Non-specific vaginitis

　　The common pathogens are generally pyogenic bacteria such as Staphylococcus, Streptococcus, Escherichia coli, etc. Non-specific vaginitis is caused by general pathogens such as Proteus, Streptococcus, Staphylococcus, Escherichia coli, etc., and not by specific pathogens. Factors such as foreign bodies (uterine pessaries, retained cotton balls and gauze), injury, corrosive chemical drugs, allergic reactions, radiotherapy after treatment, long-term uterine bleeding, and decreased body resistance can all create conditions for pathogens to cause secondary infection. The disease is also related to infections by Haemophilus, mycoplasma, and various anaerobic bacteria.

　　1. Acute inflammation:The patient first feels discomfort in the vulva, followed by itching and pain, or a burning sensation. At the same time, there may be swelling and congestion of the skin and mucosa in the vulvar area (including the labia majora and minora, clitoris) to varying degrees. In severe cases, erosion, ulceration, or large areas of eczema may occur, and accompanied by dysuria and sexual pain. In addition, when furunculosis occurs in the vulvar area, the vulva can become highly swollen and painful due to the occurrence of abscesses, leading to boils.

　　2. Chronic inflammation:The main manifestations are pruritus of the vulva, thickening, roughness, and fissuring of the skin, and may also be accompanied by dysuria or sexual pain.

　　In addition to the above clinical manifestations, special attention should be paid to the examination of the vaginal and urethral orifice, paraurethral glands, and attention should be given to the presence of urinary fistula or fecal fistula. In addition, laboratory tests such as vaginal discharge, urine sugar determination, and fecal egg examination should also be performed to exclude infections such as candidiasis, trichomoniasis, gonorrhea, diabetes, and pinworm infection.

　　During the acute period, there may be a slight increase in body temperature, an increase in white blood cells, general weakness, a sense of discomfort in the lower abdomen, an increase in vaginal discharge, which is purulent, serous, or bloody, with a burning sensation in the vagina, visible congestion of the vaginal mucosa under the speculum, and sometimes superficial small ulcers, with a slightly alkaline vaginal pH value.

　　1. Harm:The greatest harm of non-specific vulvovaginitis to women is its impact on fertility. If non-specific vulvovaginitis is not treated for a long time, the inflammation will spread, causing vaginal adhesion, vaginal abscess, or uterine cavity abscess, and it is easy to cause pelvic inflammatory disease, cervicitis, and other inflammatory diseases. If pregnant women have non-specific vulvovaginitis, it may cause premature rupture of the amniotic membrane, and may also cause chorioamnionitis.

　　2. Prognosis:Sexual intercourse cannot be performed if infected with non-specific vulvovaginitis. If sexual intercourse continues with non-specific vulvovaginitis, it is easy to cause bacterial infection in women, leading to exacerbation of inflammation. During the onset, it may cause vaginal bleeding and pain. Therefore, sexual intercourse should be prohibited in women infected with non-specific vulvovaginitis.

　　Detailed inquiry about the existence of the above causes, although there is a lot of vaginal discharge, it is not foamy or curd-like. After Gram staining of the secretion smear, non-specific suppurative bacteria can be found under the microscope. Multiple checks do not show trichomonads or molds.

　　Avoid spicy foods such as garlic, ginger, chili, scallions, etc., to prevent triggering vulvar itching, and avoid spicy foods. Avoid seafood, sweet and greasy foods, such as lard, butter, mutton fat, beef fat, and fatty pork, and high sugar foods such as sweet pastries, candies, cream cakes, and chocolate, which have the effect of promoting dampness and increasing heat, which will increase the secretion of leukorrhea and affect the treatment effect. Avoid smoking and drinking, and eat more fresh vegetables and fruits to keep the bowels smooth; drink more water to prevent urinary tract infections.

　　First, prevention

　　1. Pay attention to personal hygiene, keep the vulva clean.Washing the vulva with 5% concentration of Jieren Yin (clean vulva solution) every day can kill pathogenic bacteria, prevent the spread of sexually transmitted diseases, and can lubricate the vagina, protect the vaginal mucosa, eliminate odor, and play a preventive role.

　　2. Pay attention to diet and nutrition, improve physical quality.

　　Second, the method of treating non-specific vulvovaginitis in traditional Chinese medicine

　　Traditional Chinese medicine treatment:The syndrome of dampness descending to the spleen is manifested as itching and swelling in the genital area, difficult to control, with dripping after scratching accompanied by excessive, thin leukorrhea, decreased appetite, loose stools, pale and red tongue, white and slippery coating, deep and slow pulse, and other symptoms. Treatment with the method of invigorating the spleen and removing dampness to relieve itching can be chosen to add or subtract the prescription of Wan Dai Decoction. The medicine includes: 20 grams each of Cangzhu (Atractylodes macrocephala), Baizhu (Atractylodes macrocephala), Shanyao (Dioscorea opposita), Cheqianzi (Plantago asiatica), Baixianpi (Daphne genkwa), Shechuangzi (Cnidium monnieri), Baishao (Paeonia lactiflora), and Wu ye (Coptis chinensis) each 15 grams, 30 grams each of Baijie (Rhizoma Alismatis) and Kusen (Sophora flavescens), and 9 grams of Wu ye (Coptis chinensis). If there is a broken vulva with dripping or blood丝 mixed with leukorrhea, 30 grams each of Tufuling (Rhizoma Smilacis glabra) and Xianhecao (Equisetum arvense) can be added. In addition, spray Shixueping (snow melon powder) on the damaged area, 2-3 times a day, or apply Zhenzhu San (pearl powder) externally.

　　1、肝经湿热型

　　除见有阴部瘙痒、肿痛，甚至坐卧不安的主症外，外阴可有充血、灼热或糜烂溃疡，以及带下量多，色黄质稠，有臭秽，烦躁易怒，口干口苦，便秘、溲黄，舌苔黄腻，脉弦数等症状。治疗则用清热解毒、燥湿止痒之法，选择龙胆泻肝汤加减。药如：龙胆草、栀子、黄柏、生地、泽泻、车前子、丹皮各15克，柴胡、木通各9克，败酱草、薏苡仁各30克。兼见头晕、耳鸣者，加菊花、白蒺藜各15克，桑叶9克；口舌生疮者，加黄芩、黄连、竹叶、元参各9克；外阴肿痛，渗流脓水，或有皮肤破损者，还可与五味消毒饮合用。药如：蒲公英、地丁、野菊花、金银花、天葵子等。

　　2、肝肾阴亏型

　　此类证型的表现为阴部瘙痒，外阴皮肤增厚、粗糙可有皲裂，伴见头晕耳鸣，手足心热，腰酸腿软，舌红少苔，脉弦细数等症。治疗可用滋阴降火，养血活血之法，选用知柏地黄汤加减。药如：熟地、萸肉、山药、首乌、当归、丹皮、泽泻、茯苓、牛膝、蛇床子、白鲜皮各15克，知母、黄柏、草红花、茜草各9克。夜寐不佳者，加甘松、炒枣仁各30克；神疲乏力，食少便溏者，可加太子参、白术各15克，藿香梗6克，减去方中丹皮。

　　在应用上述内服药的同时，还需配合外用药治疗，则效果更佳。一般可采用熏洗方，药如：蛇床子9克，乌贼骨、白鲜皮、枯矾、苦参各15克。上方可煎汤，趁热先熏后洗，每日2次，5日为1个疗程。如有破溃流水，或生疮流脓者，则用冰硼散或珍珠散，或西瓜霜等喷涂局部。

　　三、非特异性阴道炎西医治疗方法

　　药物治疗：如有全身反应，应卧床休息，注意营养。局部治疗的原则是：恢复阴道的正常酸硷度，根据病原菌使用抗生素乳剂或粉剂，方法：应用15乳酸或0.5％醋酸或1：5000高锰酸钾溶液冲洗阴道，拭干后涂抗生素乳剂或9粉剂，一天一次，10天为一疗程。

　　1、滴虫性阴道炎

　　由致病原――阴道毛滴虫所引起的，通过性交传播或间接传播（经浴池、浴盆、游泳池、衣物、敷料及污染的器械等传播），主要表现为外阴搔痒，白带增多，白带为淡黄色泡沫状，严重时白带可混有血液。并有灼热感、性交痛，伴有尿道感染时可有尿频、尿痛，甚至血尿。

　　用药之道：治疗通常可给予敏感抗菌素口服及阴道内放置灭滴灵栓，7-10天为一疗程，连续3月，1％乳酸液冲洗外阴。丈夫也应同时治疗，在治疗期间应避免性生活。此外，患者应注意个人卫生，避免不洁性交和交叉感染。

　　2、霉菌性阴道炎

　　由致病原――白色念球菌感染引起，多发生于长期使用激素、抗生素的女性、糖尿病及孕妇身上，传染途径主要是性交、浴池、浴巾等。主要表现为豆腐渣样白带及外阴搔痒。

　　用药之道：可口服抗霉菌药物，也可用制霉菌栓塞入阴道治疗。治疗期间避免性生活，勤换内裤，洗涤用具均应用开水烫洗等。

　　3、加特纳菌性阴道炎

　　由致病原――加特纳杆菌引起，可通过性交传染，在性关系混乱的人群中，加特纳菌性阴道炎有高流行率。加特纳杆菌引起的感染多见于性活跃女性。急性期白带增多，有鱼腥或氨的臭味，外阴潮湿不适，常伴有阴道灼热感、性交痛及外阴骚痒。

　　用药之道：治疗这种阴道炎症可将四环素和磺胺噻唑制成栓剂，置入阴道深部，每晚一次，共10日；口服敏感抗菌素。有全身感染者，可静脉用药。

　　4、淋菌性阴道炎

　　由致病原――淋病双球菌引起，可通过不洁或混乱的性交而传染。也有少数因借穿感染淋球菌的泳衣或通过淋球菌污染的浴缸、坐式便器等间接传染。其症状表现为下腹部疼痛，阴道分泌物增多，显脓性白带，阴道口红肿疼痛等，如不及时治疗，可转为慢性妇科炎症，有10％～20％的妇女可出现不孕或宫外孕。

　　用药之道：治疗用敏感受抗生素肌注一个疗程。同时可选用麻柳叶，苍术，黄连，黄柏，败酱草，蛇床子，白头翁等辨证加减用药，水煎。趁温热时洗外阴，每日1～2次，7天为1疗程，一般1～2个疗程即可痊愈。

　　5、幼女阴道炎

　　多见于穿开裆裤的小女孩，发病原因是女孩在玩耍时坐在地上或在地上爬着玩，或手指直接捅进阴道，甚至置放异物，致使外阴、阴道受污染，诱发阴道炎。主要症状表现为外阴红肿，阴道内流水样分泌物，阴道灼痛或奇痛难忍。

　　用药之道：治疗幼女阴道炎，只需用花椒水或六一散（含滑石、甘草）冲水清洗阴道和外阴，便可收到满意效果。为防患于未然，不要给女孩子穿开裆裤，改穿宽松易脱的闭裆裤，同时教育女孩讲究卫生，勿用手或异物触摸阴道，每晚给女孩清洗会阴。

　　6、少女初潮阴道炎

　　女孩子第一次来月经，出于少女羞涩和对月经的朦胧认识，她们往往不懂或不注意经期卫生，滥用不洁净的卫生纸，致使外阴受不洁卫生纸污染，病菌乘机孳生和进犯，引起初潮阴道炎。特点是：会阴部有下坠及灼烧感，阴道分泌物增多，甚至呈脓性样分泌。由于阴道分泌物外溢，刺激尿道口，出现尿频，尿痛症状。

　　The way to take medicine: Patients can clean the vaginal orifice and vulva before going to bed, dry them, and gently push the Jier Yin suppository into the vagina with clean fingers. It has a good anti-inflammatory effect and will not damage the hymen.

　　7. Tight pants vaginitis

　　As the name implies, this kind of vaginitis is caused by women often wearing tight-fitting triangular panties and high elasticity tight fitness pants. Some beautiful girls like to wear tight clothes that show their body shape. These pants are tight, cover the buttocks, and the fabric is dense and not breathable. Vaginal discharge and sweat are not easy to disperse, which is conducive to the breeding of bacteria, causing vaginitis. The main symptoms are: excessive leukorrhea, itching of the vagina and labia minora, accompanied by frequent urination, urgency, and urinary tract irritation symptoms.

　　The way to take medicine: When treating this kind of vaginitis, first do not wear tight cotton pants, change to cotton underwear and loose pants. Use medicine appropriately under the guidance of a doctor.

　　8. Senile Vaginitis

　　It is a common disease in postmenopausal women, mainly caused by local resistance reduction due to estrogen deficiency, leading to inflammation caused by the invasion and reproduction of pathogens. It is manifested as vulvar itching or burning sensation, and in severe cases, urinary frequency, dysuria. Vaginal discharge increases,呈淡黄色, severe cases have bloody purulent vaginal discharge, and are accompanied by an odor. At this time, further examination should be carried out to exclude the possibility of tumors.

　　The way to take medicine: Once found to have senile vaginitis, it must be treated in time. Delaying treatment may lead to vaginal adhesion. Treatment usually involves local washing with potassium permanganate solution at a concentration of 1:5000, inserting diethylstilbestrol tablets or suppositories into the vagina, or systemic application of estrogen, but treatment must be under the guidance of a doctor.

　　9. Vaginitis during Pregnancy

　　It is best to check whether you have vaginitis before pregnancy, and if you do, get pregnant after thorough treatment, because at this time, doctors can boldly use medicine without worrying about the effect on the fetus, and the treatment effect during the non-pregnancy period is much better than that during pregnancy. During pregnancy, the hormone level of women increases, secretions increase, the vaginal pH changes, and the bacteria living in the vaginal area also become active with the change of the environment, among which candidal vaginitis is the most common in pregnant women.