Vaginitis

　　Vaginitis has always been one of the more common diseases that困扰 many women, and the causes of this disease are generally divided into four categories: neglecting personal hygiene, using vaginal cleansers, misuse of antibiotics, and substandard hygiene products. These are relatively common causes of vaginitis that can be controlled and prevented in daily life.

　　Unsanitary hygiene products: Women using unclean or poorly disinfected hygiene products are also prone to vaginitis. For example, unclean toilet paper, sanitary napkins, and sanitary napkins.

　　Neglecting personal hygiene: Using public toilet seats or swimming in public swimming pools can also lead to vaginitis, with trichomoniasis and candidiasis being particularly prone to occur. In addition, women not paying attention to menstrual hygiene, not changing their underwear frequently, and not disinfecting their underwear strictly can also cause vaginitis.

　　Frequent use of vaginal cleansers: Some women also like to use vaginal cleansers to clean the vulva or vagina, thinking that this can keep the vulva clean. However, they do not realize that frequent use of cleansers will disrupt the vaginal acid-base balance, thereby increasing the risk of vaginitis infection.

　　Misuse of antibiotics: The misuse of antibiotics is also a major cause of vaginitis. This is because antibiotics, while killing pathogenic bacteria, also inhibit the growth of some beneficial flora in the female body, giving harmful bacteria an opportunity to cause vaginitis. Commonly seen is candidal vaginitis.

　　Vaginitis is not limited to simple vaginitis, there are many types, such as: trichomonal vaginitis, candidal vaginitis, bacterial vaginitis, etc. Although the main symptoms of vaginitis are vulvar itching and abnormal leukorrhea, due to the difference in types, there are also differences in symptoms. However, regardless of which type, the harm to women is undeniable.

　　Complications of vaginitis:

　　1. It can be complicated with urethritis, cystitis, pyelonephritis, which can cause infertility, bringing greater distress to patients and their families.

　　2. It is not easy to be cured, tends to recur, can cause preterm labor, fetal infection and malformation, the treatment of pregnant women with vaginitis must not be negligent, and it is necessary to cooperate with the doctor to achieve complete cure.

　　3. It can induce reproductive organ infections, pelvic inflammatory disease, perinephric abscess, sexual pain, and if vaginitis is not treated in time, it is certain to cause other gynecological diseases. Of course, it will also affect sexual life and the harmony of the couple's feelings.

　　4. It can cause vaginal adhesions, vaginal and uterine cavity abscesses, and uterine cavity lesions, which are very serious and may likely lead to tumors and cancerous changes.

　　Vaginitis is characterized clinically by changes in the nature of leukorrhea and pruritus and burning pain of the vulva, and sexual pain is also common. When infection involves the urethra, symptoms such as dysuria and urgency may occur. Common types of vaginitis include bacterial vaginitis, trichomonal vaginitis, candidal vaginitis, and senile vaginitis.

　　Garder et al. conducted a study on 1181 cases of vaginitis, finding that 41% were bacterial, 27% fungal, and 24% trichomonal. Senile vaginitis occurs after menopause, in women who have had their ovaries removed, or after pelvic radiation therapy, with an incidence reported to be as high as 98.5%.

　　Candidal vaginitis

　　Candidal vaginitis (monilial or mycotic vaginitis) is caused by fungal infection. Its incidence rate is second only to trichomoniasis vaginitis.

　　The most common symptoms of candidal infection are an increased amount of leukorrhea, burning and itching of the vulva and vagina, difficulty in urination due to external factors, and vulvar erythema in a map-like pattern (moldy or candidal vulvovaginitis). The typical leukorrhea is curd-like or in the form of pieces, with the vaginal mucosa highly red and swollen, with white thrush-like plaques attached, which are easily peeled off, with a damaged mucosal eroded base underneath or shallow ulcers forming, and in severe cases, ecchymosis may remain. However, not all leukorrhea has the above typical features, and from watery to curd-like leukorrhea can appear, such as some that are completely thin and clear serous exudates, often containing white flake-like substances. The itching symptoms of candidal vaginitis during pregnancy are particularly severe, even causing discomfort that makes it difficult to sit or lie still, with extraordinary pain, and may also have symptoms such as frequent urination, dysuria, and pain during sexual intercourse. In addition, about 10% of women and 30% of pregnant women may be carriers of candidiasis, but show no clinical symptoms.

　　Trichomoniasis vaginitis

　　Trichomoniasis vaginitis is a common vaginal inflammation caused by Trichomonas vaginalis.

　　The main symptoms of an increased amount of leukorrhea and pruritus vulvae due to trichomoniasis are an increased amount of thin, foamy leukorrhea and pruritus vulvae. If there is a mixed infection with other bacteria, the discharge may be purulent and may have an odor. The main areas of itching are the vaginal orifice and vulva, with occasional burning, pain, and pain during sexual intercourse. If there is infection at the urethral orifice, there may be frequent urination, dysuria, and sometimes hematuria. During examination, congestion of the vaginal mucosa can be seen, with scattered hemorrhagic spots in severe cases. The cul-de-sac is filled with a large amount of leukorrhea, which appears in gray yellow, yellowish white thin liquid or yellow green purulent discharge, often in a foamy state. The vaginal mucosa of carriers may not show any abnormalities. A few patients may have trichomonas in the vagina without any inflammatory reaction and are called carriers. Some people believe that trichomonas alone cannot cause inflammation, as it consumes the glycogen in the vaginal epithelial cells, changes the vaginal acid-base balance, disrupts the defense mechanism, and promotes secondary bacterial infection, so inflammation often occurs during changes in vaginal pH, such as before and after menstruation, during pregnancy, or after childbirth.

　　Bacterial vaginosis

　　Bacterial vaginosis is a vaginal inflammation mainly caused by Gardnerella vaginalis and can be transmitted through sexual contact.

　　The typical clinical symptoms of this disease are marked increase in abnormal vaginal discharge, which is thin, homogeneous, or runny, and appears in grayish white, gray yellow, or milky yellow color, with a peculiar fishy odor. Due to the alkaline prostatic fluid that can cause amines to be released, the odor can become stronger during or after sexual intercourse. The vaginal pH value increases during the menstrual period, so the odor can also be more pronounced during or after menstruation. Patients may have an uncomfortable feeling in the external genitalia, including varying degrees of pruritus vulvae, which is generally not time-specific, but the itching sensation is more obvious in a state of rest or when anxious. There may also be varying degrees of burning sensation, and some patients may experience pain during sexual intercourse. A few patients may have lower abdominal pain, difficulty in sexual intercourse, and abnormal urination sensation. The vaginal mucosal epithelium does not show obvious congestion during the onset of the disease.

　　Amoebic vaginitis

　　Amoebic vaginitis (amebic vaginitis) is mostly caused by the direct infection of the vulva or vagina by amoebic pathogens excreted with feces.

　　The vaginal discharge is serous or mucoid, from which large trophozoites can be found. When the vaginal mucosa forms ulcers and hemorrhages, the discharge may turn into purulent or hemorrhagic. Sometimes fragile ulcers may appear on the cervix and vulva, fusing into large necrotic areas. In some cases, due to severe connective tissue reaction, irregular tumor-like proliferation may occur, with a hard texture, ulcer surfaces covered with hemorrhagic mucous secretions, which are easily misdiagnosed as malignant tumors.

　　Non-specific vaginitis

　　Vaginitis that is not caused by Candida albicans, Trichomonas vaginalis, or gonorrhea is called non-specific vaginitis, also known as bacterial vaginosis.

　　During the acute period, there may be a slight increase in body temperature, an increase in white blood cells, general fatigue, a feeling of坠胀 discomfort in the lower abdomen, increased vaginal discharge, which may be purulent, serous, or hemorrhagic, and a burning sensation in the vagina. The speculum may show congestion of the vaginal mucosa, with superficial small ulcers at times, and the vaginal pH is alkaline.

　　Pinworm vaginitis

　　Pinworm vaginitis is an infectious disease caused by the parasitism of Enterobius vermicularis in humans. It is transmitted among people through indirect contact and direct contact via the anal-hand-mouth route.

　　Severe itching around the anal area and vulva, or accompanied by a burning sensation, which is more pronounced at night. An increase in the amount of thin, yellow pus-like vaginal discharge with an odor. There may be mild loss of appetite, abdominal distension, abdominal pain, and diarrhea. Symptoms such as restlessness, insomnia, night terrors, and nocturnal bruxism may also occur.

　　Allergic vaginitis

　　Allergic vaginitis refers to the manifestation of allergic reactions similar to those in the nose, eyes, lungs, and skin in the vaginal mucosa.

　　Increased vaginal discharge, which is purulent and bloody, with the excretion of decaying tissue, and an odor. The discharge from patients with candidal infection may resemble the cheese-like substance made from defatted milk powder. There may be itching, a burning sensation around the vulva, and sexual intercourse difficulties in adult women.

　　Tuberculous vaginitis

　　Tuberculous vaginitis is an inflammatory disease of the vagina caused by Mycobacterium tuberculosis. Tuberculous vaginitis is a manifestation of genital tuberculosis, mostly secondary infection. Due to the slow course of the disease and atypical manifestations, it is easily overlooked.

　　Primary symptoms: Some patients may appear normal with no obvious discomfort. They often complain of vaginal discomfort, pain, and tenderness, with white or brownish discharge. Some patients with severe illness may have systemic symptoms such as poor appetite, low fever, and weight loss.

　　Secondary symptoms: When accompanied by tuberculosis of other reproductive organs such as fallopian tubes and uterine tuberculosis, symptoms such as infertility, lower abdominal坠痛, abnormal menstruation, and copious purulent or serous leukorrhea may occur. When secondary to tuberculosis of organs such as the lung, peritoneum, intestines, and joints, or urinary system tuberculosis, other symptoms caused by the affected organs such as pleuritic pain, abdominal pain, frequent urination, hematuria, weight loss, low fever, fatigue, alternating diarrhea and constipation, dry cough, and hemoptysis may occur.

　　Vaginal hemolytic vaginitis

　　Vaginal hemolytic vaginitis is caused by vaginal hemolytic bacteria.

　　Main symptoms: Abnormal leukorrhea, increased, with a fishy or ammonia smell. Sometimes the leukorrhea is grayish and creamy and very thick, resembling the symptoms of trichomonal vaginitis. Mild cases may only have increased leukorrhea and odor, with moist and uncomfortable vulva. It is often accompanied by vaginal burning, sexual intercourse pain, and vulvar itching.

　　Vaginitis in infants and young children

　　Vaginitis in infants and young children, commonly occurring in girls aged 2-9 years, is a common disease in female infants and young children.

　　It is mainly characterized by itching and increased vaginal discharge. The mucosa of the vulva, clitoris, urethral orifice, and vaginal orifice becomes congested and edematous. There is an increase in discharge, even purulent discharge. A large amount of discharge causes vulvar itching, crying, restlessness, and even scratching with hands. Infection spreads further through fingers and scratch marks. Some may be accompanied by urgency and frequency of urination. After the acute stage, small labial adhesions may occur, with small holes above or below the adhesion, and urine flows out through the small holes.

　　Vulvovaginal atrophy

　　Vulvovaginal atrophy, also known as atrophic vaginitis, is a non-specific vaginitis.

　　Increased vaginal discharge, thin discharge, pale yellow, severe cases show purulent and bloody leukorrhea with an odor. The discharge irritates, causing itching and burning sensation in the vulva. The vaginal mucosa atrophies, and there may be sexual intercourse pain. Sometimes there is urinary incontinence. Infection can also invade the urethra, causing symptoms of urinary urgency, frequency, and pain in the urinary system. Gynecological examination shows atrophic changes in the vaginal mucosa, disappearance of rugae, thinning and smoothing of the epithelium, congestion and redness of the vaginal mucosa, and visible出血 points or hemorrhagic spots, which are most obvious at the posterior fornix and cervix. In severe cases, ulcers or erythema and erosion of the vulva may also occur.

　　Other:

　　Menstrual vaginitis: It is often caused by not paying attention to menstrual hygiene during the menstrual period, especially using unclean menstrual products, which leads to contamination of the vulva with unclean substances. It is characterized by a feeling of坠 and burning in the perineum, and increased vaginal discharge.

　　Honeymoon vaginitis: It is more common in newlywed women. It is mainly caused by not paying attention to the hygiene of the sexual organs and sexual life. It is characterized by increased vaginal discharge, itching and pain inside and outside the vagina, and red and swollen mucosa.

　　Pyogenic vaginitis: It is more common in women with vaginal tears or birth injuries. It is characterized by increased vaginal discharge, which is yellow and purulent, has a foul smell, and the vagina has a burning and painful sensation, with red and swollen mucosa.

　　Simple vaginitis: It worsens one week before the menstrual period and has some relief after menstruation. The skin becomes red and swollen, with severe itching, and may be accompanied by burning and itching in the vulva and vagina. There is a large amount of white, thick, curd-like or dreg-like vaginal discharge. There may be vaginal pain, irritation, and difficulty in sexual intercourse.

　　Chancroid vaginitis: One or several small red papules occur on the labia minora, which quickly ulcerate and expand into ulcers as large as soybeans or larger. The base is soft, dirty, with a lot of pus, and there is significant pain, which gradually expands.

　　1. Abstain from unclean sexual intercourse. Many women have multiple sexual partners or do not pay attention to hygiene after sexual intercourse, all of which are important factors that can trigger vaginitis. It is recommended to always use a condom during sexual intercourse. After sexual intercourse, urinate first, then rinse the vulva with clean water to keep the vulva clean.

　　2. After treatment, most patients with vaginitis can be cured, but some are prone to recurrence. To avoid the recurrence of vaginitis, it is best to wear loose and breathable clothing and avoid tight pants, jeans, and other clothing. In addition, the underwear should be cotton, and it should be dried in the sun after washing.

　　3. Use disinfected cotton pads during menstruation, and pay special attention to avoid bacterial infection. Pay attention to the cleanliness of the bathroom facilities, avoid sharing with multiple people, and reduce the probability of infection.

　　4. Pay attention to avoid spicy and刺激性 foods in diet, and moderately consume lactose-containing beverages such as yogurt, which is conducive to maintaining the acidic environment of the vagina.

　　The examination of vaginitis is mainly divided into four categories, mainly including routine gynecological examination, vaginal secretion examination, vaginal secretion culture, and electronic colposcopy. The most commonly used judgment examination is routine gynecological examination and vaginal secretion examination. In cases where it is not easy to judge or when complications occur, it is also recommended that patients undergo secretion culture and colposcopy to further determine the condition.

　　One, gynecological examination

　　This is one of the most routine examinations for women's health, the purpose of which is to preliminarily screen for possible diseases and take secretion samples for necessary examinations.

　　Two, vaginal secretion examination

　　The purpose of this examination is to check the cleanliness of the vagina, whether there is fungal, trichomonas, bacterial (clue cells, pus cells) infection.

　　Three, vaginal secretion culture

　　When diagnosing vaginitis, this examination is performed to determine the pathogen causing the infection of the patient and provide accurate diagnostic evidence for the doctor.

　　Four, electronic colposcopy

　　The advantage of this examination is that it can magnify 50 times and observe the relevant lesions of the vagina, cervix, and other parts accurately and clearly, and accurately select suspicious areas for biopsy, which has a relatively high value for the early detection and early diagnosis of cervical cancer and precancerous lesions.

　　Vaginitis is very difficult to cure, which is closely related to daily health care. Therefore, patients with vaginitis should pay attention to their diet, strictly adhere to what can and cannot be eaten, and if the disease is cured but recurs due to diet, it would be a loss without gain.

　　1. Avoid spicy foods:Excessive intake of spicy foods (such as chili, ginger, scallion, garlic, etc.) can easily cause dryness and heat, causing internal organs to be hot and toxic, leading to symptoms such as swollen gums, ulcers on the tongue, short and red urine, burning sensation in the anus, and itching and pain in the vulva and perineum, thereby aggravating the symptoms of the disease.

　　2. Avoid seafood allergens:Products with fishy and pungent flavors, such as mandarin fish, yellow croaker, hairtail, black croaker, shrimp, crab, and other aquatic products, can promote damp-heat, making the itching of the vulva worse after eating, which is not conducive to the regression of inflammation, so they should be avoided.

　　3. Avoid sweet and greasy foods:Greasy foods such as lard, fatty pork, butter, beef butter, sheep butter, etc., high-sugar foods such as chocolate, candy, sweet pastries, cream cakes, etc., these foods have the effect of promoting dampness and increasing heat, which can increase the secretion of leukorrhea and affect the efficacy of treatment.

　　4. Abstain from smoking and alcohol:Smoking can worsen bacterial vaginosis, which is due to nicotine in tobacco that weakens the binding force of arterial blood and oxygen. Alcohol can promote dampness and heat, so it should be avoided. Similarly, alcohol-containing drinks such as rice wine, medicinal wine, etc., should not be consumed.

　　5. Pay attention to diet and nutrition:It is recommended to eat more fresh vegetables and fruits to keep the bowels smooth; it is recommended to drink more water; prevent urinary tract infections.

　　Vaginitis is mainly divided into three categories: trichomonas vaginitis, vulvovaginal candidiasis, and bacterial vaginosis. The medication also varies according to different types. Below, we will analyze in detail the medication methods and treatment courses for each type of vaginitis.

　　Trichomonas Vaginitis:

　　Systemic medication: Trichomonas vaginitis often accompanied by trichomoniasis infection in the urinary生殖 system and intestines, it is not easy to completely eliminate trichomonads with simple local medication, so systemic medication should be used. Metronidazole tablets have good absorption and efficacy with low toxicity, used for 7 days, the husband or sexual partner needs to be treated at the same time. Tinetazole tablets can be taken, which have better efficacy than metronidazole, and the adverse reactions in the gastrointestinal tract are reduced.

　　Local medication: Local medication is also effective, but slightly worse than oral administration. Metronidazole tablets are inserted into the vagina once a night, for a total of 7-10 days. It should be taken continuously for 3 cycles.

　　Vulvovaginal Candidiasis:

　　Eliminate the cause: Stop using antibiotics and estrogens, and actively treat diabetes.

　　Local medication: Miconazole soft capsules are used vaginally once a night, for a total of 3 days, or clotrimazole suppositories are used once a night, for a total of 7 days.

　　Systemic medication: Suitable for unmarried women without sexual life, women who are not convenient for local medication when traveling, and women who are about to have their period. Fluconazole tablets are taken once a day for 3 days.

　　Bacterial Vaginosis:

　　Systemic medication: Metronidazole tablets are taken orally twice a day, used for 7 days, with an efficacy rate of up to 98.8％; clindamycin is taken twice a day, used for 7 days, with an efficacy rate of 94％.

　　Local medication: Metronidazole tablets are placed inside the vagina, used for 7 days, and clindamycin ointment is applied to the vagina, used for 7 days. The efficacy is slightly lower than oral administration.