Vaginitis and endometritis refer to inflammation of the vagina and endometrium, respectively. There are several types of vaginitis caused by bacteria, parasites, fungi, or atrophy. Bacterial vaginitis is commonly caused by Haemophilus or E. coli. Parasitic vaginitis is often due to Trichomonas. Fungal vaginitis is usually candidiasis. Atrophic vaginitis occurs in postmenopausal women. Endometritis has acute and chronic forms and can be caused by bacterial infection after childbirth or an abortion. Diagnosis involves examining vaginal or endometrial smears under a microscope. Treatment depends on the underlying cause but

1. COLPITIS (VAGINITIS) AND
ENDOMETRITIS
Nilay Gajbhiye
1524

2. VAGINITIS
· Definition: inflammation of the vagina
·Types:
·Bacterial vaginitis
·Parasitic vaginitis
·Atrophic vaginitis
·Fungal vaginitis
·Viral vaginitis

3. BACTERIAL VAGINITIS
·Haemophilis vaginitis:
- Most common cause of non-specific vaginitis
-Diagnosis: presence of
·Small polymorphic G-ve aerobic cocco-bacilli
·Few inflammatory cells
-Lactobacilli are usually present

4. E.COLI VAGINITIS
-Suppurative vaginitis in young girls or post-
menopausal women due to atrophic changes
-Infected epithelial cells show common cellular
changes with large number of neutrophils

5. ACTINOMYCOSIS
· Causative organism s: G+ve branched filamentus bacteria.
·Causes:
·Increased pH
·Decreased body resistance
Injury to epithelium
·Diagnosis:
·Amorphus clusters of small filaments with large number of
neutrophils.
·Histocytes, lymphocytes, few giant cells and necrotic debris.
·Most common in women with prolonged intrauterine device

6. GONOCOCCAL VAGINITIS
- It is venereal infection caused by G-ve diplococci
(Neisseria gonorrhea).
-Clinically: Suppurative vaginal discharge involve
urethra, and vagina.
- Diagnosis:
·By the presence of diplococci inside or outside
neutrophils or histocytes.

7. TB OF FEMALE GENITAL TRACT
- Common in endometrium and fallopian tube.
-Rare sites are: vagina and cervix.
-Diagnosis:
·Typical Langhan's giant cells, lymphocytes and
cluster of epithelial cells.
·Presence of Acid fast mycobacterial1 bacilli.

8. GRANULOMA INGUINAL
·Venereal G-ve encapsulated coccobacilli (Donovania
granulumatis)
·Diagnosis:
·Scraping margins of ulcero-granulomatous regions of moist
skin, surface genitals, rectal, urethral, and
inguinal areas ---> intra-cytoplasmic
donovania bodies (bean-shaped organisms) of large cystic
macrophages with eccentric nuclei.
·Large number of neutrophils, cellular debris, and
granular protein deposit in the background.

9. PARASITIC (PROTOZOAL )VAGINITIS
Trichomonas vaginalis:
-Causative organisms: Flagellated parasite , oval or
pear shaped with active amoeboid movements.
-Predisposing factors: +
pH of vagina, tissue injury
-Clinically: is associated with greenish-yellow
discharge, itching, soreness, and offensive odour.

10. DIAGNOSIS BY VAGINAL SMEAR
Fresh specimen of vaginal smear
without
delay of examination shows motile
parasite.

11. DIAGNOSIS BY VAGINAL SMEAR
-Fixed and stained smear field show large cells,greenish grey
in colour, with red granular cytoplasm,and dark shadow
nuclei, surrounded by large number of neutrophils.
-Cytoplasm of epithelial cells show polychromasia, red in
colour,irregular membrane,with hyperkeratosis, pyknosis,
and karyorrhexis.
-Hypertrophy of intermediate and basal cells.

12. FUNGAL VAGINITIS
Moniliasis or Candida albicans:
- It is the most common cause of acute and chronic
vaginitis
- Commonly seen with pregnancy
-Causative organisms: yeast like cells
- Clinically: milky white vaginal discharge
- Diagnosis: red long bodies (hyphae), with pear shaped
rounded bodies (budding yeast)

13. ATROPHIC (SENILE) VAGINITIS
· Definition: it is a condition result from combination of
three
factors:
- Lack of estrogenic stimulation with thin vaginal wall.
-Secondary bacterial infection due to loss protective
epithelium and increase pH
parabasal cells to infection.
- Vaginal pH become alkaline
expose less resistant

14. ·Clinically: postmenopausal bleeding with yellow bloody
discharge.
Diagnosis: cytological smear contain-
-Increased number of parabasal cells
-Parabasal cells vary in shape and size
- Degenerative changes are seen in many parabasal cells
- Inflammation of endocervical canal with some stripped
nuclei may be involved

15. TREATMENT
Treatment of colpitis depends on the underlying cause.
For example:-
1) Antibiotics treat colpitis due to bacterial infection.
2) Anti-fungal creams or medicines treat colpitis due to
yeast or fungal infection.
3) Antiparasitic medicines treat colpitis due to
trichomoniasis.
4) Colpitis due to vaginal atrophy is treated by hormonal
therapy such as estrogen creams, rings, or tablets.
5) Lifestyle modifications can treat non-infectious colpit

16. ENDOMETRITIS

17. DEFINITION
Inflammation of the endometrium.
·Types:
·Acute endometritis
·Chronic endometritis
- Chronic non-specific endometritis (Puerperar
endometritis)
- Chronic specific endometritis: TB; actinomycosis, ....
·Atrophic endometritis

18. SYMPTOMS
Symptoms may include
Fever, lower abdominal pain, and abnormal vaginal
bleeding or discharge.

19. CAUSES
-Bacterial invasion of endometrial cavity
-Retained gestational contents
-Endometrial polyp
-Fibromyoma
- Secondary to introduction of foreign objects:
-Criminal abortion
-Contaminated intrauterine device

20. PUERPERAL ENDOMETRITIS
-Causes:
Following bacterial invasion in abortion or labour
·Clinically:
-Vaginal bbleeding
-Offensive vaginal discharge
- Fresh or clotted blood with endometrial cells
Diagnostic endometrial smear:
- Large number of acute and chronic inflammatory cells
-Abundant fragmented cytoplasm and nuclei
- Increase number of histocyte and multinucleated giant
cells

21. ATROPHIC ENDOMETRITIS
·Causes:
- Sever deficiency in estrogenic hormones in
postmenopausal women associated with secondary
bacterial infection.

22. · Diagnostic endometrial aspiration:
-Few endometrial cells
- Fresh or clotted blood
- Increased number oflymphocytes and plasma cells
- Moderate amount of cellular debris and protein
deposits
- Metaplastic epithelium usually parabasal cells; with
semi-keratinized cytoplasm.

23. TREATMENT
1.Combined oral contraceptive pills
2.Danazol
3.Gonadotropin-realsing hormone
analoges
4.Surgery:-a) Laproscopic Ablation
b) Local surgery with the
recection
c)Hesteractomy

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