Vaginal Dryness

Question 1

size and positioning of the vagina

Answer 1

Normal vaginal length is variable usually 8 -10 cm.

positioned at a 45° angle, upwards and posteriorly.

It is in close proximity to the bladder, urethra, perineum and rectum

Question 2

what is the effect of estrogen on the vagina

Answer 2

0 induces maturation of epithelial cells and stimulates proliferation of epithelial basal cells

• increaes cells ability to store glycogen, which is metabolized to lactic acid by Lactobacillus vaginalis (pH 3.505.5)
• lower pH lowers non pathogenic lactobacilli to thrive and mroe troublesome microflora to be controlled

Question 3

healthy vaginal dischange

Answer 3

• varies in quantity, consistency and appearance throughout the menstrual cycle
• discharge can be due to mucus production of cervical glands, transudate from capillaries of vaginal walls and other sources like uterus
• dischage can be pasty, white and scanty
• at ovulation its wet and slippery with consistency of uncooked egg white
• can be no apparent discharge days immediately after menses has stopped
• should not cause irritation, burning or itching

Question 4

odour of vaginal discharge

Answer 4

0 mild odour can occur when discharge combines with secretions from glands in vulvar area

• odour should ot be unpleasant or cause concern
• causes of unusual or unpleasant odour, genital irritation or itching may include poor hygiene, allergic or sensitivity reactions, vaginal infections, or a forgotten tampon

Question 5

genital hygiene

Answer 5

• perineal area should be washed 1d using warm watera nd mild unscented soap
• outer labia should be gently separated and the clitoral area cleaned and rinsed
• vagina cleans iself and does not require further cleansing
• does not reuqire specialized commercial products
• panty liners, continence pads and sanitary napkinds can cause vulvar irritation by inc moisture and temp and possibly modify vulvar pH -> charge the products frequently and avoid unless necessary

Question 6

describe vaginal douching

Answer 6

• process of instilling fluid into vagina and flushing cavity
• no substantiated benefits and can have sig averse outcomes
• >can disrupt environment, increase risk of irritation or infection
• > can inc risk of HIV or herpes
• > avoid 24 hr prior to vaginal exam

* never recommended as a contraceptive method or as a treatment for suspected vaginal infections

Question 7

ex of douching solutions

Answer 7

Plain warm water (simple and least likely to be harmful)

Vinegar and water (available commercially or can be made at home by adding 15–30 mL vinegar to 1 L of warm water; produces transient decrease in vaginal microflora, similar to flushing with saline)​[16]

Commercially available products containing perfumes, astringents, anti-infectives or proteolytics (these ingredients do not increase effectiveness and can be irritating)

Question 8

instillation of vaginal douching

Answer 8

• via vaginal syringe
• 2 types: fountain and bulb
• > fountain: tubing attached to bad, nozzel inserted in and gravity creates flow of solution
• bulb: no tubing

*presssure should be gentle, too much pressure can cause reflu of folution into uterus and inc risk of pelvic infection

Question 9

what are genital towelettes

Answer 9

• premoistened disposable wipes, safe for occasional use
• contain perfumes, astringents, emollients and anti-infectives and can be irritating or cause allergic reactions
• milkd soap and warm water preferred for daily cleansing

Question 10

describe genital washes

Answer 10

aex: Summer’s Eve
- liquid cleansers designed for daily use on external genitalia
- provide no additional benefit over mils soap and water, but no significant risk for their use

Question 11

genital deodorant sprays

Answer 11

ex: Summer’s eve FDS
- contain ingredients like perfumes and propellants marketed to reduce genital odour
- not recommended
- can mask the odour of infections and cause treatment delays
- use is associated with a high incidence of irritation and allergic reactions. If used, they must not be applied to the inside of the vagina.

Question 12

use of talcum powder with vagina

Answer 12

• ternational Agency for Research in Cancer (IARC) classifies talc as possibly carcinogenic to humans
• mixed evidence available to identify perineal talc use as a risk factor for ovarian cancer but the American and Canadian Cancer Societies caution women about the possible risk of use.

Question 13

what medications are associated with decreased vaginal lubrication

Answer 13

Antiarrhythmics

Antidepressants

Antihistamines

Antihypertensives

Chemotherapy

Combined hormonal contraceptives

Question 14

what causes vaginal drynes

Answer 14

• low estrogen levels during preimenopause or menopause, in postpartum period, during breastfeeding, or immediately following menses -> results in vaginal dryness

Question 15

Reduced estrogen levels cause thinning of the vaginal tissue, loss of collagen support, increased vaginal pH and reduced production of vaginal lubrication even when sexual arousal has occurred.

can cause

Answer 15

Abnormal bleeding

Discharge

Dyspareunia (pain during sexual intercourse)

Pruritus

Slow production of lubrication with sexual arousal

Vaginal dryness

Question 16

goals of therapy for treating vaginal dryness

Answer 16

Provide lubrication to vaginal tissue

Decrease symptoms associated with vaginal dryness

Increase level of comfort during sexual intercourse

Question 17

patinet assessment for vaginal dryness

Answer 17

• majority of women seekign advice and relief are peri or post menopause
• approx 15% of perimenopausal and 29-57% postmenopausl women experience urogenital atrophay, including vaginal dryness
• can recommend a trial of vaginal lubricants or moisturizers to women with mild to moderate symptoms
• if severe vaginal dryness or those who have been unresponsive to vaginal lubricants or moisturizers should be referred

Question 18

non pharmacologic therapy for vaginal dryness

Answer 18

• can get some relief from inc blood flow to pelvic region through sexual stimulation
• any form of sexual excitment can help restore vaginal moisture
• intercourse not necessary to achieve this effect and should be avoided if its painful

Question 19

first line therapy for vaginal dryness

Answer 19

• lubricatns and moisturizers

Question 20

examples of vaginal lubricants and how they are used

Answer 20

• can be applied to penis or outside of condom and opening of vagina during intercouse
• water based: K-Y Liquid/Jelly, AstroGlide

silicone based: Astroglide X Silicone Liquid

• oil based: mineral oil or olive oil

*cannot use oil based with latex condoms

• also exist as lubricant suppository (Mae) and labia lubricant cream for symptomatic relief

Question 21

describe vaginal moistuizers

Answer 21

• include polycarbophil and hyaluronic acid gels
• attach to vaginal epithelium and provide water and electrolytes to the cells
• have a longer duration of action (2-3 days) then lubricants and used on regular basis, not immediately prior to intercourse
• most women gain max refief from symptoms is applied every 3 days, but can be used more of less freq as needed
• avoid oil based bc can be irritating, difficult to remove and can damage condoms, diaphragms and cervical caps

Question 22

hormone supplimentation for vaginal drynes

Answer 22

supplement with estrogens and progesterone

• can be in form on systemic horome therapy or by vaginal application of estrogen
• reverses the vaginal changes seen with menoapuse and relieves symptoms
• provides localized benefits with less systemic absorption/effects compared with oral therapy
• concurrent progestogen supplementation generally not req with low doses of vaginal estrogen
• even is on systemic estrogen may need veginal application too

Question 23

natural health products for vagina dryness

Answer 23

black cohosh

• evidence of efficacy is generally of low quality
• can cause nausea and headache and is contraindicted in pregnency and breasftfeeding
• usual dose is 3–6 mL per day of a 1:5 tincture in 60% ethanol, or 500–1000 mg dried root or rhizome 2–3 times daily.
• hepatotoxiicty reported, but not confirmed