Vaginal and Vulval Conditions

Question 1

What can be used to treat the symptoms of vaginal atrophy related to oestrogen deficiency in postmenopausal women?

Answer 1

Estradiol pessaries, cream and gel

Reviewed initially at 3 months, then at least annually.

Question 2

What can be used to treat the symptoms of vaginal atrophy related to pelvic organ prolapse?

Answer 2

Estradiol pessaries, cream and gel

Question 3

What non-hormonal vaginal moisturisers are available to treat vaginal atrophy?

Answer 3

Vaginal moisturisers and lubricants alone or with vaginal oestrogen

Question 4

What can be used to treat vulvovaginal candidiasis?

Answer 4

Either:

Oral azole e.g.

• Fluconazole
• Itraconazole

or

• Clotrimazole
• Econazole nitrate
• Miconazole

Supplemented with:
- topical anti-fungal cream

Intravaginal imidazole 1-14 days. Can be repeated

Question 5

What can be used to treat vulvovaginal candidiasis in pregnancy?

Answer 5

Intravaginal application of an imidazole (such as clotrimazole)

Pregnant women need a longer duration of treatment, usually about 7 days

Treatment with oral azole should be avoided in pregnancy

Question 6

What are the predisposing factors for recurrent vulvovaginal candidiasis?

Answer 6

• Recent antibacterial therapy
• Poorly controlled diabetes mellitus
• Pregnancy
• Immunosuppression
• HRT use
• Possibly oral contraceptive use

Question 7

What should be used to treat recurrent vulvovaginal candidiasis?

Answer 7

Oral Fluconazole (induction regimen) 
- 150 mg every 72 hrs for 3 doses, then 150 mg once weekly for 6 months