Vaginal conditions Flashcards
What is Atrophic vaginitis? Causes?
- Vaginal inflammation causing mucosa to become thinner and fragile.
- Due to a fall in oestrogen.
Causes:
- menopause, oophorectomy, anti-oestrogen Rx (e.g. tamoxifen), radio or chemotherapy, postpartum, breast feeding
Presentation of Atrophic vaginitis (5)
Key Syx: PMB, dyspareunia, dryness
(1.) Vaginal dryness and itching
(2.) Dyspareunia
(3.) PMB/PCB -tissue easily damaged
(4.) PV discharge from inflammation
(5.) Urinary syx: due to vaginal epithelium becoming inflamed. Changes in vaginal pH and vaginal flora may predispose to UTI
Ex signs + Ix of Atrophic vaginitis
(1.) Examine for signs of atrophy (pale mucosa/ thin skin/ reduced skin folds/ erythema/ dryness/ sparse pubic hair/prolapse)
(2.) TV USS + endometrial biopsy - due to PMB, endometrial ca must be excluded
(3.) Infection screen
- Itchy + discharge can be due to genital infections
- These may co-exist, as atrophic vaginitis predisposes the vagina to bacterial infection
Management of Atrophic vaginitis
(1.) Hormone Rx
- HRT if menopausal
- Topical oestrogen creams
(2.) Non-hormonal Rx
- Lubricants: short-term improvement for vaginal dryness + dyspareunia
- Moisturisers
What is Vulvovaginitis? causes?
- Vulval + vaginal inflammation + irritation due to sensitive, thin skin + mucosa. Often affects 3-10y
- Vagina is more prone to colonisation + infection with faecal bacteria.
- Exacerbated by: wet nappies, chemicals/soaps, tight clothing, poor toilet hygiene, threadworms, constipation, heavily chlorinated pools, pressure to area e.g. horse riding.
- Vulvovaginitis improves and less common after puberty, as oestrogen keep skin and vaginal mucosa healthy and resistant to infection.
Presentation of Vulvovaginitis
Young girls before puberty
- Soreness
- Itching
- Erythema around labia
- PV discharge
- Dysuria
- Constipation
Mx of Vulvovaginitis
(1.) Treat for UTI and thrush if present
(2.) Treat for constipation and worms where applicable
(3.) Conservative: avoid perfume products, wipe front to back, loose cotton clothes, keep area dry
What is Bacterial Vaginosis? RF? Causes? complications?
- Overgrowth of vaginal bacteria. It is not STI. (H/e can inc risk of developing STI).
- Due to loss of lactobacilli “friendly bacteria”, which normally produce lactic acid + keeps vaginal pH low (<4.5) + prevent other bacteria overgrowing
Causes:
- Gardnerella vaginalis (most common), Mycoplasma hominis, Prevotella species
RF
- multiple partners, excessive vaginal cleaning, recent abx, smoking, copper coil
Complications
- STI, HIV
- Pregnancy: miscarriage, preterm delivery, PROM, low birth weight, postpartum endometriosis, chorioamnionitis
Clinical feature of BV (1). Criteria used + 4 features for it?
(1.) Fishy-smelling watery grey/white discharge
- Note: itchy, irritation, pain are not associated with BV
AMSEL’S criteria for dx, must have 3 of 4 following:
- Thin white discharge
- Clue cells on microscopy
- Vagina ph >4.5
- +ve whiff test (fishy)
Ex + Ix of Bacterial Vaginosis
(1.) Speculum + HVS
(2.) Vaginal pH with swab + pH paper
- normal = 3.5-4.5, BV = >4.5
(3.) Charcoal vaginal swab + microscopy
- clue cells on microscopy = BV (common MCQ).
Mx of Bacterial Vaginosis
(1.) Asyx does not require Rx
(2.) Abx Metronidazole (PO or PV)
- avoid alcohol during Rx as can cause “disulfiram-like reaction” - N+V, flushing, shock, angioedema (common examiner Q)
(3.) Advice on reducing risk: avoid vaginal irrigation, cleaning with soaps as it may disrupt normal flora
What is Vaginal Candidiasis/thrush? RF?
- Most common is Candida albicans.
- Candida may colonise the vagina without causing syx + progresses to infection when the right environment occurs e.g. pregnancy or after broad-spectrum abx that alter the vaginal flora.
RF:
- pregnancy
- Poorly controlled DM
- Immunosuppression
- Broad-spectrum Abx
Clinical features of Vaginal Candidiasis (2)
(1.) Thick, white discharge that does not typically smell
- ‘cottage cheese’ + non offensive discharge
(2.) Vulval/vaginal itching/irritation/discomfort
Note: More severe infection can lead to: erythema, fissures, oedema, dyspareunia, dysuria
Ix of Vaginal Candidiasis/thrush
Can be treated based on presentation
(1.) Vaginal pH <4.5
- Ddx: BV and trichomonas will have pH > 4.5
(2.) Charcol swab + microscopy can confirm dx
Mx of Vaginal Candidiasis/thrush. Contraceptive advice? Rx for recurrent infection
(1.) General: good hygiene, loose clothes, avoid perfume irritants/douching
(2.) PO fluconazole 150 mg single dose (1st line)
(3.) Pessary clotrimazole (2nd line)
(4.) Advise about contraception
- Antifungal can damage condoms and spermicides, so alternative contraceptive is required for >5d after use.
(4.) Recurrent infections (>4/year)
- 6m maintenance regime with PO or PV antifungal.
