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Vaginal discharge & pruritis vulvae

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vaginal discharge, pruritis vulvae, vulvovaginitis, bacterial vaginosis, candidal infection, cervicitis, foreign body, intestinal worm, itching in children, vesicovaginal fistula, vulvar dystrophy. gapapentin, vestibulitis, vulvar pain syndrome

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Vaginal discharge & pruritis vulvae

  1. 1. PRURITIS VULVA & VAGINAL DISCHRGE By Magdy Abdelrahman Mohamed Lecturer of OBS/GYN 2016
  2. 2. PRURITIS VULVA
  3. 3. Prutitis Vulva • Definition: – Strong desire to scratch the vulva.
  4. 4. Aetiology I- Itching with discharge: – Caused by infection ( vulvovaginitis) ex. cadidiasis & trichomonas vaginitis.
  5. 5. II- Itching without discharge: – General causes (DM, uremia, obstructive jaundice). – Skin diseases ( eczema, scabies, pediculosis) – Allergic disease (contact dermatitis). – Vulvar dystrophy. – Vulvar carcinoma. – Urinary & rectal causes ( urinary incontinence, ring worm) – Idiopathic.
  6. 6. Treatment • Trearment of the cause. • Local measures: – Good hygiene, cotton underwear. – Calamine lotion. – Topical steriod.
  7. 7. Treatment • General treatment: – Antihistaminic. – Gabapentin. – Sedative & hyponotic at night. – Local estrogen. • Surgical treatment: – Subcutaneous injection of absolute alkohol. – Vestibulectomy ( in resistant cases).
  8. 8. VAGINAL DISCHARGE
  9. 9. Normal Vaginal Discharge – Vulvar secretion • Bartholin glands • Sweat glands • Sebaceous glands • Skene glands – Vagina – Cervix – Endometrial glands – Fallopian tubes
  10. 10. Normal Vaginal Discharge • Increased when: – Ovulation—endocervical glands – Premenstrual phase – Pregnancy – Sexual excitement—Bartholin’s glands
  11. 11. Types of vaginal discharge • Physiological: – Colourless, odourless, doesnot stain underwear. • Pathological: – Excessive vaginal discharge. – Offensive or malodorous discharge. – Yellowish or mucopurulent discharge.
  12. 12. Pathological Vaginal Discharge • Non infective: – Chemicals (doushes & spermicidal …etc) – Foreign bodies. – Cervical polyp. – Genital malignancy. – Fistula. • Infective: – Vulvovaginitis – Cervicitis – Batholin abscess.
  13. 13. Bacterial Vaginosis • Characterized by thin, homogenous, malodorous frothy white-to-grey vaginal discharge, adherent to the vaginal mucosa. • Caused by an overgrowth of organisms like Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, and Peptostreptococcus species.
  14. 14. Bacterial Vaginosis • For diagnosis of BV, 3 out of the following 4 criteria must be present (amsell’s criteria) • Homogenous, white, adherent discharge. • Vaginal pH higher than 4.5. • Whiff test:Release of fishy odor from vaginal discharge with potassium hydroxide (KOH). • Clue cells.
  15. 15. Vaginal Candidiasis • Second most common cause of vaginitis. • Risk Factors- Diabetes, pregnancy, broad spectrum antibiotic therapy, COCs & steriod therapy. • Pruritus is the most common symptom.
  16. 16. Vaginal Candidiasis • Thick, odorless, white vaginal discharge (cottage cheese like). • Associated with – Vulvar candidiasis with vulvar burning, – Dyspareunia – Vulvar dysuria.
  17. 17. Trichomoniasis • Third most common. • Caused by Trichomonas Vaginalis, flagellated protozoa. • Sexually transmitted. • Profuse frothy yellowish grey discharge. • Vulvar/vaginal erythema and edema. • Strawberry Cervix . • Saline wet mount – motile oval or fusiform protozoa.
  18. 18. Foreign Bodies • Children • Adults—contraceptive devices, pessary, swabs, tampons • Purulent vaginal discharge; foul-smelling, bloody • Speculum; may use nasal or aural speculum • Removal then antiseptics
  19. 19. Urinary and fecal discharge • Urinary discharge – Urethro-vaginal fistula – Vesico-vaginal fistula – Uretero-vaginal fistula • Fecal discharge – Recto-vaginal fistula
  20. 20. THANK YOU

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