Vagina health
Vaginal health will be one of the main concerns of any woman after reaching puberty. A healthy vagina contains normal bacteria called vaginal flora, which is important to the health and well being of all women.
Vaginal flora:
Vaginal flora of a normal asymptomatic reproductive-aged woman includes multiple aerobic or facultative species as well as obligates anaerobic species. Of these, anaerobes are predominant and outnumber aerobic species at an approx ratio of 10 to 1.
The function of and reason for bacterial colonization of the vagina remains unknown. Bacteria does exist in a symbiotic relationship with the host and are alterable, depending on the microenvironment. These organisms localize where their survival needs are met, and have exemption from the infection-preventing destructive capacity of the host.
Within this vaginal ecosystem, some microorganisms produce substances such as lactic acid and hydrogen peroxide that inhibit non-indigenous organisms. In addition, several other antibacterial compounds, termed bacteriocins, provide a similar role and include peptides such as acidocin and lactacin. Moreover, some species have the ability to produce proteinaceous adhesions and attach to vaginal epithelial cells.
For protection from many of these toxic substances, the vagina secretes leukocyte protease inhibitor. This protein protects local tissues against toxic inflammatory products and infection.
Vaginal pH:
Typically, the vaginal pH ranges between 4 and 4.5. Although not completely understood, it is believed to result from Lactobacillus species' production of lactic acid, fatty acids, and other organic acids. In addition, amino acid fermentation by anaerobic bacteria results in organic acid production as does bacterial protein catabolism. Glycogen present in healthy vaginal mucosa is believed to provide nutrients for many species in the vaginal ecosystem. Accordingly, as glycogen content within vaginal epithelial cells diminishes after menopause, this decreased substrate for acid production leads to a rise in vaginal pH
Several other events predictably alter lower reproductive tract flora and may lead to patient infection. Treatment with a broad-spectrum antibiotic or menstruation may result in symptoms attributed to inflammation from Candida albicans or other Candida species. Menstrual fluid also may serve as a source of nutrients for several bacterial species, resulting in their overgrowth. What role this plays in the development of upper reproductive tract infection following menstruation is unclear, but an association may be present.
Evaluation of a patient with vulvar and/or vaginal symptoms requires a detailed history and physical examination, including inspection of other mucosal and skin surfaces. Specific questions regarding symptoms of vulvar or vaginal pain, itching, discharge, and previous infections should be elicited. Sexual activity, the use of feminine hygiene products (douching, soaps, perfumes), and medications (oral contraceptive pills, antibiotics) can alter the normal vaginal flora. Any underlying medical conditions, such as diabetes, can impact the development of certain vulvovaginal disorders. Overlying garments made of synthetic fabrics that retain heat and moisture can exacerbate vulvovaginal symptoms.
The first symptom of vaginal irritation is often vulvar pruritus, which often results from contact with vaginal discharge. Any variance from the normal, physiologic milky vaginal discharge should be noted. Before menarche, a scant vaginal discharge occurs that normally does not cause irritation and is not considered abnormal. Inspection in the adolescent girl may reveal a small amount of white mucoid material in the vaginal vault that is the result of normal desquamation and accumulation of vaginal epithelial cells. The most common cause of leukorrhea (vaginal discharge) is a vaginal infection. The presence or absence of odor, pruritus, and the color can help determine the etiology.
After the clinical history is obtained, the vulva, vagina, and cervix should be thoroughly inspected
Bacterial Vaginosis (BV):
This common and complex clinical syndrome reflects abnormal vaginal flora, and is poorly understood. It has been variously named, and former terms include Haemophilus vaginitis, Corynebacterium vaginitis, Gardnerella or anaerobic vaginitis, and nonspecific vaginitis.
For unknown reasons, the vaginal flora's symbiotic relationship shifts to one in which there is overgrowth of anaerobic species including Gardnerella vaginalis, Ureaplasma urealyticum, Mobiluncus species, Mycoplasma hominis, and Prevotella species. Bacterial vaginosis (BV) is also associated with a significant reduction or absence of the normal hydrogen peroxide-producing Lactobacillus species.
Treatment: -Metronidazole (500 mg orally twice daily for 7 days)
-Metronidazole gel 0.75%(5 g intravaginally once daily for 5 days)
- Clindamycin cream 2%(5 g intravaginally at bedtime for 5 days)
Analgesia with nonsteroidal anti-inflammatory drugs or a mild narcotic such as acetaminophen with codeine may be prescribed. In addition, topical anesthetics such as lidocaine ointment may provide relief. Local care to prevent secondary bacterial infection is important.
Patient education is mandatory and specific topics should include the natural disease history, its sexual transmission, methods to reduce transmission, and obstetric consequences. Acquisition of this infection may have significant psychological impact, and several websites provide patient information and support.
Women with genital herpes should refrain from sexual activity with uninfected partners when prodrome symptoms or lesions are present. Latex condom use potentially reduces the risk for herpetic transmission.
Fungal Infection:
This infection is most commonly caused by Candida albicans, which can be found in the vagina of asymptomatic patients, and is a commensal of the mouth, rectum, and vagina. Candidiasis is seen more commonly in warmer climates and in obese patients.75% of women will experience an episode of vulvovaginal candidiasis. Additionally, immunosuppression, diabetes mellitus, pregnancy, and recent broad-spectrum antibiotic use predispose women to clinical infection. It can be sexually transmitted, and several studies have reported an association between candidiasis and orogenital sex
The typical vaginal discharge is described as a cottage cheese-like discharge. Vaginal pH is normal (less than 4.5).
Treatment: Intravaginal agents:
- Butoconazole(2% cream5 g intravaginally for 3 days) or (5g once)
- Clotrimazole(1% cream, 5 g intravaginally 7 to 14 days)or(100 mg tablet intravaginally for 7 days)or (100 mg tablet intravaginally, 2 tablets for 3 days)
- Miconazole(2% cream, 5 g intravaginally for 7 days)
- Nystatin(100,000-unit tablet intravaginally for 14 days)
- Tioconazole(6.5% ointment, 5 g intravaginally once)
-Oral agent:Fluconazole 150 mg oral tablet once
Women who have four or more candidal infections during a year are classified as having complicated disease, and cultures should be obtained to confirm the diagnosis. Non-albicans candidal species are not as responsive to topical azole therapy. Therefore, prolonged local intravaginal therapy regimens and addition of oral fluconazole, one to three times a week, may be required to achieve clinical cure. Primary treatment for prevention of recurrent infection is oral fluconazole, 100 to 200 mg weekly for 6 months. For non-albicans recurrent infection, a 600-mg boric acid gelatin capsule intravaginally daily for 2 weeks has been successful candida infection.
Oral azole therapy has been associated with elevation in liver enzymes. Thus, prolonged oral therapy may not be feasible for that reason or because of interactions with other patient medications such as calcium channel blockers, warfarin, protease inhibitors, trimetrexate, terfenadine, cyclosporine A, phenytoin, and rifampin. In these cases, local intravaginal therapy once or twice weekly may give a similar clinical response.
Scented soups and shower gels exacerbate the problem rather than cure it and so all you're doing is temporarily masking the smell and setting yourself up for a worse fall later. Instead of using these things for vaginal odour, you should instead consider the benefits of using natural products. Herbal soaps may be a very useful addition to your hygiene arsenal.
