Vaginal and Vulvovaginal Disorders Flashcards
What factors impact the vaginal ecosystem
number and types of endogenous organisms, vaginal pH, glycogen concentration, hormonal fluctuations, drug therapy, douching, sex partners
What is the normal vaginal pH
4-4.5
What are the characteristics of normal vaginal discharge
odorless
clear to white in color
high vicosity
When are increases in vaginal secretion normal
ovulation
pregnancy
after menses
sexual excitement
What are the common causes of vaginitis
BV
VVC
Trichomoniasis
Why is it important to distinguish VVC from BV and trichomoniasis
VVC can be treated with OTC antifungal while BV and trichomoniasis require treatment with prescription medications
What is the cause of BV
polymicrobial resulting from imbalance in normal vaginal flora
What are the presenting symptoms of BV
fishy odor
discharge
pruritis
What are the risk factors that can lead to BV infections
multiple or new sexual partners
use of IUD
douching
sexual practices
tobacco use
prior pregnancy
Does BV change pH
yes it increases
What causes trichomoniasis
STI caused by trichomonas vaginalis
What are the symptoms of trichomoniasis
pruritis
yellow-green discharge
irritation is possible
dysuria
*asymptomatic in 50% patients
What are the risk factors of trichomoniasis
multiple or new sexual partners
nonuse of barrier contraceptives
presence of other STIs
Does trichomoniasis change vaginal pH
yes it increases
What is the cause of VVC
candida overgrowth
What are the symptoms of VVC
pruritis
discomfort
dysuria
thick, clumpy discharge
What are the risk factors of VVC
pregnancy
use of antibiotics and immunosuppressive agents
Does VVC change vaginal pH
no
What are presenting symptoms of VVC
vulvar pruritis
thick, white, curdy vaginal discharge
erythema
irritation
external dysuria and dyspareunia
normal vaginal pH
What are self-screening skits used for
used to identify elevations in pH
*patients with a pH above 4.5 need to be referred to a provider
What are the limitations of self-screening kits
must wait at least 72 hours after using any vaginal preparation
must wait at least 48 hours after sexual intercourse
must wait at least 5 days after a menstrual period
What is uncomplicated VVC
sporadic or infrequent
mild-to-mod symptoms
likely C. albicans
non-immunocompromised women
responds to short course regimen
What is complicated VVC
recurrent VVC (>3 episodes/year or recurrence within 2 months)
severe symptoms
non-albicans candidiasis
women who are pregnant
women with uncontrolled diabetes
immunocompromised women
should be evaluated by a healthcare provider
*may require longer treatment
What are exclusions from self-treatment of VVC
pregnancy
children under the age of 12
concurrent symptoms of fever or pain in pelvic area, lower abdomen, back or shoulder
medications that predispose you to VVC
medical disorders that predispose you to VVC
recurrent VVC
first vulvovaginal episode
symptoms consistent with BV or trichomoniasis
What is the OTC treatment option available for VVC
vaginal antifungals
recommended for initial therapy for uncomplicated VVC
provide relief of external vulvar itching and irritation associated with infection
What is the MOA of imidazoles and what OTC drugs fall into this category
MOA: alter fungi membrane permeability through decreased synthesis of the fungal sterol ergosterol
OTC drugs: clotrimazole, miconazole, and tioconazole
When should patients seek further medical attention
symptoms persist after 1 week of treatment
symptoms recur within 2 months
vaginal symptoms worsen or change
When should relief of symptoms occur
with 3 days of starting treatment but may take a week for complete resolution
**important to complete full course of treatment even if symptom relief is sooner
What are some non-pharmacologic measures someone can do
sodium bicarb sitz bath may provide quick, temporary relief of vulvar irritation
lactobacillus preparations: proposed to reestablish normal vaginal flora
vaginal tea tree oil: proposed to be antibacterial and antifungal
gentian violet
Boric acid vaginal suppository: may be useful for non-C.albicans infections
What is genitourinary syndrome of menopause(GSM)
vaginal atrophy that can lead to genital, sexual and urinary symptoms
What is the pathophysiology of GSM
decreased estrogen levels lead to decreased vaginal lubrication and thinning of vaginal epithelium
What are the vaginal and sexual symptoms of GSM
vaginal dryness
dyspareunia
vaginal irritation
itching
vaginal tenderness
vaginal bleeding/spotting during intercourse
What are the urinary symptoms of GSM
dysuria
urgency
frequency
nocturia
urinary incontinence
recurrent UTIs
What are the exclusions for self-treatment of GSM
severe symptoms
symptoms that are not localized
vaginal dryness of dyspareunia not relieved by vaginal lubricants or moisturizers
What are vaginal moisturizers and lubricants
products used to relieve symptoms by temporarily moistening the vaginal tissues
can be applied internally and externally
When should a moisturizer be used over a lubricant
when pt bothered by vaginal dryness outside of intercourse
When should a pt use a lubricant over a moisturizer
experiencing dryness during intercourse
When should a patient start to experience symptom relief
may be apparent within hours after first dose
typically improves within a few days
When should a patient seek medical attention for GSM
if no response within one week
worsening of symptoms
vaginal bleeding
