disoders of vagina in gynecology.

1. DISORDERS OF VAGINA
Sreepriya KS
4th yr Bsc nursing
MIMS CON,Malappuram

2. Anatomy of vagina

3. VAGINAL
DISORDERS
Trichomoniasis.
Moniliasis.
Toxic shock
syndrome.
Vulvovaginitis in
childhood
Vaginitis due to Chlamydia
trachomatis.Atrophic vaginitis.
Non-specific vaginitis.

4. VULVOVAGINITIS IN CHILDHOOD
•Inflammatory conditions of
the vulva and vagina are
the commonest disorders
during childhood.
•Due to lack of estrogen

5. Etiology
Non-specific vulvovaginitis.
••Presence of foreign body in the vagina.
••Associated intestinal infestations—threadworm
Being the commonest.
••Rarely, more specific infection caused by candida
Albicans or gonococcus

6. Clinical features
•Pruritus of varying degree and vaginal discharge
•Painful micturition
•Inspection reveals soreness of the vulva
•Labia minora may be swollen and red.

7. Investigations
•Vaginal discharge for direct examination and culture in Stuart’s
media
Vaginoscopy
• Needed to exclude foreign body or tumor in a case with recurrent
infection.

8. Treatment
•Perineal hygiene
•In cases of soreness or after removal of foreign body,
estrogen cream is to be applied locally, every night for two
weeks
•When the specific organisms are detected, therapy should be
directed

9. TRICHOMONAS VAGINITIS
Most common and important cause of
vaginitis in the childbearing period.
Caused by trichomonas vaginalis
Mode of transmission : sexual
contact, toilet articles from, through
examining gloves
Incubation period is 3–28 days.

10. Clinical features
•There is sudden profuse and offensive vaginal discharge often dating
from the last menstruation.
• Irritation and itching of varying degrees withinand around the
introitus are common.
• Urinary symptoms such as dysuria and frequency of micturition.
• Women with trichomoniasis should be evaluated for other STDs
including N. gonorrheae, C. trachomatis,

11. On examination
(a) There is thin, greenish-yellow and frothy offensive
discharge per vaginum.
(b) The vulva is inflamed with evidences of pruritus.
(c) Vaginal examination may be painful. The vaginalwalls become red and
inflamed with multiple punctate hemorrhagic spots

12. Diagnosis
•Hanging drop preparation. If found negative even on repeat
examination, the confirmation may be done by culture.
•Culture of the discharge collected by swabs in diamond’s tym or
feinberg whittington medium.

13. Treatment
•Metronidazole 200 mg thrice daily by mouth is to be given for 1
week.
•Tinidazole single 2 gm dose PO is equally effective
•The husband should be given the same treatment schedule for 1 week

14. CANDIDA VAGINITIS (MONILIASIS)
•Caused by candida albicans.
•a gram positive yeast-like
fungus

15. Pathology
Predisposing factors for Candida vaginitis
•™Diabetes : • ↑ Glycogen in the cells, glycosuria
•Pregnancy : • ↑ Vaginal acidity, glycosuria• ↑ Glycogen in the cells
•™Broad spectrum antibiotics : • ↓ Acid forminglactobacillus
•™Combined oral pills
•™Immunosuppression – HIV
•™Drugs–steroids
•™Thyroid, Parathyroid disease: • Obesity

16. Clinical features
•Vaginal discharge with
•Intense vulvovaginal pruritus
•On examination:
•The discharge is thick, curdy white and in flakes,(cottage cheese type
• Vulva may be red and swollen with evidences ofpruritus.
• Vaginal examination may be tender. Removal ofthe white flakes
reveals multiple oozing spots

17. Diagnosis
Wet Smear of vaginal discharge
Vaginal boric acid capsule (600 mg gelatin capusles)

18. Treatment
•Local fungicidalpreparations commonly used are of the polyene
orazole group. Nystatin, clotrimazole, miconazole,econazole
•Single dose oral therapy with fluconazole(150 mg) or itraconazole.
•Associated intestinal moniliasis should be treated by fluconazole 50
mg daily orally for 7 days

19. ATROPHIC VAGINITIS (SENILE
VAGINITIS)
•Vaginitis in postmenopausal women is
called
•Atrophic vaginitisdue to estrogen
deficiency.
•Desquamationof the vaginal epithelium
which may lead to formationof adhesions
and bands between the walls.

20. Clinical features
• Yellowish or blood stained vaginal discharge.
• Discomfort, dryness, soreness in the vulva.
• Dyspareunia.
On examination
• Evidences of pruritus vulvae.
•Vaginal examination is often painful and the walls are found inflamed

21. Diagnosis
Senile endometritis may co-exist andcarcinoma body
or the cervix should be excludedprior to therapy.

22. Treatment
•Improvement of general health and treatment of infection
•Systemic estrogen therapy
•Intravaginal application of estrogen cream by an applicator

23. TOXIC SHOCK SYNDROME (TSS)
•TSS is commonly seen in menstruating
women between 15 and 30 years of age
following the use oftampons
(polyacrylate)
•Other condition associatedwith TSS is
use of female barrier contraceptive
diaphragm).

24. It is characterized by the following features of abrupt onset :
Fever >38.9°C.
xx Diffuse macular rash, myalgia.
xx Gastrointestinal : Vomiting, diarrhea.
xx Cardiopulmonary : Hypotension, adult respiratory
distress syndrome.
xx Platelets : < 100,000/mm3.
xx Renal : ↑ BUN (> twice normal).
xx Hepatic : Bilirubin, SGOT, SGPT rise twice the
normal level.
xx Mucous membrane (vaginal, oropharyngeal) :
Hyperemia.

25. Treatment
Correction of hypovolemia and hypotension with intravenous fluids
and dopamine infusion
Parenteral corticosteroids
Blood coagulation parameters and serum electrolytes are checked and
corrected.
Infection is controlled by b-lactamase resistant antistaphylococcal
penicillin (cloxacillin, clindamycin and oxacillin) for 10–14 days.
Cotton tampons are the safest.

26. THANK YOU