Vaginal Disorders Lecture Flashcards by Beth Cocker

Self treatable conditions

VVC
Atrophic vaginitis/vaginal dryness
Overactive bladder

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Not self treatable conditions?

Trichomoniasis

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Lactobacillus species?

Important in creating a acidic environment
pH 4-4.5
~90% of vaginal flora
– acidic environment helps protect the vagina from infection due to bacteria

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Vaginal discharge?

Leukorrhea
~1.5 gm produced dialy
Odorless, clear or white, viscous or sticky

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Increased vaginal discharge due to?

Ovulation
Pregnancy
Menses
Sexual excitement
Emotional flares

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Changes in vaginal flora are due to?

Hormonal fluctuations
Drugs
Douching
Number of partners
Vaginal irritants: deodorant products, tampons, contraceptive products

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What is BV?

Most common
Sexually-active women
Polymicrobial infection resulting from imbalance in normal flora
- Not typical to treat sex partner
- Uses OCs and condoms

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Common signs/symptoms of BV?

FOUR ODOR
Increased discharge
Discolored discharge (gray, green, tan)

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Risk factors of BV?

New sex partner
African-american
IUD
Douching Oral
Tobacco
Prior pregnancy

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What is trichomoniasis?

Trichomonas vaginalis
STI
Treat sex partners
Use condoms

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Common signs/symptoms of trichomoniasis?

Erthema
Vulvar edema
YELLOW DISCHARGE

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Risk factors of trichomoniasis

Multiple sex partners
New sex partners
Nonuse of barriers
Presence of other STIs

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What is VVC?

Yeast infection
Affects 50% of all women by 25
Candida fungi
- Not typical to treat partners
- Tight fitting clothes, pantyhose, increased intake of sugars
- Does not effect pH

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Signs/symptoms of VVC?

Erthema, itching, vulvar edema
Thick “cheesy” discharge
ABSENCE OF ODOR

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Risk factors of VVC?

Pregnancy
High dose combo OCs
Diabetes
Recent antibiotic use
Immunosuppressive drug use

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Non-treatment can lead to?

PID
UTI
Endometriosis
Preterm labor

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VVC Self-care exclusions?

Pregnant
Under 12
Fever
Low ab, back, shoulder pain
Predisposing meds
Reccurent: 3 per year or within past 2 months
HIV

Goals of therapy for VVC

Relieve symptoms
Eradicate infection
Reestablish normal flora

Non-pharmacologic treatment options?

Decrease dietary consumption of sucrose and carbs
Consumption of live cultures
Discontinue causative drugs

Pharmacologic treatment options?

Imidazole products

First like therapy
Relieves external itching and irritation

Imidazole products MOA?

Alter the membrane permeability of fungi resulting in loss of normal membrane function

Vaginal formulations come in?

Suppositories, tablets or creams

Couseling points?

Do not skip days
No tampons
Okay during periods

Single-dose regimens?

Gynazole
Monistat
Vagistat

What are non-curative products for itching and irritaiton?

Vagisil Massengill Pusatilla - Decreased efficacy, frequent local site reactions, longer treatment durations

What are complementary therapies for VVC?

Lactobacillus preparation Gentian violet Boric acid

Lactobacillus preparation?

Eat yougurt | Reestablish normal flora

Gentian violet?

Dye used for resistant vaginal candidal infection | Stains fabric and skin

Boric acid?

Non-C. albican infections 600 mg 85-95% effective

Define atrophic vaginitis

Inflammatory response Due to atrophy of vaginal mucosa or decrease in estrogen levels 10-40% in postmenopausal women Reuslt in dyspareunia (painful intercourse)

Signs and symptoms of atrophic vaginitis?

Irritaiton Dryness, itching, burning Dyspareunia Vaginal bleeding/discharge

Treatment of atrophic vaginitis?

Vaginal/topical/personal lubes (short term improvement) | - Astroglide, KY jelly, replens

What is overactive bladder?

Bladder squeezes too often or without warning Chronic condition Categorized by: frequency, urgency, urge incontinence

Treatment of OAB?

Oxytrol patches - 18+ - 3.9 mg dialy - Relaxes bladder muscles - Adverse effects: dry mouth, dizziness, drowsiness, skin irritation

Counseling for OAB?

Apply and leave on for 4 days Rotate application site Wear under clothing -- no light

Do not treat OAB if?

``` Burning upon urination Blood Lower back or side pain Male History of bladder cancer Recently pregnant ```

Define douching

Irrigating the vagina | Achieve good vaginal hydien or vaginal cleanse

Water and vinegar douching?

Acetic acid | - Minimal effect on lactobacilli but inhibit some pathogens

Povidone/iodine douching?

Inhibit all flora | May allow growth

Adverse effects of douching?

``` Increased risk of PID Reduced fertility Ectopic pregnancy Vaginal infections STI Low birth weight Cervical cancer ```

Counseling for douching?

Not recommended | Not to treat infection, as birth control

Do not use if?

``` Used a diaphragm, cervical cap or spermicide (for 8 hours after) 3 days after teh last vaginal antifungal 48 hrs after gynecologic exam Pregnant or breast feeding More than twice weekly If dryness or irritation occur ```