Reviewed by: Qinping Liao (Tsinghua Changgeng Hospital, Beijing)
Author: Tan Xianjie (Peking Union Medical College Hospital)
Vaginitis is the most common disease in gynecology. It is mainly manifested by changes in the characteristics of vaginal discharge, itching and burning pain in the vulva, and dyspareunia is also common. If the infection involves the urethra, there may also be symptoms such as dysuria and urgency. If left untreated, inflammation can further infect the fallopian tubes, ovaries, and pelvic peritoneum, leading to pelvic inflammatory disease.
Due to estrogen deficiency, thin vaginal epithelium, and reduced intracellular glycogen content, young girls and postmenopausal women are less resistant to vaginal resistance and are more susceptible to infection than adolescent and women of childbearing age.
Vaginitis varies in its type because of the different pathogens. Common vaginitis are trichomoniasis vaginitis, fungal vaginitis (also called vulvovaginal candida disease), bacterial vaginosis, senile vaginitis, and vaginitis in young women.
Statistics show that bacterial vaginosis accounts for 40% of all vaginitis, and trichomoniasis and fungal vaginitis each account for about 25%. You may wonder, how can I roughly judge which one I am? Below I will give you a detailed introduction to several common vaginitis.
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1. Trichomoniasis vaginitis
Trichomoniasis vaginitis is a common type of vaginitis, the pathogen is trichomonas vaginalis, which is a very small protozoan microorganism that must be seen under a microscope, it is suitable for growing in a humid environment of 25 °C ~ 40 °C, pH 5.2 ~ 6.4, very viable, can survive for ten hours in a semi-dry environment, can survive for 45 to 120 minutes in ordinary soapy water, but it is difficult to grow in an acidic environment below pH 5 or an alkaline environment with a pH value of 7.5 or more.
Vaginal pH before and after menstruation is close to neutral, and trichomoniasis hidden in vaginal glands and folds often multiply, causing inflammation. Trichomoniasis not only parasitizes the vagina, but also enters the urethra or paraurethral glands, and even into the bladder and aphrodites, as well as into the foreskin folds, urethra and prostate in men. 60% of patients with trichomoniasis vaginitis have bacterial vaginosis.
Propagation method
Sexual transmission is the main mode of transmission. After men pass on the trichomoniasis to women, women may pass it on to men in turn, and men pass it on to women, so that "courtesy exchanges".
Men are often asymptomatic after infection with trichomoniasis, but can still transmit the disease and become a recessive source of infection. A few also spread through public baths, bathtubs, bath towels, toilets, clothing, etc.
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Symptoms and diagnosis
Trichomoniasis vaginitis is characterized by increased vaginal discharge and itching of the vulva, as well as burning, pain, and dyspareunia. The secreted vaginal discharge is thin and purulent, yellow-green, foamy, and odorous. The itching site is mainly in the vaginal opening and vulva. If concomitant urinary tract infection, there may be urinary frequency, painful urination, and even hematuria. Trichomonas vaginalis can devour sperm and affect the survival of sperm in the vagina, causing infertility.
How can trichomoniasis vaginitis be transmitted?
The disease is easily diagnosed based on the above symptoms and can be confirmed if trichomoniasis is found in vaginal discharge. Take 0.9% sodium chloride solution drop by drop on a slide, take a little vaginal discharge mixed with this drop solution, immediately microscopic examination, microscopic detection of trichomoniasis. If trichomoniasis vaginitis is highly suspected, but trichomoniasis has not been found on multiple tests, culture of secretions is required.
treat
The treatment of trichomoniasis vaginitis is simple, inexpensive and effective. The mainstay of treatment is metronidazole or tinidazole, and sexual partners should also be treated at the same time. In addition, underwear and washing towels should be boiled for 5 to 10 minutes to avoid repeated infections.
2. Fungal vaginitis
Also known as "vulvovaginal candidiasis (VVC)", it was once called "vulvovaginal candidiasis". Foreign data show that 3/4 of women have had at least one intimate contact with VVC in their lives, and half of women have experienced 2 or more episodes of illness.
VVC is caused by Candida saccharomyces, and 90% of pathogens are Candida albicans. 10% to 20% of non-pregnant women and 30% of pregnant women have this bacterial parasitism in the vagina, but the amount of bacteria is small and does not cause symptoms. However, when broad-spectrum antibiotics, pregnancy, diabetes, immunosuppressants, etc. are applied, resulting in a decline in local immunity in the whole body and vagina, the bacteria can multiply in large quantities and clinical symptoms appear.
Propagation method
VVC is mainly endogenous infection, Candida is a conditional pathogenic bacteria, can parasitize outside the vagina, can also parasitize the mouth, intestine, 3 parts of the bacteria can be transmitted to each other; a small number of patients can be directly transmitted through sexual life; can also be caused by contact with infected clothing, but rarely.
Diagnosis of symptoms
VVC is characterized by vulvar itching, burning pain, dyspareunia, and dysuria. Vaginal discharge is white and thick and curd-like or tofu-like. Some patients have an unbearable itch, and after scratching, they appear vulvar redness, swelling, erosion, and superficial ulcers.
Typical cases of VVC can be diagnosed by an experienced doctor at a glance, and the diagnosis can be confirmed by finding false hyphae under the microscope. The method is similar to that of trichomoniasis, but the solvent is 10% potassium hydroxide to dissolve other cellular components in the vaginal discharge, leaving candida bacteria behind. If highly suspected but negative microscopy, mold culture is required.
treat
Treatment of VVC includes elimination of triggers and pharmacotherapy. Mainly vaginal topical medication, but also with systemic medication. Topical use of the vagina is an over-the-counter drug that can be purchased in pharmacies and is commonly used, including clotrimazole and miconazole. Because most of the infections of VVC are endogenous, sexual partners are not routinely treated, and those who have symptoms need treatment.
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3. Bacterial vaginosis
Bacterial vaginosis is a mixed infection caused by an excessive number of bacteria that causes the normal flora in the vagina to be disordered, but neither clinical symptoms nor pathological examination have typical inflammatory features.
In normal vaginas, Lactobacillus peroxide produces dominant, and when suffering from bacterial vaginosis, the lactobacillus bacteria that can produce hydrogen peroxide in the vagina are reduced, and other microorganisms multiply, especially anaerobic bacteria, resulting in the occurrence of bacterial vaginosis.
The cause of changes in the vaginal flora may be related to frequent sexual intercourse, multiple sexual partners, or vaginal alkalinization by vaginal irrigation.
Diagnosis of symptoms
10% to 40% of patients are asymptomatic, if the symptoms are mainly increased vaginal discharge, fishy odor, aggravated after sex, may have mild vulvar itching or burning sensation. Secretions can also be taken to check for "clue cells", which are granular particles adhering to the edges of epithelial cells that have fallen off the vagina, that is, various anaerobic bacteria that accumulate.
treat
Although the symptoms of bacterial vaginosis are not severe, it can be uplinked to cause endometritis, pelvic inflammatory disease, etc. For pregnant women, it also leads to chorioamnionitis, premature rupture of membranes, premature birth, etc. Therefore, treatment is required after the diagnosis of bacterial vaginosis. Detailed treatments can be found below:
4. Senile vaginitis
Atrophic vaginitis, also known as "senile vaginitis", is common in postmenopausal women. When estrogen levels are low for various reasons, the vaginal wall shrinks, the mucous membrane thins, bacteria are easy to invade, and the glycogen in the vaginal epithelial cells is reduced, resulting in an increase in vaginal pH, lactobacilli are no longer dominant, local resistance is reduced, and other pathogenic bacteria overproliferate.
Diagnosis of symptoms
The main symptoms are burning discomfort in the vulva, itching, and increased vaginal discharge. Vaginal discharge is thin and yellowish. The doctor's examination will find that the vaginal mucosa is atrophied, and the mucous membrane is congested, thin, and scattered at bleeding points. Sometimes there are superficial ulcers, and in severe cases, vaginal adhesions and atresia.
Depending on the patient's age and symptoms, tests that do not reveal trichomoniasis or Candida can be largely diagnosed as atrophic vaginitis.
treat
Treatment regimens are primarily supplementation with estrogen to increase vaginal resistance, while topical vaginal antibiotics are used to inhibit bacterial growth.
5. Infant vaginitis
Common in girls under 5 years of age. Poor development of the vulva in infants and young children, can not cover the urethral opening and vaginal vestibule, estrogen deficiency, vaginal epithelium is thin, these make it resistant to weak, bacteria are easy to invade, if poor hygiene habits are easy to cause infection.
In addition, infants and young children will put foreign objects such as erasers, pencil heads, buttons and other foreign objects into the vagina and cause infection.
Diagnosis of symptoms
It is characterized by a large and purulent vaginal discharge. Secretion stimulation causes pain and itching of the vulva, and the child cries incessantly, is irritable, and often scratches the vulva with his hand. Examination may reveal hyperemia, edema, and purulent discharge from the vaginal opening.
In severe cases, ulceration of the vulva may be seen, and the labia minora are adhesion. Infants and young children have poor language expression ability, mainly relying on the mother's careful observation. In addition, it is necessary to be vigilant about whether young girls or adolescent girls may be sexually assaulted.
treat
The principles of treatment are: keep the vulva clean, dry, and reduce friction; foreign bodies in the vagina must be removed as soon as possible; labia minora adhesions, which can be separated by gentle insertion along the upper or lower holes with small curved forceps, which are easy to perform and do not require anesthesia; select appropriate oral antibiotic therapy for pathogens, or drop antibiotic solution into the vagina with a straw; and give fluttering deworming treatment in people with pinworms.
6. Vaginal foreign body
One of the main causes of vaginitis in infants and young children is a vaginal foreign body, but the vaginal foreign body is not a patent of young girls, and adults can also be treated for vaginal foreign bodies. Curious infants and young children, all kinds of small objects at their fingertips may become vaginal foreign bodies, such as hairpins, matchsticks, peanut rice, corn kernels, soybeans, wheat grains, bicycle balls, cigarette filters, small stones, plastic pen caps, hemp stalks, pins, mother-daughter buckles, short plastic ropes, glass ampoules, metal perfume bottle caps, etc.
In adults, vaginal foreign bodies have been reported to include contraceptives, cucumbers, oranges, onions, perfume bottles, etc.
There are many different types of vaginal foreign bodies, and the causes are strange, but the main consequences are all caused by inflammation. If the foreign body is too large and hard, prolonged inactivity can compress the rectum and bladder, causing a rectovaginal fistula or bladder-vaginal fistula. Therefore, after the diagnosis, the foreign body should be removed in time and treated symptomatically.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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