Module 3 (b) Vulvovaginal Health

Question 1

Vaginal Discharge

Answer 1

1. Mid-Cycle —Egg white, clear viscous fluid — promotes sperm movement
2. Luteal Phase (14 days after ovulation)— Thick, pasty, sometimes yellow-ish
3. Components of DC include:
   - Cervical mucus, endometrial fluid, exudate from accessory glands
   - Exfoliated squamous cells from vaginal walls
   - Indigenous vaginal flora
4. Characteristics change with pregnancy, douching, sexual activity and immunosuppression

Question 2

Vaginal Discharge across the Lifespan

Answer 2

1. Newborn — Vaginal DC 1-10 days post birth as a result of maternal hormone exposure
2. Pre-pubertal — similar to menopausal and post-menaupausal — Low levels of estrogen — Increase vaginal pH
3. Reproductive age — varies with menstrual cycle
4. Menopause
   - Low estrogen levels
   - Thinning, inactive vaginal epithelium
   - Vaginal pH 6-8 range

Question 3

Leukorrhea Definition

Answer 3

1. Physiologic vaginal discharge — NORMAL
   - Composed of mucous endocervical secretions
   - Sloughed endothelial cells and vaginal flora

Question 4

Self-Cleaning Vagina

Answer 4

1. Estrogen promotes the growth of lactobacilli
2. Lactobacilli are healthy bacteria that produce hydrogen peroxide and lactic acid — Leading to an ACIDIC environment pH between 3.5-4.5
   - This creates a hostile environment to bacteria other than lactobacilli
3. Decreased Lactobacilli leads to alkaline environment
   - This allows bacterial pathogens to proliferate — pH >4.5 — Ex: bacteria: Gardnerella, corynebacterium and E. Coli

Question 5

Normal Vaginal Findings on Microscopy

Answer 5

1. Vaginal pH <4.5
2. Presence of squamous epithelial cells
3. Lactobacillus
4. NO WBC’s or very FEW*

Question 6

Vaginal Health Promotion

Answer 6

1. Personal Hygiene
2. Front to back wiping after voiding and defecation
3. Frequent change of sanitary products

Question 7

Goal of vulvovaginal care

Answer 7

Keep the vulva dry and free from irritants

1. Wash with warm water +/- mild, unscented soaps
2. Avoid douches, wipes, sprays, powders
3. Wear cotton underwear, avoid thongs
4. White toilet tissue
5. Unscented, cotton menstrual hygiene products (Tampons vs pads)
6. Avoid scented detergent, bubble bath, scented oils
7. Avoid shaving/waxing

Question 8

Vulvo-Vaginal Irritants

Answer 8

1. Body Fluids - excessive vaginal DC, feces, Semen, sweat, urine
2. Hygiene products — soap, detergents, bubble baths, scented toilet paper
3. Antiseptics
4. Rubber products
5. Emollients
6. Dyes
7. Adult or baby wipes
8. Contraceptive condoms, creams, jellies, foams,
9. Topical medications — steroids, HPV meds, anesthetic, Antibacterials, antimycotics

Question 9

Skin Conditions that occur Elsewhere that Also occur on the Vulva

Answer 9

1. Vitiligo
2. Angioma
3. Hypertrophic papillae
4. Skin tags, Nevi
5. Folliculitis
6. Molluscum contagiosum
7. Psoriasis
8. Varicosities