Vaginal and Vulvovaginal Disorders Flashcards by Sydney Van Otterloo

What factors impact the vaginal ecosystem

number and types of endogenous organisms, vaginal pH, glycogen concentration, hormonal fluctuations, drug therapy, douching, sex partners

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What is the normal vaginal pH

4-4.5

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What are the characteristics of normal vaginal discharge

odorless
clear to white in color
high vicosity

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When are increases in vaginal secretion normal

ovulation
pregnancy
after menses
sexual excitement

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What are the common causes of vaginitis

BV
VVC
Trichomoniasis

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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

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What is the cause of BV

polymicrobial resulting from imbalance in normal vaginal flora

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What are the presenting symptoms of BV

fishy odor
discharge
pruritis

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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

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Does BV change pH

yes it increases

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What causes trichomoniasis

STI caused by trichomonas vaginalis

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What are the symptoms of trichomoniasis

pruritis
yellow-green discharge
irritation is possible
dysuria
*asymptomatic in 50% patients

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What are the risk factors of trichomoniasis

multiple or new sexual partners
nonuse of barrier contraceptives
presence of other STIs

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Does trichomoniasis change vaginal pH

yes it increases

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What is the cause of VVC

candida overgrowth

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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

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