Vaginal and vulval conditions

Question 1

Vaginal atrophy

Answer 1

• During menopause… the vaginal walls become thinner due to reduced oestrogen levels, known as menopausal atrophic vaginitis.
• A cream containing an oestrogen may be applied on a short-term basis to improve the vaginal epithelium in menopausal atrophic vaginitis. Non-hormonal cream Replens MD can also be used
• However, topical oestrogens should be used in the smallest effective amount to minimise systemic effects.
• The risk of endometrial hyperplasia (thickening of the uterus) and carcinoma (cancer) is increased when systemic oestrogens are administered alone for prolonged periods.

Question 2

Vulvovaginal candidiasis in pregnancy -> (The vulva is the female external genitals)

Answer 2

Vulvovaginal candidiasis is common during pregnancy and can be treated with vaginal application of an imidazole (such as clotrimazole) and a topical imidazole cream for vulvitis.

• Pregnant women need a longer duration of treatment… usually about 7 days, to clear the infection
• Oral antifungal treatment should be avoided during pregnancy

Question 3

Recurrent vulvovaginal candidiasis

Answer 3

 Recurrence of vulvovaginal candidiasis is likely if there are predisposing factors such as antibacterial therapy, pregnancy, diabetes or oral contraceptive use.
 The partner may be the source of reinfection and if symptomatic should be treated with a topical imidazole cream at the same time.
 Treatment may need to be extended for 6 months in recurrent vulvovaginal candidiasis.

Question 4

• Bacterial Vaginosis =

Answer 4

Metronidazole 2g single dose

Question 5

• Vaginal trichomoniasis =

Answer 5

Metronidazole 2g single dose

Question 6

• Candidal vulvitis =

Answer 6

imidazole external cream e.g. miconazole, clotrimazole

Question 7

• Vaginal candidiasis =

Answer 7

imidazole pessary/internal cream e.g. clotrimazole. PO = fluconazole, itraconazole

Question 8

• Recurrent vulcovaginal thrush =

Answer 8

6 month treatment