Vaginal and Vulvovaginal Disorders

Question 1

What is the difference between vulva and vagina?

Answer 1

Vulva: external structure
Vagina: internal structure

Question 2

What is vulvovaginal candidiasis (VVC)?

Answer 2

• % of vaginal infection: 20-25%
• causative organisms: Candida species
• Vaginal pH: Normal (4 - 4.5)
• Discharge Characteristics: thick, white (“cottage cheese”)
• Odor: no odor
  Other symptoms: vulvovaginal itching, irritation, erythema, dysuria

Question 3

What is Bacterial Vaginosis?

Answer 3

% of Vaginal Infection: 30%
Causative Organisms: Polymicrobial
Vaginal pH: >4.5
Discharge Characteristics: Thin (watery), white or gray, sometimes foamy
Odor: Malodor (“fishy”); ↑ after sex or menses
Other Symptoms: possible vaginal itching and irritation; possible dysuria

Question 4

What is Trichomoniasis?

Answer 4

% of Vaginal Infections: 20-25%
Causative Organisms: Trichomonas Vaginalis
Vaginal pH: >4.5
Discharge Characteristics: Frothy, yellow-green (or discolored)
Odor: Malodor
Other Symptoms: possible vaginal itching and irritation

Question 5

What is the normal range for vaginal pH?

Answer 5

pH = 4 - 4.5

Question 6

Describe the use of home vaginal pH testing.

Answer 6

• Vaginal swab that uses color test to determine vaginal pH
• Symptoms with vaginal pH > 4.5 suggest bacterial or trichomonal infection
  - Refer to PCP
• Limitations:
  - Must wait 72hrs after using vaginal preparation (eg. contraceptives’, spermicide or antifungal product)
  - Must wait 48hrs after sex or douching
  - Must wait 5 days after period

Question 7

What is uncomplicated vulvovaginal candidiasis?

Answer 7

% of VVC cases: 95%
Freq: Sporadic, infrequent
Sx severity: mild to moderate
Health conditions: no diabetes or immunocompromising conditions/meds
Preg status: not pregnant
Self-treatment: appropriate

Question 8

What is complicated vulvovaginal candidiasis?

Answer 8

% of VVC cases: 5%
Freq: Recurrent (≥4 infections per year)
Sx. Severity: severe
Health conditions: diabetes or immunocompromising conditions/meds
Preg status: pregnant
Self-treatment: refer to PCP