lowest among Asian women and women with no history of sexual contact with men. Bacterial vaginosis is not considered a sexually transmitted disease although itcan be acquired by sexual intercourse.

Bacterial vaginosis is not caused by a particular organism but is a change inthe balance of normal vaginal bacteria. Ninety percent of the bacteria foundin a healthy vagina belong to the Lactobacillus family. For unknown reasons, there is a shift in the bacterial population that results in overgrowth of other bacteria. Patients suffering from bacterial vaginosis have very high numbers of bacteria such as Gardnerella vaginalis, Mycoplasmahominis, Bacteroides species, and Mobiluncus species. These bacteria can be found at numbers 100 to 1000 times greater than found in the healthy vagina. In contrast, Lactobacillus bacteria are in very low numbers or completely absent from the vagina of women with bacterial vaginosis.

Candida vulvovaginitis also has been called "vulvovaginal candidiasis," "candidal vaginitis," "monilial infection," or "vaginal yeast infection." Twenty to 25% of the vaginitis cases are candida vulvovaginitis. It has been estimated that about 75% of all women get a vaginal yeast infection at least once. In80-90% of the cases, candida vulvovaginitis is caused by an overgrowth of the yeast Candida albicans. The remaining cases are caused by other species of Candida. It is not known what causes the yeast overgrowth. However, antibiotics can inadvertently kill normal bacteria in the vagina and cause an overgrowth of Candida. Candida vulvovaginitis is not considereda sexually transmitted disease because Candida species are commonly found in the healthy vagina. It is a rare disease in girls before puberty andin celibate women. Vaginal yeast infections tend to occur more frequently inwomen who are pregnant, diabetic and not controlling their disease, taking birth control pills, or taking antibiotics. Some women have four or more attacks per year which is called "recurrent vaginal candidiasis."

Trichomoniasis, which is sometimes called "trich," accounts for 15-20% of thecases of vaginitis. It is estimated that two million to three million American women get trichomoniasis each year. Unlike the previous two causes of vulvovaginitis, trichomoniasis is a sexually transmitted disease. This means thatthe disease is passed from person-to-person only by sexual contact. Trichomoniasis occurs in both men and women and is caused by an infection with the single-celled parasite Trichomonas vaginalis. Infection with Trichomonas vaginalis is frequently associated with other sexually transmitted diseases and assists the spread of the AIDS virus.

Vulvovaginitis is most often caused by a bacterial, fungal, or parasitic infection as described above. Other microorganisms may cause vulvovaginitis, or it may be caused by allergic reaction, irritation, injury, low estrogen levels, and certain diseases. Risk factors for bacterial vaginosis include using anintrauterine device (IUD), being of a non-white race, prior pregnancy, firstsexual activity at an early age, having multiple sexual partners, and havinga history of sexually transmitted diseases. Persons at an increased risk forcandida vulvovaginitis include those who have had previous candida infections, frequent sexual intercourse, use birth control pills, have AIDS, are pregnant, are taking antibiotics or corticosteroids, are diabetic, use douches, use perfumed feminine hygiene sprays, wear tight clothing, or use vaginal sponges or an IUD.

The typical symptoms of vulvovaginitis are: vaginal discharge, itching, and irritation. Some women may have few or no symptoms, while others may have pronounced symptoms. The main symptom of bacterial vaginosis is a fishy-smelling,thin, milky-white or gray vaginal discharge but itching and burning may alsobe present. The fishy smell is stronger after sexual intercourse. The symptoms of candida vulvovaginitis are itching, soreness, painful sexual intercourse, and a thick, curdy, white (like cottage cheese) vaginal discharge. Trichomoniasis symptoms are: painful urination, painful sexual intercourse, and a yellow-green to gray, foul smelling, sometimes frothy, vaginal discharge.

To diagnose vulvovaginitis, the doctor will examine the vagina (using a speculum to keep the vagina open) and take a sample of the vaginal discharge for tests and microscopic analysis. Diagnosis may be difficult because there are many different causes of vulvovaginitis.

There are four signs that indicate that a woman has bacterial vaginosis. These signs (called "Amsel's criteria") are: a thin, milky white discharge that clings to the walls of the vagina, presence of a fishy odor, a vaginal pH of greater than 4.5, and the presence of "clue cells" in the vagina. Clue cells are vaginal cells that are covered with small bacteria. A diagnosis of candidavulvovaginitis is made after finding a normal vaginal pH (4 to 4.5) and thepresence of many yeast cells in the sample of vaginal discharge or growth ofyeast on laboratory media. A trichomoniasis diagnosis is made when the parasites are found in the vaginal discharge either by microscopic examination or in laboratory cultures.

Both bacterial vaginosis and trichomoniasis must be treated with prescriptionmedication. Candida vulvovaginitis may be treated with either prescription or over-the-counter medicines (not recommended in the absence of a confirmed diagnosis).

Vulvovaginitis is a disease with minor symptoms and most women respond well to medications. It is believed that certain vaginal infections, if left untreated, can lead to more serious conditions such as pelvic inflammatory disease,endometritis, postsurgical infections, and spread of the AIDS virus.

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