Vaginitis, inflammation of and around (vulvovaginitis) the vagina is no beauty contest. There are no winners. But there is a hierarchy of prevalence, however. The numbers 1, 2, and 3 causes of vaginitis, in that order are:
- Bacterial vaginosis, a bacterial change in the normal vaginal flora that results in irritating breakdown products of the vagina’s natural sugars.
- Yeast vaginitis, a fungus—usually Candida.
- Trichomonas, a sexually transmitted disease (STD) that can present with symptoms in both a woman and her partner.
These make up 90% of vaginal irritations, resulting in inflammation, itching, redness, pain, sexual discomfort, and painful urination. The other 10%? They are less common, but not rare:
By this is meant chemicals that are harsh irritants to the vagina. Antifungal creams and suppositories can be too harsh for the delicate vaginal tissue. Vaginal tissue doesn’t have a number of layers of dead cells to buffer them like your skin has. They are susceptible to irritation from direct contact with things like soaps and the exotic things Gwyneth Paltrow is recommending, such as jade eggs and vaginal steaming. (Sorry, Gwyneth.)
Treatment for chemical vaginitis is simply ending the exposure of the irritant.
Estrogen is responsible for building up the linings of the vaginal tissues, thickening them. This also causes elasticity of the vaginal walls, important in intercourse and childbirth. When estrogen is gone, as with menopause, or if there is a hormone imbalance, as in breastfeeding, the replenishment of dead cells tip over to not being enough. This causes more cells to die and fall away, resulting in a hypersensitive thin-walled vagina and a discharge that, under the microscope, proves to be nothing more than amassed dead cells.
Treatment is with estrogen, but with the controversies going back and forth over risks vs benefits of hormone replacement therapy, a good compromise is using estrogen locally only in the vagina, limiting its absorption into the rest of the body (Estring vaginal ring).
Others in the minority 10% are of autoimmune or genetic provocation:
Lichen sclerosis et atrophicus (LSA)
This is primarily evident on the tissues around the vagina, called the vulva. Vulvitis and vulvovaginitis are sometimes difficult to separate. LSA is an inflammatory disease of the mucocutaneous areas that occur most often outside of the estrogen years—prepubescent girls and postmeopausal women. The skin becomes thickened with cracks and fissures and, untreated, can cause scarring and constriction of the vagina. A complication of LSA is lichen simplex chronicus (damage from excessive scratching).
Treatment for LSA includes topical corticosteroids (clobetasol cream or ointment; and halobetasol as Ultravate cream or ointment). If necessary, surgery of the affected tissues may be indicated. Diagnosis is via biopsy.
Erosions that result in loss of the labia minora and narrowing of the vaginal entrance.
Treatment for Lichen Planus includes topical corticosteroids (clobetasol cream or ointment; and halobetasol as Ultravate cream or ointment). These may also include antifungal ingredients. If necessary, surgery of the affected tissues may be indicated. Diagnosis is via biopsy.
Bright red, raised lesions, with the characteristic silver scales only on the mons (area above the vagina). Unless severe and associated with other areas, treatment is the same as with the lichenoid (LSA and planus) vulvovaginitis.
An allergic reaction. Sexual lubricants, condoms, or other substances that can make contact with the vagina are often the cause. Treatment is avoidance of exposure and if severe, corticosteroids.
This is atopic dermatitis, a genetic mutation resulting in a dermatitis. It is usually distinguished from contact dermatitis by the presence of severe itching and a family history.
In the words of Paul Simon, “One man’s ceiling is another man’s floor.” The vagina sits between the bladder and the rectum. If there is trauma (as in difficult vaginal birth or criminal rape) or infection severe enough, there can rip a communication between the vagina and bladder (or urethra) or between the vagina and rectum. These heal but can leave a communicating tract between them and the vagina.
A communication between the bladder and vagina causes a chronic leakage of urine which, although sterile, can be harsh on the vaginal tissues causing a chemical vaginitis. Treatment is by surgery to close the fistula.
A rectovaginal fistula is more a problem, since leaking fecal material can seed the vagina with rectal bacteria, including e. coli. This can result in a horrible and malodorous discharge. Treatment is by surgery to close the fistula.
Vaginitis and vulvovaginits are easy to diagnose and treat
The vagina is a world unto its own. It is a unique tissue type that provides the sensitivity and elasticity to promote and accommodate intercourse, adaptive in this ability to an extreme, as in accommodating a baby’s head at delivery. Its elasticity depends on a nurtured estrogen-supported tissue that by its very nature is not covered with a thick armor like the outside skin has. This makes it susceptible to irritation from chemicals, bacteria, virus, protozoans, and genetic and autoimmune problems. The conditions known as vaginitis and vulvovaginits will get a person’s attention quickly, but thankfully, they are usually straightforward to diagnose and easy to treat.
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