Vaginitis

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Rare is the woman who has escaped vaginitis; it affects each of us, on average, at least once in our lifetime. While usually not a serious health threat, it is a definite annoyance and inconvenience. Yet for those who recognize its early signs, new oral and topical treatments, especially ointments sold over-the-counter, have made it possible to limit episodes of vaginitis and perhaps prevent future occurrences altogether.

Symptoms
Vaginitis is a general term for an inflammation of the vagina. Its symptoms are anything but subtle. It can itch and burn, necessitate frequent trips to the bathroom, and make intercourse painful.

Whatever its other symptoms, vaginitis is often accompanied by an unusual discharge. Compared to normal vaginal secretions, which are odorless and dear or milky, those associated with vaginitis can be unpleasant smelling, thick, and profuse.

Causes
The vagina is populated by a variety of microorganisms that usually coexist in relative harmony. One group of bacteria called lactobacilli plays a dominant role in maintaining the delicate balance of organisms in the vaginal ecosystem by secreting lactic acid, which keeps other microbes from multiplying disproportionately When this climate is altered, organisms other than lactobacillus increase significantly. Their secretions are responsible for vaginal irritation and abnormal discharges.

An overgrowth of Candida albicans is the most common cause of vaginitis. This ubiquitous yeast has a special preference for moist areas such as the rectum or the vagina, but can inhabit other regions of the body It is most likely to thrive when the hormonal climate is altered, for example by birth control pills, hormone replacement therapy, pregnancy, or the cyclical fluctuations of the menstrual cycle. Systemic antibiotics, which suppress bacteria and allow the yeast to overgrow, can have a similar effect. Women with diabetes are especially susceptible to yeast vaginitis, and, for some, recurrent candida infection can be the first notification of that disease. It can also be the first sign of HIV infection.

Itching is the most common symptom of a yeast infection. It may be accompanied by irritation -- during urination and sexual intercourse. The discharge is usually thick and white, resembling cottage cheese.

Candida may be treated with creams or suppositories containing clotrimazole, miconazole, butoconazole, or other antifungal drugs or with ketoconazole tablets. Although the vaginal preparations now sold over the counter are very effective, it is important to see your doctor or nurse-practitioner, particularly if you have a first-time infection or one that seems difficult to eradicate. He or she can determine whether organisms other than candida are contributing to your vaginitis, or whether some underlying factor, such as diabetes or a disorder of the immune system, is responsible. Treating any predisposing condition provides added insurance against recurrence. Your clinician may also suggest other treatments to relieve symptoms such as vaginal boric-add capsules or povidone-iodine (Betadine) douches.

Many women swear by home remedies for yeast infections. As long as these are harmless, such as drinking cranberry juice, eating yogurt, or reducing sugar intake, they may be worth trying. Even though you may prefer self-treatment, you should see a doctor or nurse-practitioner when infections recur, if only to rule out underlying conditions. If you are pregnant, you Should not try to treat yourself, especially with douches or vaginal preparations.

Bacterial vaginosis, caused by an overgrowth of the bacterium Gardnerella vaginalis and other microorganisms, usually produces less severe symptoms. It tends to affect only the most superficial layer of the surface Fining the vagina, causing a relatively mild infection without much inflammation. The discharge, which is usually gray-green and fishy smelling, is less profuse and the burning and itching are less intense than those produced by candida and trichomonas. Because bacterial vaginosis tends to occur more frequently in premenopausal women and in postmenopausal women taking hormone replacement therapy, scientists suspect that estrogen affects the vaginal lining in ways that favor an overgrowth of certain bacteria.

Bacterial vaginosis is most responsive to the antimicrobial drug, metronidazole (Flagyl). Flagyl is usually taken orally in a single large dose, or in smaller doses over 7-10 days. It is not a pleasant drug --it can leave a metallic taste in the mouth, and can trigger vomiting if you drink alcohol while taking it. Because it has been connected with birth defects, it shouldn't be taken during the first trimester of pregnancy. Many of Flagyl's side effects can be avoided by using MetroGel, metronidazole in a vaginal gel form, or Cleocin, a vaginal cream containing the antibiotic clindamycin.

Trichomoniasis is caused by the protozoan Trichomonas vaginalis. It produces a heavy, yellow-green foul-smelling discharge, as well as vaginal burning and itching. Because creams and ointments can't reach the protozoan, which is sequestered in the glands of the vagina, oral antimicrobial treatment, usually with Flagyl, is recommended.

Other sources of irritation
Not all vaginitis is caused by infectious agents; atrophic vaginitis, a common problem for post-menopausal women, is due to estrogen deficiency, which results in a thinning of the vaginal epithelium. The superficial layer is often lost entirely, exposing the basal layer, which is more vulnerable to inflammation. It is best treated with estrogen cream.

Irritation can also be due to allergies, irritation from douches, contraceptive creams, feminine hygiene sprays and deodorants, or a forgotten tampon or diaphragm. Rarely, malignancies of the cervix or vagina may cause a vaginal discharge.

Although uncommon, vaginal discharge can be a sign of an infection of the cervix by Neisseria gonococcus (gonorrhea), Chlamydia trachomatis, Herpes simplex, or another microorganism, mycoplasma. in such cases, it is especially important for a doctor to perform a pelvic exam to examine the cervix, where a culture may need to be taken. If untreated, these organisms can infect the pelvic organs.

If you have vaginitis . . .
It is important to see your clinician, who will try to identify the cause of the vaginitis so that a specific therapy can be recommended for you and perhaps your sexual partner as well. Trichomonas, chlamydia, and gonorrhea, or mycoplasma -- and income instances bacterial vaginosis --are sexually transmitted. Treating both partners can prevent a "ping-pong" infection -- one that is volleyed back and forth indefinitely Using condoms during intercourse or refraining until both partners have completed treatment also prevents reinfection.

Don't schedule a medical appointment to coin-ride with your period because the menstrual flow will make the vaginal examination more difficult. Refrain from douching beforehand. It will reduce the discharge, and limit your practitioner's ability to identify the organisms responsible.

Your practitioner should take a medical history of illnesses, medications, previous gynecological infections, sexual practices including contraception, and remedies you have tried already. He or she should perform a pelvic exam to assess the vagina and cervix and check for tenderness by palpating your lower abdomen. Taking a sample of the vaginal discharge makes it possible to identify the microbe responsible so that a specific treatment can be prescribed. Occasionally, there is no obvious organism, and your physician will recommend treatment with Flagyl or antimicrobial vaginal cream.

While you are being treated for vaginitis, especially if you are using vaginal cream, use a sanitary pad to protect your clothing. Avoid tampons, which may absorb the medication.

Always use all of the medication prescribed, even if your symptoms improve. Failure to complete the treatment may fail to clear up the infection completely Return to your clinician after treatment to determine whether the infection has been eradicated.

Until symptoms improve, try not to scratch. Doing so spreads infection. Cool, baking soda compresses may relieve itching; Borofax ointment can soothe irritated tissues.

Preventing vaginitis

Wear cotton panties that "breathe," rather than nylon or spandex. Avoid tight-fitting under-garments that may tend to trap moisture, creating a good medium for microorganisms.
When you use the toilet, wipe front to back to avoid contaminating the vaginal area with organisms from your bowel. Microbes that cause no trouble in the rectum can set off rampant inflammation once they encounter the environment of the vagina.
Avoid concentrated douches, if you use them at all.
Wash your vulva and anus regularly but avoid excessive scrubbing, especially with harsh soaps.
Make certain that you and your partner are dean before you have sex. Use a condom unless both of you are monogamous and uninfected.
If you need lubrication during sexual intercourse, use a water-soluble ointment such as Replens or Astroglide.
If you are prone to yeast vaginitis and taking a course of antibiotics for another reason, you might want to purchase an over-the-counter vaginal ointment to have on hand if you experience a recurrence.

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Some women have successfully used tracheal as a way to relieve their BV symptoms. Mix a teaspoon of this in a warm cup of water and create a tea to have before bed, this is an acquired taste so if you prefer you can take this in pill from as well. Increasing the amount of yogurt to out into your system will also go along way to helping to cure BV. The probiotics that are natural in yogurt will assist in regaining the healthy balance your body requires.