Vulvovaginitis - an inflammatory disease of bipartite including vulvitis and vaginitis.Inflammation affecting the external genitals, called vulvitis.When inflammation of the affected area of the vagina, it is called vaginitis.The greatest number of cases occur in vulvovaginitis in girls and older women are not inferior to them on the prevalence and vulvovaginitis in children.
Depending on the nature of the pathogen isolated specific and nonspecific vulvovaginitis.The nature of inflammation determines the pathogen.The specific cause inflammation of chlamydia, gonorrhea, mycoplasma, trichomonas, ureaplasma, Candida fungi or viruses.When specific inflammation clinic expressed most clearly, the process takes place in an acute form.
nonspecific vulvovaginitis developed with the participation of staphylococcus, streptococcus, E. coli and Pseudomonas.In most cases, when vulvovaginal inflammation occur, with the participation of mixed flora.
Chronic vulvovaginal is characterized
fundamental factor in the development of inflammation in the vulvovaginal is a violation of the composition of the microflora of the mucous membranes.The vaginal environment is a specific set of microbial associations having a constant number of members.Persistence of vaginal environment, together with the immune system provides a protective function of the mucous membranes of the lower genital tract and prevents the uncontrolled proliferation of opportunistic and pathogenic microorganisms.
vaginal environment is composed of predominantly rod-shaped (Lactobacillus, Corynebacterium) and coccal flora (anaerobes, streptococci, enterococci).Small amounts are found Klebsiella, E. coli, Candida and other fungi.Lactobacilli are involved in maintaining a constant pH (acidity) of the vagina, normally it is 3.8 - 4, 5. The presence of pathogens in the vagina does not indicate the disease.
ratio of microorganisms in the composition of the vaginal flora should be constant.If the proportion of lactobacilli decreases acidity changes and unwanted microflora begins to multiply uncontrollably, causing inflammation.In some cases, the immune system can deal with itself starts changing, and vulvovaginal regresses.On pathological process should speak only if develops marked inflammation and symptoms of the disease.
Qualitative and quantitative changes in the microflora of the vagina can have a variety of causes and conditions that must be considered when selecting therapies.
If the inflammatory process involved representatives of specific flora (such as trichomonas), a woman with a source of vulvovaginal infection of the sexual partner.
Vulvovaginitis is not a rare disease.In the structure of gynecological diseases, accounting for about 65%.
In most cases, diagnosis and treatment of vulvovaginal do not cause trouble.Forecast disease if adequate therapy is favorable.
Inflammatory diseases of the vulva and vagina occur, as a rule, against violations microbiocenosis vagina.
During pregnancy and menopause cause vulvovaginitis are physiological changes in the composition of the vaginal microflora.Hormonal changes in the direction of the dominant effect of progestogens on the background of reduction of immunity in pregnant women leads to changes in the number of lactoflora and the pH of the vagina.Older women natural decrease of estrogen in the body leads to a thinning of the mucous membranes of the vulva and vagina, followed by qualitative and quantitative changes in the composition of the vaginal microflora.
Vulvovaginitis in children often begins with primary vulvitis.
Vulvovaginitis girls in the vast majority of bacterial origin and is caused by several reasons:
- allergic process in the body;
- mechanical damage to the mucous membranes of the external genitalia;
- foreign bodies in the vagina;
- viral or infectious processes (measles, scarlet fever);
- incorrect hygienic procedures;
- low immunity;
- incorrect antibiotic therapy.
bacterial vulvovaginitis in girls does not have a specific pathogen and is associated with low immunity.They suffer from weakened children.
Vulvovaginitis in children may be due to intrauterine infection during pregnancy if the woman has not passed a full examination and treatment of sexually transmitted infections.
System goiter, endocrine and hormonal disorders, allergic diseases can serve as unfavorable background of vulvovaginitis in women.
Sexually transmitted infections, candidiasis, bacterial vaginosis, vulvovaginal promote development.
Continuous hormonal contraception can contribute to changes in vaginal microflora dysbiotic.Reducing the effect of estrogen leads to a decrease in the number of lactobacilli in the vagina and change the pH, opportunistic flora begins to vegetate vigorously.By rising dysbiosis joins inflammation, and formed a picture of vulvovaginitis.
aggressive methods of personal hygiene can contribute to the development of inflammation of the vagina.While douching balanced vaginal flora may just be "washed".
Failure to use tampons can cause pathological inflammation.If a tampon into the vagina is more than 2 hours (which is prohibited by the rules of use), it provokes unfavorable flora.
inflammatory process may begin with the vulvovaginal mucous external genitalia and spread upward through the vagina.When the primary site of inflammation in the vagina, the disease process can go down below - to the external genital organs.
symptoms of vulvovaginal
Vulvovaginitis a bipartite disease, it brings together the pathological inflammation of the vulva and vagina.Consequently, vulvovaginal clinic will have all the features of both pathologies - vulvitis and vaginitis.
main symptoms of vulvovaginal are malodorous abnormal discharge (leucorrhoea) of varying intensity, color and quantity.Older women may complain of dryness in the vulva area, discomfort in the vagina.The source of the cables is a pathological vaginal mucosa.Vulva in the secretory function does not participate, but contains a large number of nerve endings.Because of the increased sensitivity of the vestibule respond to arising at the selection vaginitis, and patients worried about itching, discomfort, a burning sensation or pain.If the inflammation has spread to the urethra, there are additional complaints of frequent urination (dysuria), and discomfort in the projection of the urethra.
Fever indicates severe disease.
clinical picture of vulvovaginal largely determined by the form of the disease.Sluggish vulvovaginitis may be asymptomatic.Active patient complaints are absent during the inspection revealed signs of sluggish inflammation: redness of the mucous and a small amount of vaginal discharge.
acute vulvovaginal different bright clinical picture: pain, profuse discharge, itching, burning, dysuria.At gynecological examination the vulva and vagina visible swelling and redness expressed.
nonspecific vulvovaginitis has a distinctive feature - on the walls of the vagina are visualized pathological grayish deposits, similar to the film.When you try to delete them or if they are self-rescue in the form of mucous minor abrasions, because of vaginal discharge may be bloody.
Intense inflammation of the mucous membranes lead to the development of pronounced edema impairing introduction speculum.In such cases, a pelvic exam may be painful for the patient.
Acute vulvovaginitis in girls can sometimes occur with bleeding from the genital tract.This is due to traumatization of the mucosa of the vulva.In children, the vulva is looser and vulnerable, any infection in such conditions can penetrate deeply and quickly, damaging the mucous layer.
nature of the symptoms of vulvovaginal can be determined by one pathogen or microbial association.For example, when Candida mucous allocation similar to liquid sour cream or have a "cheesy" look, when infected with Trichomonas they are festering, and in non-specific inflammation of the appearance of vaginal discharge does not have the characteristic features and varies from liquid watery to thick "milk" or purulent.
Chronic vulvovaginal runs more quietly, the symptoms are mild.Swelling and redness of the mucous insignificant pain is not.In the foreground are the symptoms of vulvitis: discomfort, itching of the external genitals.During remission of the symptoms may disappear entirely.
Due to the variety of causes and clinical manifestations of vulvovaginal the accuracy of the diagnosis is confirmed only by laboratory methods.Laboratory diagnosis include bacterioscopic (smear microscopy) and bacteriological (culture) study of material from the cervix and vagina and urethra.
volume of laboratory tests depends on the survey data and gynecological examination.For example, in the bacteriological diagnosis of nonspecific inflammation has no diagnostic value because of the wide variety of opportunistic pathogens in the vagina, and precipitates bacterioscopy is very important.
presence of a large number of leukocytes in the smears confirmed the inflammatory nature of the disease process in the vulvovaginal.
Since vulvovaginitises can be triggered by specific flora, it is necessary to examine the patient for the presence of major urogenital infections: trichomoniasis, gonorrhea, chlamydia and others.Survey method selects the doctor, depending on the technical equipment of a local laboratory.The material for the study may be blood or vaginal contents.
When vulvovaginitah marked change in the overall analysis of urine - increased white blood cell count analysis may be appointed as needed to reveal the nature of inflammation in the urethra.
Girls inspected vulva, speculum examination is not carried out.During a visual inspection of the vulva mucosa hyperemia and edema, may have traces of scratching.In marked inflammation visualized copious who take the study of special tools.Laboratory diagnosis of vulvovaginitis in girls is similar to that in adult women.An additional method in children may be the analysis on helminth eggs.
Instrumental methods of examination of patients with vulvovaginal conducted solely for the purpose of differential diagnosis.If you want to establish the presence of inflammation in the uterus and appendages, appointed an ultrasound scan of the pelvic organs.
If the diagnosis of vulvovaginal requires clarification, patients should consult with other doctors - allergists, venereologists, TB specialists, therapists and so on.
Vulvovaginitis on the background of extragenital pathology in need of treatment of joint gynecologists and related specialties.
When vulvovaginitises untimely medical intervention can have quite serious complications:
- Go to the chronic form of the disease with an unpredictable outcome;
- a long-term inflammatory process due to lower local immunity can cause abnormal changes in the cervix and migrate to the uterus and appendages;
- Long-specific inflammation of the vagina leads to infertility;
- Girls inflammatory exudate when vulvovaginitis may cause "sticking" small and large labia.For a short time formed adhesions (adhesions), which are closed over the entrance to the urethra, causing urinary disorders;
- In elderly patients an inflammation of the vagina causes sores on the mucosa;
- During pregnancy under physiological dysbiosis and reduce local immunity inflammatory process may be rising through to get to the amniotic membranes and infect the fetus.
nature of inflammation and degree of severity can be determined only after a doctor studying patient complaints, gynecological examination and analysis of laboratory diagnostics.For a correct understanding of the causes and nature of the inflammation is necessary to take into account the background processes in the body of the patient, presence extragenital pathology.
self-medication and self-diagnosis of vulvovaginal unacceptable!
At the heart of vulvovaginal candidiasis is an infectious process caused by yeast fungi genus Candida.It occurs most often in young women, is much less common in girls and women in menopause.
During pregnancy vulvovaginal candidiasis reveals almost half of the women.
yeasts Candida in the small amounts present in the composition of pathogenic microflora of the vagina and does not cause adverse changes.Candidal inflammation develops only if the number of fungal microflora in the vagina begins to increase.
causes and mechanism of the appearance of vulvovaginal candidiasis are not well understood, it is known that an important development is a violation of microbiocenosis infection of the vagina, followed by a change in its pH.
Sometimes fungi Candida in the excess of "normal" amounts may be present in the vagina in the absence of clinical signs of disease.This condition is called carriage.The carrier does not exclude the disease.
When vulvovaginal candidiasis inflammation localized in the surface layers of the epithelial layer.Failure fungi to penetrate into the deeper and breeding grounds for mucosal sites leads to infection that may be present in the vagina for many years.If the protective properties of the vaginal environment is not lost, it will try to bring the pathogen from the body, preventing it from provoking the disease, which leads to the carrier state.Loss or reduction of protective mechanisms of the vaginal microflora leads to the development of the disease.
Vulvovaginal candidiasis has three clinical forms: carriage, acute and recurrent vulvovaginal (chronic) vulvovaginitis.
Asymptomatic kandidonositelstvo is only a slight increase in the population of fungi in the vaginal environment.It occurs in one in five pregnant women.
special feature is the nature of vulvovaginal inflammation secretions: they are white (sometimes with a yellowish tint), thick consistency and resemble cottage cheese.The rest of the clinical manifestations are similar to those of other origins and vulvovaginitah no different specificity.
acute vulvovaginal candidiasis expressed different clinical picture.On examination revealed redness of the mucous membranes, heavy or moderate cheesy discharge.In a laboratory study revealed a high titer of the content of fungal flora.The acute phase of the disease lasts no more than two months.
Chronic candidiasis differ long duration (more than two months).When viewed on the mucous membranes of the vagina and vulva can see signs of atrophy and infiltration (thickening).
clinical picture of vulvovaginal candidiasis depends on many factors: the composition of the vaginal microflora, concomitant gynecological diseases of the immune system.If the patient has intestinal dysbiosis, candidiasis vulvovagint seen as part of a generalized process.