Other Causes of Vulvovaginitis

 OTHER CAUSES OF VULVOVAGINITIS

 

Atrophic vaginitis is defined as atrophy of the vaginal ep-ithelium due to diminished estrogen levels. Although more common in postmenopausal women, atrophic vaginitis can be observed in younger premenopausal women. Estrogen status plays a crucial role in determining the normal state of the vagina. When estrogen levels decrease, there is loss of cellular glycogen with resulting loss of lactic acid. In the prepubertal and postmenopausal states, the vaginal epithe-lium is thinned, and the pH of the vagina usually is elevated (4.7 or greater). Loss of elasticity in the connective tissue may also occur, resulting in shortening and narrowing of the vagina. The urinary tract may also be affected and may demonstrate atrophic changes. Patients with atrophic vaginitis may have an abnormal vaginal discharge, dryness, itching, burning, or dyspareunia. Typical urinary symp-toms include urgency, frequency, recurrent urinary tract infections, and incontinence. Atrophic vaginitis is treated with topical or oral estrogen therapy.

Desquamative inflammatory vaginitis is generallyseen in perimenopausal and postmenopausal women, and is characterized by purulent discharge, exfoliation of epithe-lial cells with vulvovaginal burning and erythema, relatively little lactobacilli and overgrowth of gram-positive cocci; usually streptococci are seen. Vaginal pH is greater than 4.5. Initial therapy is clindamycin cream 2%, applied daily for 14 days.

Comments

Post a Comment

Popular posts from this blog

The Postpartum Visit

  THE POSTPARTUM VISIT   At the time of the first postpartum visit, inquiries should be made into the following: status of breastfeeding, re-turn of menstruation, resumption of coital activity, use of contraception, interaction of the newborn with the fam-ily, and resumption of other physical activities such as return to work. Observation about and appropriate ques-tions concerning sadness and depression, anxiety, the par-ents’ concerns about infant care, and the relationship of mother and her partner are also part of the first postpar-tum visit. Involutional changes will have occurred in most instances. Inflammatory changes because of the healing of the cervix may result in minor atypia on a Pap smear performed at this time. Unless there is a history of signifi-cant cervical dysplasia, repeating the Pap smear in 3 months is appropriate.
Read more

Clinical Findings of Tubal Ectopic Pregnancy

  CLINICAL FINDINGS   Abdominal and pelvic findings are notoriously scant in many women before tubal rupture. Prior to rupture, the di-agnosis of an ectopic pregnancy is primarily based on labo-ratory and ultrasound findings. With rupture, however, nearly three-fourths of women will have marked tender-ness on both abdominal and pelvic examination, and pain is aggravated with cervical manipulation. A pelvic mass, in-cluding fullness posterolateral to the uterus, can be palpated in about 20% of women. Initially, the ectopic pregnancy may feel soft and elastic, whereas extensive hemorrhage produces a firmer consistency. Many times, discomfort pre-cludes palpation of the mass. Avoidance of pelvic examina-tions may actually help avert iatrogenic rupture.   Fever is not expected, although a mild elevation in temperature in response to intraperitoneal blood may occur. A temperature of 38 ° C may suggest an infectious cause to a patient’s symptoms. Abdominal distension and tender...
Read more

Anxiety, Depression, and the Postpartum Period

Image
  ANXIETY, DEPRESSION, AND THE POSTPARTUM PERIOD   Although pregnancy and childbirth are usually joyous times, depression to some degree is actually common in the postpartum period. There is a wide spectrum of response to pregnancy and delivery, ranging from mild postpartum blues to postpartum depression (Table 11.2). Approximately 70% to 80% of women report feeling sad, anxious, or angry beginning 2–4 days after birth. These  postpartumblues  may come and go throughout the day, are usuallymild, and abate within 1 to 2 weeks. Supportive care and reassurance are helpful in ensuring that symptoms are self-limited. Approximately 10% to 15% of new mothers ex-perience  postpartum depression (PPD),  which is a more serious disorder and usually requires medication and counseling.  PPD differs from postpartum blues in the sever-ity and duration of symptoms.  Women with PPD have pro-nounced feelings of sadness, anxiety, and despair that interfere with acti...
Read more