Vaginal Disorder

Question 1

Which organism predominantly causes Vulvovaginal Candidiasis?

Answer 1

Candida albicans

Question 2

What are the factors causing Vaginal Yeast infection and are associated with medication?

Answer 2

-Hormone level changes - oral contraceptives (also pregnancy)
-Diabetes - SGLT2 -> pee out glucose (food for yeast) in the urine
-Immunosuppression - Glucosteroids
-Broad-spectrum antibiotics - disturbing natural flora

-Others: Onset of sexual activity, Contraceptive sponge

Question 3

Vulvovaginal Candidiasis
Bacterial Vaginosis
Trichomoniasis
Atrophic Vaginitis

Which of these is treatable with OTC products?

Answer 3

VVC and Atrophic Vaginitis

Question 4

How to test for VVC?

Answer 4

Vaginal pH test strips
-color change indicates abnormal pH -> refer

Question 4

How is VVC different from the other vaginal infections?

Answer 4

-all have discharge
-VVC discharge is thick, white and odorless
-intense pruritus
-normal pH (the other ones with basic pH)

Question 5

When is VVC self-treatment appropriate?

Answer 5

-Infrequent episodes (1-3 vaginal infections per
year spaced more than 2 months apart)

-Mild-to-moderate symptoms with no fever or
lower back pain

Question 6

Treatment for VVC

Answer 6

-Nonpharmacologic: Address predisposing
factors

-Pharmacologic: Vaginal antifungals, agents for
symptom relief

Question 7

Vaginal antifungals

Answer 7

-Clotrimazole (Gyne-Lotrimin®, Mycelex-7®)
-Miconazole nitrate (Monistat®)
-Tioconazole (Vagistat®

Question 8

Adverse effects of Antifungals

Answer 8

-Burning, itching, irritation (could also be from the infection - same ADR)
-abdominal cramping, headache, partner penile irritation, allergic reaction

Question 9

Which population is not appropriate to treat with antifungals?

Answer 9

-<12 years old: children usually do not suffer from vaginal infection (REFER: potential sexual abuse)

-pregnant women: some products are, REFER for consultation

Question 10

Patient education on VVC Medication

Answer 10

-use the product at night bc less movement is involved (+ sanitary pad to absorb leakage)
-continue using for the duration directed !!!
-symptoms relief after 2-3 days

-seek advice if symptoms don’t improve after 3 days, symptoms persist after 7 days, symptoms get worse

Question 11

Symptom relief approach (not treatment)

Answer 11

-for external Vulva irritation: Sitz bath to help with relief while the antifungal reaches its full effect (before application of antifungal) -> 15mins PRN

-Vagisil (still need to the infection)

Question 12

Atrophic Vaginitis

Answer 12

-Inflammation of the vagina and decreased lubrication secondary to decreased estrogen levels

Question 13

When does Atrophic Vaginitis occur?

Answer 13

-Most commonly occurs during postpartum,
breastfeeding, and menopause

-May result in dyspareunia – painful intercourse
-Treatment goal: lubricate vaginal tissue to

Question 14

How to treat Atrophic Vaginitis?

Answer 14

-Vaginal lubricants

-Self-treatment only when ->
-Mild to moderate symptoms confined to vaginal
area
-No bleeding present

Question 15

Common Active Ingredients for Atrophic Vaginitis

Answer 15

-glycerin, propylene glycol, polyethylene glycol, dimethicone, mineral oil, hydroxypropyl cellulose

-AVOID petroleum jelly (too thick, too inclusive)

Question 16

For Atrophic Vaginitis, Lubricants should be applied externally and internally if used during intercourse. T/F

Answer 16

True
applying it to the partner may also help

Question 17

When to expect symptom relief in atrophic Vaginitis?

Answer 17

-relief should occur within hours after the first application; regular application can reverse atrophic symptoms to some extent

-if no improvement is noticeable within a week if symptoms worsen, or if there is any vaginal bleeding -> REFER

Question 18

Why are Vaginal cleansing products NOT recommended?

Answer 18

-douching
-the vagina is a self-cleaning organ that doesn’t require additional cleansing
-too frequently: risk of vaginal irritation, infection, risk for Pelvic Inflammatory Disease

Question 19

How to self-clean the vagina if needed

Answer 19

-gently washing with lukewarm water and mild soap
-only the external area