this ppt is about the vaginal disorders, types of vaginal infections, etiological factors and risk factors. the pathophysiology of vaginal infections, its management, treatment and prevention.

1. Vaginal
Diseases
Presented by Sonam Yeden and Sonam Dorji

2. Learning outcomes
1
2
3
Definition
Types and
classification
Cancers of the
vagina
4 7
6
5
Etiological factors and
Risk factors
Pathophysiology
Clinical manifestations
9
8
Complications
Diagnostic studies
Management and
Prevention

3. Vagina
The vagina is a tubular structure 3-4 in long and
lined with squamous epithelium.
The fluid secreted by the vagina helps protect
against vaginal infection. The fluid includes:
1. Cervical mucus
2. Desquamated epithelium
3. A watery secretion during sexual intercourse
The muscular and erectile tissue of the vaginal walls
allows enough dilation and contraction to
accommodate the passage of the fetus during
labour and the penetration of the penis during
intercourse.
Anatomy Review

4. External Genitalia
•The external genitalia commonly called the
vulva consists of the mons pubis, labia minora,
clitoris, and the urethral meatus.

5. Definition
A vaginal disease is a pathological condition that affects part or all of the
vagina. Vaginitis is an inflammation of the vagina that can result in
discharge, itching and pain.
The female genital tract is susceptible to different types of infections
especially when the balance of the pH is altered. Usually, the pH of the
vagina is 4.5 which helps prevent the occurrence of bacterial infection. The
pH level is maintained when there is a sufficient level of estrogen and
lactobacillus and naturally occurring bacteria that colonize the vagina.

6. Incidence of the condition
Vaginal infection is more common in adult women and
uncommon in prepubertal girls. Bacterial vaginosis accounts for
40-50% of the cases; vaginal candidiasis 20-25% and
trichomoniasis 15-20%.
In US bacterial vaginosis is the most common in women of
childbearing age. An estimated 7.4 million new cases of bacterial
vaginosis occur each year. Its prevalence in college students is 5-
25% and 12-61% in patients with STDs.
An estimated 3 million cases of trichomoniasis occur each year in
the United States. The worldwide prevalence of trichomoniasis is
174 million.

7. Types
1. Bacterial Vaginosis: when the bacteria Lactobacilli which normally lives in the vagina gets too
low or overgrows it leads to a condition known as bacterial vaginosis. It is asymptomatic in up to 50%
of women.
Manifestations are watery discharge with fish-like odour. May or may not have other symptoms.
2. Vulvovaginal Candidiasis: a vaginal infection caused by a yeast called candida albicans.
Candida is a bacterium that lives in our body and our vagina in small numbers but can cause infection
if conditions inside the vagina change and encourage its growth.
Manifestations are: itching and thick white curd-like discharge.

8. 3.Trichomonas Vaginitis: it is a sexually transmitted infection which is caused by a bacteria called
trichomonas vaginalis.
Manifestations are itchiness and frothy greenish or grey discharge. Hemorrhagic spots on the cervix or
vaginal walls.
4.Cervicitis: inflammation of the cervix caused by bacteria like Chlamydia trachomatis, and Neisseria
Gonorrhea. It is sexually transmitted and can also be caused by allergies, injury and vaginal bacteria
imbalance.
Manifestations are mucopurulent discharge with postcoital spotting from cervical inflammation.

9. Cancers of the vagina
1.Vaginal Cancer
Vaginal cancers are rare with about 5170 new cases annually and are usually found in women of
age 50 to 70.
The most common type of vaginal cancer is squamous cell carcinoma. Intrauterine exposure to
diethylstilbestrol increases the risk for clear cell adenocarcinoma of the vagina.
Treatment of vaginal cancer depends on the type of cells involved, the stage of the disease, size
and location of the tumour.

10. 2.Vulvar Cancer
Vulvar cancer is relatively rare with about 6020 cases annually.
Preinvasive lesions referred to as vulvar intraepithelial neoplasia precede invasive cancer. The invasive
form occurs mainly in women over the 60s with the highest incidence in the 70s.
Patients with vulvar cancer may have symptoms such as:
• Itching and burning sensation
• Pain
• Bleeding
• Discharge
Women who are immunosuppressed and/or have diabetes mellitus, hypertension, or chronic
vulvar dystrophies are at a higher risk of developing vulvar cancer.

11. Etiological factors
1.Gardnerella vaginalis and Corynebacterium vaginale
2.Candida species
3.Trichomonads

12. Risk Factors
Modifiable etiological factors
i. Intake of drugs
Alter the hormonal balance in our body and cause the growth of bacteria which causes infection.
ii. Sexual activity and douching
Douching alters the natural acidity and microbiome of the vagina, causing an overgrowth of bacteria.
Lower genital tract infections are related to sexual intercourse, it transmits organisms, injures the
tissues and alter the acid-base balance of the vagina.
iii. Clothing and hygiene
Organisms gain entrance to the lower genital tract through contaminated hands and clothes. The warm,
moist and dark conditions of tight and wet clothing can cause irritation and sweating which allows the
growth of yeast.

13. 2.Non-modifiable etiological factors
i. Age
The chances of developing vaginal infections due to genitourinary
syndrome of menopause.
ii. Pregnancy
Hormonal changes during pregnancy can lead to the growth of bacteria.

14. Pathophysiology
The female genital tract is easily affected by different types of infections, especially when the pH of the
genital tract is altered. Typically, the pH of the vagina is 4.5 which prevents the occurrence of bacterial
infection. The pH of the vagina is maintained through a combination of sufficient levels of estrogen and
Lactobacillus, a naturally occurring bacteria colonizing the vagina.
Due to etiological factors such as intake of drugs like contraceptive pills, bad hygiene, unprotected sexual
intercourse and douching the level of estrogen or the presence of lactobacillus is disturbed. Aging and poor
nutrition can affect the bacterial level or mucosa, leading to alterations in the pH of the vagina. This
increase in the pH level of the vagina encourages the growth of bacteria and since there is a decrease in the
level of estrogen there is a decrease in the normal clear discharge from the vagina and making the vulva
and urethra weak. Due to this environment of the vagina, the microorganisms multiply in number and
secrete enzymes which degrade the epithelial cells lining the vagina. The immune system of the body is
activated and the immune cells fight the bacteria developing the symptoms such as redness, itchiness and
changes in discharge.

15. Etiological factors:
 Intake of drugs
 Sexual activity
 Douching
 Hygiene
Decrease in estrogen
level or presence of
lactobacillus is disturbed
Altered pH value of the
vagina (increased).
The microorganisms multiply in
number and secrete enzymes
which degrade the epithelial cells
lining the vagina.
Symptoms are activated.
Change in vaginal discharge
Immune cells
are activated

16. Clinical Manifestations
Common manifestations of vaginal disorders:
• Abnormal discharge
• Reddened vulvar lesions
• Itching
• Pain during sexual intercourse and urination

17. Complications of vaginal infections
1. Cause life-threatening complications.
2. Bacterial vaginosis results in the pelvic inflammatory disease that results in infertility and
increases the chances of having adverse outcomes of pregnancy.
3. Trichomoniasis may increase the risk of transmission of the human immunodeficiency virus and
may cause low birth weight or premature infant delivery.
4. Untreated yeast infections can sometimes get into the bloodstream and can lead to candidemia.
5. Infections risk after gynecologic surgery: it also increases the risk of developing a post-surgical
infection after procedures such as hysterectomy or dilation and curettage.

18. Diagnostic Evaluation
1. History Collection
Ask onset of the symptoms.
Any changes in the vaginal discharge?
Any previous occurrence if any, trauma and sexual history?
The type of discharge.

19. 2.Physical examination
The physical examination of the vaginal disorder includes the examination of
the vulva, clitoris, vestibule, vagina, cervix and pelvis.
During the examination of the vagina:
•Note if any odour is emitted from the vagina
•Look for any discharge or abnormal discharge like thin and changes in
colour.
•Look for lesions

20. 3. Diagnostic test
Non-invasive procedure
1.pH measurement: measurement of the vaginal helps to determine which infections may be
contributing to the patient’s symptoms.
Technique: a pH stick is applied for a few seconds to the vaginal sidewall.
2.Culture: it has traditionally been the gold standard for diagnosing the vaginal disorder. It helps in the
identification of bacteria which can lead to antibacterial therapy. A vaginal discharge culture is used to
diagnose the type of the cause of the infection. To access cervicitis specimens are taken for chlamydial
infection and gonorrhoea.

22. Invasive procedure
Vulvar skin conditions may be examined by:
1. Colposcopy of skin lesion:
A colposcopy is often done to find cancerous cells or
abnormal cells that can become cancerous in the cervix,
vagina or vulva. These abnormal cells are also called
“precancerous tissue.” A colposcopy also looks for other
health conditions such as genital warts or noncancerous
growth called polyps.
The physician positions the special magnifying instrument,
called a colposcope, a few inches away from your vulva and
shines a bright light into your vagina and looks through the
lens of the colposcope.
2. Biopsy of the skin lesion
A small sample of the tissue is removed from the vagina and
sent to the laboratory for microscopic examination.

23. Management
The aim of the management is to:
• Reduce the discomfort
• Reduce the pain
• Educate the patient
• Minimize the complications of the infection

24. Medical Management
Treatment for vaginal diseases depend on the cause of the infection.
Antibiotics such as metronidazole to treat the bacterial infection and anti fungal such as fluconazole
to treat fungal infections.

25. Medications Dosage Side effects Mechanism of action
Metronidazole Tablet: 500 or 750 mg  Stomach pain
 Hot flushes
 Headaches
 Palpitations
It diffuses into the organism, inhibits
protein synthesis by interacting with
DNA, and causes a loss of helical DNA
structure and strand breakage.
Tinidazole Tablet;2g  Nausea and
vomiting
 Loss of appetite
 Constipation
 Headache
 Stomach pain and
cramps
The nitro group of tinidazole is reduced
by cell extracts of trichomonas.

26. Clindamycin Tablet: 150-450 mg  Abdominal pain
 Black, tarry stools
 Cloudy urine
 Hoarseness
 Decrease in the
amount of urine
It works by binding to the 50s
ribosomal subunit of bacteria. This
agent disrupts protein synthesis by
interfering with transpeptidation
reaction, which thereby inhibits early
chain elongation
Secnidazole Tablets: 2grams  Headache
 Nausea and
vomiting
 Diarrhea
 Metallic taste
Once it enters bacteria and parasitess, it
is activated by bacterial parasite enzymes
to form a radical anion, damaging and
killing the target pathogen.

27. Surgical management
Vaginectomy
Vaginectomy is a surgery to remove the vagina. If only part of the vagina is removed it’s called partial
vaginectomy. If the entire vagina is removed it’s called total vaginectomy. If there is the removal of
the vagina along with supporting tissue it’s called radical vaginectomy.
Trachelectomy
If the only cervix is removed leaving the rest of the uterus behind is called trachelectomy. The
removal of the cervix only is known as simple trachelectomy. The removal of the cervix and the
tissues around the cervix is called a radical trachelectomy.

29. Nursing management
The main nursing management of nurses during vaginal disorders are:
1.Educate women about the common infections of the genital tract and how to reduce the risk factors.
2.Recognize the symptoms that indicate a problem, and help girls and women seek health in a timely
manner.
3.When a woman is diagnosed with a genital infection, ensure that the patient fully understands the
treatment.
4.Use a nonjudging mental attitude to make women feel more comfortable while empowering them to
ask questions.
5.Explain to them that taking the full course of medication is especially important to decrease the chance
of relapse.
6.Show them how to use the applicator and how to fill it when it’s their first time using the medication.
7.Since the genitalia is such a private area use graphs and models to teach the patients.

30. Nursing Diagnosis
1. Acute pain related to difficult or painful urination due to lesions as evidenced by verbalization of
the patient.
2. Discomfort related to burning, odour, or itching from the infectious process as evidenced by a foul
smell and redness during the inspection.
3. Risk for the spread of infection related to impaired skin integrity.

31. Nutritional management
Certain foods and drinks contain compounds that may improve vaginal health and symptoms of
vaginal conditions. These include probiotics, prebiotics and fermented food.
The foods which help with vaginal disease are:
Yoghurt and kefir
Onion and garlic
Soybeans
Bananas
Cranberry juice

32. Prevention
Even if people are careful, they can still have vaginal disorders. It can be reduced by:
 Cleanliness and hygiene
 Take a shower or bath regularly using plain, mild soap or just water.
 Avoid using vaginal sprays and scented products.
 Use plain toilet tissue.
 After using bathroom, always wipe from front to back.
 Tampons, sanitary pads and liners
 Use unscented tampons, sanitary pads and liners. Change often, at least every 2 to 3 hours.

33. New technology
Human Organ Chip
“Human Organ Chip allows researchers to study effects of the microbiome on vaginal health” (Brownell,
2022)
Just as probiotics are now being prescribed to treat gut issues, living biotherapeutics are being
explored for the treatment of BV. However, it is difficult to conduct preclinical trials because the
human vaginal microbiome is drastically different from that of common animal models. Studies
have found that Lactobacilli bacteria comprise more than 70% of the healthy human vaginal
microbiome, but less than 1% of the vaginal microbiome in other mammals.
Researchers at the Wyss Institute at Harvard University have created a solution to that problem in
the form of a new Organ Chip that replicates the human vaginal tissue microenvironment
including its microbiome in vitro. Composed of the human vaginal epithelium and underlying
connective tissue cells, the Vagina Chip replicates many of the physiological features of the
vagina and can be inoculated with different strains of bacteria to study their effects on the organ’s
health.

35. THANK YOU