VAGINITIS (various causes)

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DeeTroll wrote: From Dr. R. Jelovseks E newsletter Causes of chronic vaginitis December 17, 2006 Vaginitis is seldom life threatening, but it can cause discomfort and pain, days lost from school or work, and problems with sexual functioning and self-image. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal yeast infections (candidiasis), and trichomonas. However, an estimated 30% of women with vaginal complaints may go without a diagnosis after a standard evaluation. In others, the diagnosis may be clear, but they may have recurrent or refractory symptoms that fail to respond to commonly prescribed therapy. Women who have had long term vaginitis symptoms often assume they have a chronic infection that is causing the symptoms.

This may or may not be true. In a study of 200 women in Pennsylvania, investigators looked at the causes of chronic vaginal symptoms. The diagnoses given to the women after a thorough work up with history, physical exam and laboratory tests were actually quite varied: contact dermatitis (21%)recurrent vulvovaginal candidiasis (20.5%)atrophic vaginitis (14.5%)vulvar vestibulitis syndrome (12.5%)lichen sclerosis (11%)physiologic excess discharge (9%)desquamative inflammatory vaginitis (DIV) (8%)bacterial vaginosis (6.5%)Almost 20% of the patients had two or more causes for the symptoms. Post menopausal estrogen deficiency can be associated with an atrophic vaginitis which is a form of bacterial vaginitis. It is often associated with other types of vaginitis but the treatment is topical estrogen therapy

rather than any antibiotics. Contact dermatitis; which is more of a skin allergy response to chemicals, can account for many perceived cases of vaginal infection. Women with chronic vaginal symptoms will often use many products for cleaning, deodorizing or protecting the skin of the vulva when in fact the chemicals in these products actually make the symptoms worse. They may not have caused the problem in the first place but they continue the inflammation of the skin that causes pain and discharge. Vulvar vestibulitis is a poorly understood condition of the vulvar skin that is a non bacterial inflammation of skin glands at the opening to the vagina. It causes pain with touching or intercourse.There is not as much discharge with this condition and antibiotics do not help reduce symptoms at all. The investigators found that women who had chronic vaginal symptoms also had other pain

syndromes such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, interstitial cystitis, migraines etc., more frequently. They also had more allergy, asthma and skin conditions suggesting a tendency toward an immune response that causes the vulvar skin conditions. ================ Original article in full at: Obstetrics & Gynecology 2006;108:1185-1191 © 2006 by The American College of Obstetricians and Gynecologists http://www.greenjournal.org/cgi/content/abstract/108/5/1185 Analysis of a Prospective Database of Affected Women Nyirjesy, MD, Peyton, MD, M. Velma Weitz, MSN, PhD, Leny Mathew, MS and F. Culhane, PhD