Vaginal Disorders Lecture

Question 1

Self treatable conditions

Answer 1

VVC
Atrophic vaginitis/vaginal dryness
Overactive bladder

Question 2

Not self treatable conditions?

Answer 2

BV

Trichomoniasis

Question 3

Lactobacillus species?

Answer 3

Important in creating a acidic environment
pH 4-4.5
~90% of vaginal flora
– acidic environment helps protect the vagina from infection due to bacteria

Question 4

Vaginal discharge?

Answer 4

Leukorrhea
~1.5 gm produced dialy
Odorless, clear or white, viscous or sticky

Question 5

Increased vaginal discharge due to?

Answer 5

Ovulation
Pregnancy
Menses
Sexual excitement
Emotional flares

Question 6

Changes in vaginal flora are due to?

Answer 6

Hormonal fluctuations
Drugs
Douching
Number of partners
Vaginal irritants: deodorant products, tampons, contraceptive products

Question 7

What is BV?

Answer 7

Most common
Sexually-active women
Polymicrobial infection resulting from imbalance in normal flora
- Not typical to treat sex partner
- Uses OCs and condoms

Question 8

Common signs/symptoms of BV?

Answer 8

FOUR ODOR
Increased discharge
Discolored discharge (gray, green, tan)

Question 9

Risk factors of BV?

Answer 9

New sex partner
African-american
IUD
Douching Oral
Tobacco
Prior pregnancy

Question 10

What is trichomoniasis?

Answer 10

Trichomonas vaginalis
STI
Treat sex partners
Use condoms

Question 11

Common signs/symptoms of trichomoniasis?

Answer 11

Erthema
Vulvar edema
YELLOW DISCHARGE

Question 12

Risk factors of trichomoniasis

Answer 12

Multiple sex partners
New sex partners
Nonuse of barriers
Presence of other STIs

Question 13

What is VVC?

Answer 13

Yeast infection
Affects 50% of all women by 25
Candida fungi
- Not typical to treat partners
- Tight fitting clothes, pantyhose, increased intake of sugars
- Does not effect pH

Question 14

Signs/symptoms of VVC?

Answer 14

Erthema, itching, vulvar edema
Thick “cheesy” discharge
ABSENCE OF ODOR

Question 15

Risk factors of VVC?

Answer 15

Pregnancy
High dose combo OCs
Diabetes
Recent antibiotic use
Immunosuppressive drug use

Question 16

Non-treatment can lead to?

Answer 16

PID
UTI
Endometriosis
Preterm labor

Question 17

VVC Self-care exclusions?

Answer 17

Pregnant
Under 12
Fever
Low ab, back, shoulder pain
Predisposing meds
Reccurent: 3 per year or within past 2 months
HIV

Question 18

Goals of therapy for VVC

Answer 18

Relieve symptoms
Eradicate infection
Reestablish normal flora

Question 19

Non-pharmacologic treatment options?

Answer 19

Decrease dietary consumption of sucrose and carbs
Consumption of live cultures
Discontinue causative drugs

Question 20

Pharmacologic treatment options?

Answer 20

Imidazole products

• First like therapy
• Relieves external itching and irritation

Question 21

Imidazole products MOA?

Answer 21

Alter the membrane permeability of fungi resulting in loss of normal membrane function

Question 22

Vaginal formulations come in?

Answer 22

Suppositories, tablets or creams

Question 23

Couseling points?

Answer 23

Do not skip days
No tampons
Okay during periods

Question 24

Single-dose regimens?

Answer 24

Gynazole
Monistat
Vagistat

Question 25

What are non-curative products for itching and irritaiton?

Answer 25

Vagisil
Massengill
Pusatilla
- Decreased efficacy, frequent local site reactions, longer treatment durations

Question 26

What are complementary therapies for VVC?

Answer 26

Lactobacillus preparation
Gentian violet
Boric acid

Question 27

Lactobacillus preparation?

Answer 27

Eat yougurt

Reestablish normal flora

Question 28

Gentian violet?

Answer 28

Dye used for resistant vaginal candidal infection

Stains fabric and skin

Question 29

Boric acid?

Answer 29

Non-C. albican infections
600 mg
85-95% effective

Question 30

Define atrophic vaginitis

Answer 30

Inflammatory response
Due to atrophy of vaginal mucosa or decrease in estrogen levels
10-40% in postmenopausal women
Reuslt in dyspareunia (painful intercourse)

Question 31

Signs and symptoms of atrophic vaginitis?

Answer 31

Irritaiton
Dryness, itching, burning
Dyspareunia
Vaginal bleeding/discharge

Question 32

Treatment of atrophic vaginitis?

Answer 32

Vaginal/topical/personal lubes (short term improvement)

- Astroglide, KY jelly, replens

Question 33

What is overactive bladder?

Answer 33

Bladder squeezes too often or without warning
Chronic condition
Categorized by: frequency, urgency, urge incontinence

Question 34

Treatment of OAB?

Answer 34

Oxytrol patches

• 18+
• 3.9 mg dialy
• Relaxes bladder muscles
• Adverse effects: dry mouth, dizziness, drowsiness, skin irritation

Question 35

Counseling for OAB?

Answer 35

Apply and leave on for 4 days
Rotate application site
Wear under clothing – no light

Question 36

Do not treat OAB if?

Answer 36

Burning upon urination
Blood
Lower back or side pain
Male
History of bladder cancer
Recently pregnant

Question 37

Define douching

Answer 37

Irrigating the vagina

Achieve good vaginal hydien or vaginal cleanse

Question 38

Water and vinegar douching?

Answer 38

Acetic acid

- Minimal effect on lactobacilli but inhibit some pathogens

Question 39

Povidone/iodine douching?

Answer 39

Inhibit all flora

May allow growth

Question 40

Adverse effects of douching?

Answer 40

Increased risk of PID
Reduced fertility
Ectopic pregnancy
Vaginal infections
STI
Low birth weight
Cervical cancer

Question 41

Counseling for douching?

Answer 41

Not recommended

Not to treat infection, as birth control

Question 42

Do not use if?

Answer 42

Used a diaphragm, cervical cap or spermicide (for 8 hours after)
3 days after teh last vaginal antifungal
48 hrs after gynecologic exam
Pregnant or breast feeding
More than twice weekly
If dryness or irritation occur