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The gynecological problem of Vulvovaginitis is a very common one in women of all ages. It is an inflammation of the vulva and vagina, most commonly caused by a fungal, bacterial, or parasitic infection. Vulvovaginitis is one of the most common ailment for which women often visit their gynecologist. This problem causes irritation, vaginal discharge, and itching. Usually, a woman may release a vaginal discharge, the consistency and amount of which changes during the menstrual cycle course. However, vulvovaginitis leads to a symptomatic increase in the amount of vaginal discharge.
Vulvovaginitis etiologies and the approach of vulvovaginitis patient management, depends mainly on the age of the patient. The gynecological problem of Vulvovaginitis can be categorized into 3 age groups: premenarchal, childbearing, and postmenopausal.
Causes of Vulvovaginitis
In the premenarchal age group, the causes are nonspecific, i.e., there is no etiologic agent or the patient suffers from poor perineal hygiene. The chemical irritants in the premenarchal group can result from lotions, bubble baths, etc. The causes of this infection can be pinworm infection, use of vaginal foreign bodies, and GABHS infection. The skin conditions of the patient may experience seborrhea, Eczema, and psoriasis. The etiologies of this stage are normally associated with women of childbearing age including Bacterial vaginosis, gonorrhea, Candida species, and Trichomonas species.
In the childbearing age group, vulvovaginitis occurs from sexual contact, particularly, with multiple sexual contacts. In this problem, it is generally found that the patient uses no method of birth control. The gynecologist here studies the STD history of the patient carefully and then offers treatment. This ailment is caused mainly by fungal or bacterial infections like bacterial vaginosis, Trichomonas species, and Candida species.
In the postmenarchal stage, the most common type of vulvovaginitis is Atrophic vaginitis, which is quite a common one in postmenarchal women.
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Pathophysiology of Vulvovaginitis
In case of vulvovaginitis, the normal epithelium develops into a thickened layer of epithelial cells due to the influence of estrogen, which protects women from any infection. A normal vaginal discharge comprises 1-4ml of white or transparent fluid, odorless, and thick. This physiologic vaginal discharge gets formed by the shedding epithelial cells, vaginal transudate, and normal bacteria. The discharge can be noticed during pregnancy, usage of oral contraceptive pills, or during the mid-menstrual cycle, close to the ovulation time.
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In normal vaginal secretion, the pH value is 4.0-4.5. The pH can be maintained by lactobacillus that produces hydrogen peroxide, Staphylococcus epidermis, and diptheroids. Bacterial vaginosis is the second step in bacterial overgrowth in vulvovaginitis.
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