Vulvovaginitis

Overview :

Vulvovaginitis, vulvitis, and vaginitis are general terms that refer to the inflammation of the vagina and/or vulva (the external genital organs of a woman). These conditions can be caused by bacterial, fungal, or parasitic infections. Also, vulvovaginitis can be caused by low estrogen levels (called "atrophic vaginitis") or any type of allergic or irritation response from things such as spermicidal products, condoms, soaps, and bubble bath. In general, vulvovaginitis causes vaginal discharge, irritation, and itching. One of the most common reasons why women visit their doctor is because of a change in vaginal discharge. It is completely normal for a woman to have a vaginal discharge, the amount and consistency of which varies during the course of the menstrual cycle. Each of the three most common types of vulvovaginitis will be described separately. Bacterial vaginosis Bacterial vaginosis is the most common cause of vaginitis during the childbearing years. Forty percent to 50% of vaginitis cases are caused by bacterial vaginosis. The occurrence of bacterial vaginosis is difficult to determine but studies have proposed that 10%-41% of women have had it at least once. The occurrence of bacterial vaginosis in the United States is highest among African-American women and women who have had multiple sexual partners and lowest among Asian women and women with no history of sexual contact with men. Bacterial vaginosis is not considered a sexually transmitted disease although it can be acquired by sexual intercourse. Bacterial vaginosis is not caused by a particular organism but is a change in the balance of normal vaginal bacteria. Ninety percent of the bacteria found in a healthy vagina belong to the Lactobacillus family. For unknown reasons, there is a shift in the bacterial population that results in overgrowth of other bacteria. Patients suffering from bacterial vaginosis have very high numbers of such bacteria as Gardnerella vaginalis, Mycoplasmahominis, Bacteroides species, and Mobiluncus species. These bacteria can be found at numbers 100 to 1000 times greater than found in the healthy vagina. In contrast, Lactobacillus bacteria are in very low numbers or completely absent from the vagina of women with bacterial vaginosis. Candida vulvovaginitis Candida vulvovaginitis also has been called "vulvovaginal candidiasis," "candidal vaginitis," "monilial infection," or "vaginal yeast infection." Twenty to 25% of the vaginitis cases are Candida vulvovaginitis. It has been estimated that about 75% of all women get a vaginal yeast infection at least once. In 80-90% of the cases, Candida vulvovaginitis is caused by an overgrowth of the yeast Candida albicans. The remaining cases are caused by other species of Candida. It is not known what causes the yeast overgrowth. However, antibiotics can inadvertently kill normal bacteria in the vagina and cause an overgrowth of Candida. Candida vulvovaginitis is not considered a sexually transmitted disease because Candida species are commonly found in the healthy vagina. It is a rare disease in girls before puberty and celibate women. Vaginal yeast infections tend to occur more frequently in women who are pregnant, diabetic and not controlling their disease, taking birth control pills, or taking antibiotics. The stress of military deployment has also been found to be a factor in triggering vaginal yeast infections. Some women have four or more attacks per year, a condition called "recurrent vaginal candidiasis." Trichomoniasis Trichomoniasis, which is sometimes called "trich," accounts for 15-20% of the cases of vaginitis. It is estimated that two million to three million American women get trichomoniasis each year, and as many as 120 million women worldwide. Unlike the previous two causes of vulvovaginitis, trichomoniasis is a sexually transmitted disease. This means that the disease is passed from person to person only by sexual contact. Trichomoniasis occurs in both men and women and is caused by infection with the single-celled parasite Trichomonas vaginalis. Infection with Trichomonas vaginalis is frequently associated with other sexually transmitted diseases and assists the spread of the AIDS virus.