II. Epidemiology
- Chronic vaginal symptoms in 105 women surveyed
- Women often self-treat chronic vaginal symptoms
- Over-the-counter Yeast Vaginitis medication: 73%
- Alternative MedicineYeast Vaginitis treatment: 42%
- Self-diagnosis often incorrect and may be harmful (symptoms alone cannot distinguish cause)
- Correct diagnosis of Yeast Vaginitis: 11-28%
- Secondary irritant Vaginitis: 15%
- Women often self-treat chronic vaginal symptoms
- References
III. Physiology: Normal vaginal secretions
- Variably dependent on multiple factors
- Age
- Timing of Menstrual Cycle
- Sexual arousal
- Contraceptive use
- Douching (counsel patients not to do this)
- Derivation
- Cervical Mucus
- Vaginal wall transudate
- Exfoliated vaginal cells
IV. Causes
- Common
- Normal discharge (30%)
- Candida Vulvovaginitis (20-25%)
- Bacterial Vaginosis (23-50%)
- Trichomonas Vaginitis (5-15%)
- Mixed infection or Sexually Transmitted Disease (20%)
- See Cervicitis
- Uncommon
V. Causes: Other
- Atrophic Vaginitis (post-menopausal women)
- Infectious Cervicitis
- Vaginitis or Vulvitis
- Scabies
- Neurodermatitis
- Vaginal or Vulvar Trauma
- Lichen Planus
- Vulvar Vestibulitis
- Herpes Vulvitis (presents with severe pain, often before vesicular lesions appear)
- Malignancy
- Irritant Contact Vaginitis
- Physiologic discharge
- Ovulation
- Pregnancy
VI. History: Rule out Sexually Transmitted Disease (Gonorrhea, Chlamydia, HSV)
- Multiple sexual partners
- Intrauterine Device or no Contraception
- History of Sexually Transmitted Disease
VII. Symptoms
- Vaginal itching or burning: Candida Vulvovaginitis
- Absence of itching makes Vulvovaginal Candidiasis unlikely
- Perceived odor (especially fishy): Bacterial Vaginosis
- Absence of odor makes Bacterial Vaginosis unlikely, and Candida Vulvovaginitis more likely
- Inflammatory signs and symptoms: Candida Vulvovaginitis
- Malodorous or unusual Vaginal Discharge
- External Dysuria (pain with urine passing over vulva)
- Severe pain in HSV Vaginitis
- Dyspareunia
VIII. Signs
- See Vaginal pH
- Character of vaginal secretions
- Normal: clear or white, non-clumping, odorless
- Dry cottage cheese-like discharge
- Frothy discharge (rarely present)
- Trichomonas Vaginitis
- Fishy Odor
- Bacterial Vaginosis
- Trichomonas Vaginitis
- Vagina and Cervix appearance
- Vulvar redness, edema and adherent white clumps
- Strawberry Cervix with punctate Hemorrhage
- Trichomonas Vaginitis
- Pale, dry, thin vaginal and vulvar skin
IX. Labs
X. Management
- Treat specific infectious cause
- Bacterial Vaginosis
- Candida Vulvovaginitis
- Trichomonas Vaginitis
- Herpes Vaginitis
- Consider Non-infectious causes with specific management protocols
- Atrophic Vaginitis
- Vaginal Dryness
- Irritant Contact Vaginitis (eliminate causes)
- Consider differential diagnosis
- Consider empiric treatment
- Not recommended due to poor correlation with symptoms
- Anti-yeast medication (See Candida Vulvovaginitis)
- Metronidazole
- Clindamycin cream per vagina for 7 nights
- Consider increasing vaginal acidity (lower Vaginal pH)
- May increase Lactobacillus survival
- Aci-Jel Vaginal jelly per vagina for 21 days at bedtime
- Vinegar douche is NOT recommended
- White Vinegar (2-4 tablespoons) in 1 quart water
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI) | A non-infectious or infectious inflammatory process affecting the vagina. |
| Definition (NCI_CTCAE) | A disorder characterized by inflammation involving the vagina. Symptoms may include redness, edema, marked discomfort and an increase in vaginal discharge. |
| Definition (CSP) | inflammation of the vagina characterized by pain and a purulent discharge. |
| Definition (MSH) | Inflammation of the vagina characterized by pain and a purulent discharge. |
| Concepts | Finding (T033) |
| MSH | D014627 |
| SnomedCT | 198213001, 266655004, 393596009, 155981006, 30800001 |
| English | Vaginitides, VAGINITIS, Vaginitis unspecified, Vaginitis, vaginitis (diagnosis), vaginitis, Vaginal Inflammation, Vaginitis [Disease/Finding], vagina inflammation, vaginal inflammation, inflammation of vagina, inflammation vaginal, Inflammation;vagina, inflammation vagina, Vaginitis unspecified (disorder), Vaginitis - non sp., Vaginal inflammation, Inflammation of vagina, Vaginitis (disorder), colpitis, inflammation; vagina, irritation; vagina, vagina; inflammation, vagina; irritation, Vaginitis, NOS, Colpitis, Vaginitis NOS, inflammation of the vagina |
| French | VAGINITE, Inflammation vaginale, Vaginite |
| Portuguese | VAGINITE, Inflamação da vagina, Colpite, Vaginite |
| Spanish | VAGINITIS, Inflamación vaginal, Colpitis, vaginitis, no especificada, vaginitis, no especificada (trastorno), vaginitis (trastorno), vaginitis, Vaginitis |
| German | VAGINITIS, Kolpitis, Vaginitis, Entzuendung der Vagina |
| Dutch | vaginale ontsteking, vaginitis, colpitis, irritatie; vagina, ontsteking; vagina, vagina; irritatie, vagina; ontsteking, Vaginitis |
| Italian | Infiammazione della vagina, Colpite, Vaginite |
| Japanese | 腟の炎症, 腟炎, ﾁﾂﾉｴﾝｼｮｳ, ﾁﾂｴﾝ |
| Swedish | Slidkatarr |
| Czech | vaginitida, kolpitida, pochva - zánět, Zánět pochvy, Kolpitida, Vaginitida, zánět poševní sliznice, zánět pochvy |
| Finnish | Emätintulehdus |
| Russian | VAGINIT, ВАГИНИТ |
| Croatian | Not Translated[Vaginitis] |
| Polish | Zapalenie pochwy |
| Hungarian | Hüvelyi gyulladás, Colpitis, vaginitis |
| Norwegian | Kolpitt, Vaginitt, Skjedekatarr |
Ontology: Vulvovaginitis (C0042998)
| Definition (NCI) | An inflammatory pathologic process that affects the vulva and the vagina. |
| Definition (MSH) | Inflammation of the VULVA and the VAGINA, characterized by discharge, burning, and PRURITUS. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D014848 |
| ICD10 | N76.0 |
| SnomedCT | 155981006, 198215008, 266655004, 53277000 |
| English | Vulvovaginitides, VULVOVAGINITIS, Vulvovaginitis, Vulvovaginitis unspecified, vulvovaginitis, vulvovaginitis (diagnosis), Vulvovaginitis NOS, Vulvovaginitis [Disease/Finding], Vulvovaginitis unspecified (disorder), Vulvo-vaginitis, Vulvovaginitis (disorder), Vulvovaginitis, NOS |
| Portuguese | VULVOVAGINITE, Vulvovaginite NE, Vulvovaginite |
| Spanish | VULVOVAGINITIS, Vulvovaginitis NEOM, vulvovaginitis, no especificada (trastorno), vulvovaginitis, no especificada, vulvovaginitis (trastorno), vulvovaginitis, Vulvovaginitis |
| German | VULVOVAGINITIS, Vulvovaginitis NNB, Vulvovaginitis |
| Dutch | vulvovaginitis NAO, vulvovaginitis, Vaginitis, vulvo-, Vulvovaginitis |
| French | Vulvo-vaginite SAI, VULVO-VAGINITE, Vulvovaginite |
| Italian | Vulvovaginite NAS, Vulvovaginite |
| Japanese | 外陰部腟炎ＮＯＳ, 外陰部腟炎, ｶﾞｲｲﾝﾌﾞﾁﾂｴﾝNOS, ｶﾞｲｲﾝﾌﾞﾁﾂｴﾝ |
| Swedish | Vulvovaginit |
| Czech | vulvovaginitida, Vulvovaginitida, Vulvovaginitida NOS |
| Finnish | Vulvovaginiitti |
| Russian | VUL'VOVAGINIT, ВУЛЬВОВАГИНИТ |
| Croatian | Not Translated[Vulvovaginitis] |
| Polish | Zapalenie sromu i pochwy |
| Hungarian | vulvovaginitis k.m.n., vulvovaginitis |
| Norwegian | Vulvovaginitt |
Ontology: Vaginal Discharge (C0227791)
| Definition (NCI_CTCAE) | A disorder characterized by vaginal secretions. Mucus produced by the cervical glands is discharged from the vagina naturally, especially during the childbearing years. |
| Definition (NCI) | Normal or abnormal secretions from the vagina. Mucus produced by the cervical glands is discharged from the vagina naturally, especially during the childbearing years. Causes of abnormal vaginal discharge include infectious agents (e.g., Neisseria gonorrhea, Chlamydia trachomatis, Trichomonas, and Candida albicans), the presence of foreign bodies, and cervical or vaginal cancer. |
| Definition (MSH) | A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. |
| Concepts | Finding (T033) |
| MSH | D019522 |
| SnomedCT | 139439007, 162159008, 198369007, 271939006, 70856007 |
| English | VAGINA DISCHARGE, Discharge, Vaginal, Discharges, Vaginal, Vaginal Discharges, vaginal discharge (diagnosis), vaginal discharge, vaginal discharge (physical finding), Vaginal Discharge, Discharge vaginal, Vaginal Discharge [Disease/Finding], Discharge;vaginal, fluor vaginalis, vagina discharge, vaginal discharge nos, vaginal discharges, Vaginal discharge NOS (finding), VAGINAL DISCHARGE, DISCHARGE, VAGINAL, Fluor vaginalis, Vaginal discharge, Vaginal discharge (finding), discharge; vagina, vagina; discharge, Vaginal discharge NOS, Vaginal discharge NOS (context-dependent category) |
| German | VAGINALER AUSFLUSS, Ausfluss vaginal, Vaginaler Ausfluss, Scheidenausfluss, Fluor (vaginal), Scheidenfluss, Fluor vaginalis, Ausfluss (vaginal), vaginaler Ausfluss |
| Dutch | fluor vaginalis, afscheiding; vagina, vagina; afscheiding, vaginale afscheiding, Vaginale afscheiding, Afscheiding, vaginale |
| French | Sécrétions vaginales, PERTES VAGINALES, Écoulement vaginal, Écoulements vaginaux, Ecoulements vaginaux, Pertes vaginales, Perte vaginale |
| Italian | Secrezione della vagina, Secrezione vaginale |
| Portuguese | Flúor vaginal, PERDAS VAGINAIS, Corrimento vaginal, Descarga Vaginal |
| Spanish | Flujo vaginal, secreción vaginal, SAI (categoría dependiente del contexto), VAGINAL, SUPURACION, secreción vaginal, SAI (hallazgo), secreción vaginal, SAI, Vaginal discharge NOS, flujo vaginal (hallazgo), flujo vaginal, secreción vaginal (hallazgo), secreción vaginal, Secreción vaginal, Excreción Vaginal |
| Japanese | 腟分泌物, 腟帯下, ﾁﾂﾀｲｹﾞ, ﾁﾂﾌﾞﾝﾋﾟﾌﾞﾂ, ﾁﾂﾌﾞﾝﾋﾟﾂﾌﾞﾂ |
| Swedish | Vaginalflytning |
| Czech | vaginální výtok, Výtok z pochvy, Poševní výtok, Vaginální fluor, výtok z pochvy, poševní výtok |
| Finnish | Emätinerite |
| Russian | VAGINAL'NYE VYDELENIIA, VLAGALISHCHNYE VYDELENIIA, ВАГИНАЛЬНЫЕ ВЫДЕЛЕНИЯ, ВЛАГАЛИЩНЫЕ ВЫДЕЛЕНИЯ |
| Polish | Wydzieliny pochwowe |
| Hungarian | hüvelyi váladékozás, Hüvelyi váladékozás, Fluor vaginalis |
| Norwegian | Fluor vaginalis, Utflod, Vaginal utflod |
