Vaginal disease

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 09/03/2015

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Chapter 23 Vaginal disease

Benign conditions

Vaginal epithelium changes in different phases of life:

• In the newborn, it is thick with much glycogen due to the maternal oestrogen effect; then, with the withdrawal of oestrogen, the vaginal epithelium atrophies and the basal layer is covered by a thin, cornified epithelium.

• At menarche, the epithelium regenerates.

• At climacteric, the epithelium reverts to its prepubertal state.

Vaginal discharge

Physiological vaginal discharge is a product of vaginal mucosal transudate, cervical mucus and secretions from Bartholin’s and Skene’s glands. Excess physiological discharge occurs during pregnancy, sexual arousal, at mid-cycle/ovulation, with use of a high-oestrogen oral contraceptive or an intrauterine contraceptive device, and with large cervical ectropion.

Abnormal vaginal discharge may originate from diseases of the vagina, cervix, uterus or fallopian tubes. Causes of abnormal vaginal discharge include infections, foreign body, atrophic vaginitis and neoplasia of the upper and lower genital tract.

History

• colour, consistency, odour and duration of discharge

• blood-stained discharge

• pruritus, pain

• associations with menstrual cycle, coitus

• medical history (e.g. diabetes)

• medications, contraception

• cervical cytology

Examination

• general examination

• genital/pelvic: vulval examination

• speculum: examining vagina and cervix, checking discharge (colour, odour), cervical ectropion, malignancy, cervical cytology, microbiological swabs

• pelvic examination for cervical excitation and palpable masses

Vaginal infections

During the reproductive life, the vaginal pH is <4.5, and this offers some protection against infections.

Trichomonas

• It is a flagellate, about 20 microns in size.

• It presents with vaginal discharge and pruritus.

• Examination reveals a yellow/green frothy discharge, punctate injection of vagina with pH >5.0.

• Treat with metronidazole 400 mg orally three times a day for 7 days or a 2 g dose statim, and treat the partner.

Candida

• It presents with vaginal discharge and vulval pruritus, and curd-like patches which are adherent to the epithelium.

• Predisposing factors include pregnancy, premenstrual period of cycle, glucose intolerance, and the use of the oral contraceptive pill, antibiotics and corticosteroids.

• It may be distinguished as uncomplicated (isolated episodes, albicans species and normal host), and complicated (severe, recurrent, non-albicans Candida species, abnormal host).

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