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- Vaginitis is inflammation or irritation of the vagina causing typical symptoms of vaginal discharge, burning, and itching.
- May be due to infection such as trichomoniasis, candidiasis, or bacterial vaginosis (BV); see Appendix, Table 7.
- Noninfectious causes include foreign body or exposure to an irritant or allergen.
- Vulvovaginitis is irritation or inflammation of both the vulva and the vagina; most often due to Candida albicans
- In postpubertal females, BV is the most prevalent cause of vaginal discharge and typically causes a fishy odor.
- Physiologic leukorrhea (i.e., “physiologic discharge”) is usually associated with pubertal onset and frequently precedes menarche. It is typically thin, white, and mucoid.
- Vaginitis affects females of all ages.
- In prepubescent girls, 25–75% of vaginitis is nonspecific in etiology.
- Approximately 75% of women have had at least one episode of vulvovaginitis due to candida in their lifetime.
- The most common causes of postpubertal vaginitis are as follows:
- BV (22–50%)
- Vulvovaginal candidiasis (17–39%)
- Trichomonas vaginalis (4–35%)
- For prepubertal females, poor hygiene is a common risk factor.
- Irritant risk factors often include soaps, tampons, topical products and medications, extreme cleansing, clothing, and douching.
- For BV:
- Vaginal douching
- Intrauterine device usage
- Non-white race
- Prior pregnancy
- Unprotected sexual intercourse
- Use of spermicide
- Homosexual relationships
- For trichomoniasis:
- Multiple sexual partners
- Other sexually transmitted infections
- Lack of condom use
- For vulvovaginal candidiasis:
- Use of systemic antibiotics
- Uncontrolled diabetes mellitus
- Diet high in refined sugars
- In prepubescent females, with prepubertal hormones, the vagina has a neutral pH, atrophic mucosa, and a warm environment that easily allow for bacterial overgrowth.
- Physiologic leukorrhea
- Estrogen levels; the volume of discharge varies with the menstrual cycle and is especially heavy at the time of ovulation.
- Candida vulvovaginitis
- Use of antibiotics increases the occurrence of candidiasis by eliminating competitive organisms.
- Caused by shift in vaginal flora
- Normal Lactobacillus species decrease and overgrowth of bacteria, including Gardnerella vaginalis, Mycoplasma hominis, and anaerobes such as Prevotella and Mobiluncus species
- All ages:
- Chemical, irritant, allergy
- Nonspecific vaginitis (may be associated with hygiene)
- Foreign body or material such as rolled up toilet paper
- Candidiasis associated with antibiotic use
- Trauma, mechanical irritation
- Sexual abuse
- More common in prepubertal females:
- Group A β-hemolytic Streptococcus
- Haemophilus influenzae
- Pinworms or scabies
- Congenital abnormalities
- More common in postpubertal females:
- Physiologic leukorrhea (may cause discharge but not irritation)
- Sexually transmitted infections (STIs) such as gonorrhea and chlamydia
- Pubic lice