Atlas of pathophysiology, 2 Edition

Part II - Disorders

Genital Diseases


Vaginitis is inflammation of the vulva (vulvitis) and vagina (vaginitis). Because of the proximity of these two structures, inflammation of one occasionally causes inflammation of the other. Vaginitis may occur at any age and affects most females at some time. The prognosis is excellent with treatment.


Vaginitis (with or without consequent vulvitis)

·   Trichomonas vaginalis, a protozoan flagellate, usually transmitted through sexual intercourse

·   Candida albicans, a fungus that requires glucose for growth

Clinical Tip

Some women are at particular risk of infection with C. albicans. The incidence of candidal vaginitis rises during the secretory phase of the menstrual cycle and doubles during pregnancy. The infection is also common in women with diabetes and in those who use oral contraceptives. Incidence may reach 75% in patients receiving systemic therapy with broad-spectrum antibiotics.

·   Gardnerella vaginalis, a gram-negative bacillus


·   Parasite infestation, as with Phthirus pubis (crab louse)

·   Trauma (skin breakdown may lead to secondary infection)

·   Poor personal hygiene

·   Chemical irritants, or allergic reactions to hygiene sprays, douches, detergents, clothing, or toilet paper

·   Vulvar atrophy in menopausal women due to decreasing estrogen levels

·   Retention of a foreign body, such as a tampon or diaphragm


Bacterial vaginosis is caused by a disturbance of the normal vaginal flora. There's an overgrowth of anaerobic bacteria and of an organism, Gardnerella, with an associated loss of the normally dominant Lactobacillus species.

Candida albicans is normally found in small amounts in the vagina, mouth, digestive tract, and on the skin, without causing disease or symptoms. Symptoms appear when the balance between normal micro-organisms of the vagina is lost; the C. albicans population then becomes larger in relation to other micro-organism populations. This happens when the environment (vagina) has certain favorable conditions that allow for growth and nourishment of C. albicans. An environment that makes it difficult for other micro-organisms to survive may also cause an imbalance and lead to yeast infection.

Yeast infection may develop in reaction to antibiotics prescribed for another purpose. The antibiotics change the normal flora in the vagina and suppress the growth of the protective bacteria, Lactobacillus. Infection is common among women who use estrogen-containing birth control pills and among women who are pregnant. This is due to the increased level of estrogen in the body, causing changes in the environment that make it perfect for fungal growth and nourishment.

Signs and symptoms

T. vaginitis

·   Thin, bubbly, green-tinged, malodorous discharge

·   Irritation, itching; urinary symptoms, such as burning and frequency

C. albicans

·   Thick, white, cottage cheese–like discharge

·   Red, edematous mucous membranes, with white flecks adhering to the vaginal wall

·   Intense itching

G. vaginalis

·   Gray, foul, “fishy” smelling discharge

Acute vulvitis

·   Mild to severe inflammatory reaction, including edema, erythema, burning, and pruritus

·   Severe pain on urination, dyspareunia

Chronic vulvitis

·   Relatively mild inflammation

·   Possibly, severe edema that may involve the entire perineum

Diagnostic test results

Microscopic examination of vaginal exudate on a wet slide preparation (a drop of vaginal exudate placed in normal saline solution) reveals the infectious organism.


·   Trichomonal vaginitis: oral metronidazole

·   Candidal infection:

§  topical miconazole or clotrimazole

§  single dose of oral fluconazole

·   Gardnerella infection: oral or vaginal metronidazole

·   Acute vulvitis:

§  cold compresses or cool sitz baths for pruritus

§  warm compresses for severe inflammation

§  topical corticosteroids to reduce inflammation

·   Chronic vulvitis:

§  topical hydrocortisone or antipruritics

§  good hygiene, especially in elderly or incontinent patients

·   Atrophic vulvovaginitis: topical estrogen ointment





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