VAGINITIS
By Marianne Marchese, N.D.
Vaginitis is inflammation of the vagina often causing
itching, burning, irritation discharge and discomfort. It is one
of the most common reasons a woman seeks medical care. Vaginitis
falls into three forms, irritant, hormonal, and infective. All three
can cause a woman great discomfort.
Irritant vaginitis can be due to allergic reactions to spermicides, condoms,
soaps, douches, perfumes, medications and hot tubs. Other irritants can include
abrasions, tampons, and sanitary napkins. A careful history must be obtained
to establish an etiology and a period of avoiding the possible irritant to evaluate
if symptoms subside.
Hormonal vaginitis is usually due to low levels of circulating estrogens in the
body. This causes the lining of the vaginal canal to thin and become atrophic.
A thin vaginal lining may predispose a woman to secondary infections. Typically
a woman will complain of discharge, dryness, itching or burning. Estrogen is
necessary to maintain the homeostasis of the vaginal flora and proper pH of 4.0.
The natural acidic environment of the vagina limits the growth of abnormal bacteria
and maintains the presence of healthy bacteria. Evaluation includes examining
the vaginal canal for pale, thinning tissue and loss of rugal folds. A pH above
4.5 is consistent with low levels of estrogen. A maturation index can be obtained
to determine the presence of mature squamous epithelial cells consistent with
adequate estrogen. (refer to article on maturation index).
The three most common infections of the vagina are bacterial, candida, and protozoal
(trichomonas). Bacterial vaginitis is an infection of the vagina by an overgrowth
of anaerobic bacteria, most commonly Gardnerella, and marked by a deficiency
of hydrogen peroxide-producing lactobacilli. Up to 50% of women with bacterial
vaginitis are asymptomatic. The most frequent symptom is a fishy odor coming
from the vagina. The discharge is often thin and grey-white. Diagnosis is made
on clinical grounds and wet mount. The wet mount will show clumps of clue cells
and a positive whiff test when 10% potassium hydroxide is added to the slide.
Also, the pH will be above 4.5.
Canidia vaginitis is one of the most common infections of the female genital
tract. Candida albicans which is part of the normal flora of about 20% of women
is the cause of about 90-95% of cases. When the normal flora of the vagina is
disturbed and out of balance C. albicans becomes a pathogen. Normally lactobacilli
inhibits growth of yeast in the vagina, but when lactobacilli species declines,
Candida overgrows. Women with Candida vaginitis complain of itching, irritation
and burning. The vagina and vulva is often very erythematous. Often a thick white
discharge is present, but an odor is uncommon. A wet mount with 10% potassium
hydroxide will show hyphae or budding yeast. The pH of the vagina will be below
4.5.
Trichomoniasis vaginitis is one of the most common protozoan infection in the
U.S. The primary means of transmission is sexual contact. Both men and women
can be asymptomatic providing a means of transmission and reinfection. Normally
the acidic nature of the vagina renders the environment resistant to trichomonas
infection, however when the pH rises the vagina is more susceptible to the growth
of the organism. Symptoms present as profuse frothy discharge often bloody, green,
yellow or grey. The discharge has an unpleasant odor and vaginal itching, burning
and pain may be present. The wet mount reveal live mobile Trichomonads and increase
white blood cells. The pH is between 5 and 7.
Treatment
Treatment of irritant vaginitis involves first identifying
the offending agent and then complete avoidance. Consider semen,
food, clothing, detergent and soap allergens. Discontinue the
use of hot tubs and douches. Evaluate topical medications and
natural creams as possible irritants.
Hormonal vaginitis can be treated by replenishing the vaginal tissue with intrvaginal
estrogen. This will increase lubrication, elasticity, and thickness of the
vaginal epithelium as well as restore the vaginal flora. Estriol can be compounded
in to a cream or suppositories. A typical regimen would be to insert a 1mg
estriol suppository before bed every night for 2 weeks as a loading dose to
restore the vaginal tissue. After the loading dose a women could insert one
before bed 2-3 times a week as a maintenance dose.
Bacterial, candida, and trichomonas vaginitis treatment centers on looking
at the problem holistically instead of giving medications that just kill the
organism. Prevention is the first step. Tight clothing and panty hose predispose
a women to yeast infections. Safe sex practices using barrier protection may
be helpful in preventing recurrent vaginal infections. Adequate nutrition is
important for maintaining a healthy immune system. Avoid sugar, refined carbohydrates,
and alcohol. Increase the intake of yogurt with live acidophilus cultures to
help maintain the ecosystem of the vagina.
Herbal suppositories for the treatment of bacterial vaginitis might include
herbs such as echinacea, hydrastis, althea, usnea, geranium and althea. These
are anti-microbial and can kill off the overgrowth of bacteria. Suppositories
for yeast vaginitis might include boric acid, calendula, and oregon grape root.
Tee tree has been shown to be effective in the treatment of Trichomonas infections.
A solution of 40% tee tree oil, 40% water-miscible emulsified solution, and
13% isopropyl alcohol can be applied to a tampon and inserted for 24 hours,
once a day for a week. (Note; The recommended treatment for Trichomonas is
a single dose of Metronidazole, 2 grams). Oral lactobacillus can be supplemented
in all conditions to normalize the vaginal flora.
References
1. Hudson, T. Women’s Encyclopedia
of Natural Health. Keats Publ. 1999;277-288.
2. Stenchever MA, et al. Comprehensive Gynecology. Mosby Inc.
4th edition 2001:668-678.
3. Leppart PC, Howard FM. Primary Care for Women. Lippincott-Raven
Publ. 1997:181-184.
Dr. Marianne Marchese is a naturopathic physician practicing
in Portland Oregon.
