Vulvovaginal Disorders and Conditions

Question 1

Douching

Answer 1

• NOT GOOD
• black, little education, incarcerated adolescents
  
  • Increased risk of PID, reduced fertility, ectopic pregnancy, vaginal infections, STI, low birthweight infants, cervical cancer
• irritation
• disrupt normal flora and pH
• Tactfully discourage

Question 2

Atrophic Vaginits

Answer 2

• Symptoms:
  
  • dyspareunia, lack of adequate vaginal lube
  • irritation, dryness, burning, itching, leuokrrhea (milky white discharge)
  • Incontinence in older
• Cause
  
  • Low estrogen levels
• Treatment:
  
  • Lubicrant products
    
    • water soluable
  • Sexual activity
  • Dryness: estrogen
    
    • unopposed estrogen associated with endometrial cancer
    • vaginal estrogen very well absorbed
• Exclusions:
  
  • postmenopausal bleeding
    
    • especially if bleeding and on estrogen
  • Not relieved by lubricants
  • Symptoms that are not localized
  • Severe vaginal dryness or dyspareunia

Question 3

PMS

Answer 3

• Behavioral: fatigue, irritable, depression, etc.
• Physical: bloating, breast tender, acne, appetite changes, headache
• Sign: bad before period and goes away with start of menses
  
  • ​Very dramatic, may be PMDD, need referral
• Treatment:
  
  • Charting
    
    • mark days of symptoms and days of period
  • Education, diet modification, exercise, stress managment
  • Vitamin B₆ and Calcium and Vitmain D
    
    • Mood
    • B=100mg, C and D=1000mg
  • Vitamin E
    
    • Breast tenderness’
  • NSAIDs
    
    • Headache
  • Midol and Pamprin is a bunch of crap
    
    • diuretics don’t work

Question 4

Dysmenorrhea

Answer 4

• Primary: associated with cramp-like abdominal pain without pelic disease
  
  • within 6-12 months of menarche
  • less likely after 25 yo
  • Severe pain, miss school
• Secondary: associated with pelvic pathology
  
  • IUD can cause
  • Secondary needs a cause/source
• Primary Clinical Presentation:
  
  • Dull pain and cramping
  • N/V/D
  • irritability and headache
  • at the start of menses
• Non-Pharmacological Therapy
  
  • Heat, exercise, massage, sleep
  • Omega-3-FA
• Pharmacological Therapy
  
  • ​Not aspirin or acetaminophen due to Reyes and CNS
  • NSAIDs
    
    • prostaglandins have a short half-life, so can work at onset
  • perhaps oral contraceptive pilll

Question 5

Vulvocaginal Candidiasis (yeast)

Answer 5

• Classic Symptoms:
  
  • Thick, white “cottage cheese”, no odor discharge
  • Normal pH
  • redness, itching, swelling
  • might be from immunosuppresant or antibiotics
• Treatment
  
  • not treat partner
• Non-pharmacological
  
  • Decrease refined sugar, eat yogurt
• Pharmacological
  
  • Avoid 1 day treatments
  • Should improve within 2-3 days
  • If itch, use cream
  • miconazole, clotrimazole, butoconazole, tioconozole
    
    • nystatin=yeast only=not good choice
    • fluconazole=last a long time in the body
      
      • may need to use another course if on antibiotics
• Drug interactions
  
  • warfarin and miconazole
  • warfarin and flucanazole
• Exclusions:
  
  • Preganancy
  • Girls less than 12 yo
  • fever and lower belly pain
  • uncontrolled/undiagnosed diabetes, HIV infection
  • recurrent (>3 VVC/year or within the past 2 months)

Question 6

Bacterial Vaginosis: BV

Answer 6

• Symptoms:
  
  • thin, water discharge
  • off-white or discolored
  • fishy smell
  • irritation
  • dysuria
  • itch
• Risk Factors:
  
  • new partner, IUD, smoking
• Treatment:
  
  • Requires referral
  • No treatment of partner
  • change in normal flora, not necissarily an STD
  • Common

Question 7

Trichomoniasis

Answer 7

• Symptoms
  
  • Smelly, yellow-green discharge
  • Pruritius
  • Erythema
  • Edema
• Risk Factor:
  
  • Multiple Sex partner, new sex partner, unprotected sex, other STI
• Treatment
  
  • Require referral, reportable disease
  • Treat partner
  • Tinadazole

Question 8

Toxic Shock Syndrome (TSS)

Answer 8

• Symptoms:
  
  • Red rash on palms
  • low blood pressure
  • cramps
  • nausea
  • dizziness
    
    • Day 2-3: fever, vomitting, dizziness
• Within 2 days of menses, using super absorbant tampons