Vulvodynia and vaginitis are one of the most common clinical diseases in obstetrics and gynecology. Because the vulva is exposed and adjacent to the urethra, vagina, and anus, it is often moist and prone to bacterial reproduction and is in contact with the outside world and is susceptible to various physical and chemical stimuli. The actual vagina is susceptible to inflammation and can coexist with vaginitis. Vulvodynia and vaginitis are caused by a variety of etiologies, including non-specific vulvodynia vaginitis, vestibular adenitis, mycotic vulvodynia vaginitis, trichomonas vulvodynia vaginitis and other representative diseases, while viral vulvodynia vaginitis (herpes, oral warts) is a sexually transmitted disease.
1. Simple vulvovaginitis
Causes
The main cause is secondary infection caused by lack of attention to vulvar hygiene, physical and chemical stimulation or metamorphic reactions that cause weakened local resistance. If you’re not sure what to do, you’ll be able to get a good idea of what to do. Urine from diabetic patients, feces from fistula patients and long-term impregnation of urine from urinary fistula patients can also cause vulvovaginitis, and the causative organisms can be staphylococcus, streptococcus, Escherichia coli, and metaplasma.
Clinical manifestations
In the acute stage, vulvar swelling, congestion, itching, pain, burning, erosion, papules, blisters, pustules, etc. are seen, and in severe cases, ulcers and enlarged inguinal lymph nodes are formed. Chronic inflammation may show thickening, roughness and wrinkling of the skin mucosa.
Diagnosis
Ask detailed questions about the medical history, the amount of secretions, the nature and the presence of special factors, such as diabetes, fecal leakage, urinary leakage, the patient’s hygiene, etc., and check the white belt routine if necessary.
Treatment
Etiological treatment, first of all, the cause should be treated to remove the cause, local treatment can be used 1:500 potassium permanganate solution sitz bath, antibiotic ointment application. If the cause is not completely removed, it is easy to relapse into chronic or refractory.
2, vestibular gland inflammation and vestibular gland cysts
The inflammation caused by pathogens invading the vestibular gland is called vestibular adenitis. When the opening of the vestibular gland is blocked secretions accumulate in the lumen and form cysts, called vestibular gland cysts. This disease is most common in women of childbearing age.
Causes
The vestibular gland is located in the lower 1/3 of the labia majora on both sides of the female vulva, and the glandular duct opens in the groove between the labia minora and the hymen, and secretes mucus for lubrication during sexual excitement. Because of its special anatomical location, it is infected by pathogens during sexual intercourse, childbirth and menstruation due to poor hygiene or injury, and the pathogens invade and cause inflammation. When the acute attack of inflammation first invades the ducts, resulting in vestibular gland ductitis, the opening of the ducts is often swollen and blocked, so that the pus can not flow out and accumulate, resulting in vestibular gland abscess. After the abscess subsides, the pus gradually turns into clear fluid to form a cyst. Local injury to the vulva for various reasons, resulting in obstruction of the glandular ducts and poor discharge of secretions, can also form cysts. The disease is a mixed infection, and the common pathogens are Staphylococcus, Escherichia coli, Streptococcus and Enterococcus. With the increase in the incidence of sexually transmitted diseases, Neisseria gonorrhoeae and Chlamydia trachomatis have become common pathogens.
Clinical manifestations
Inflammation is mostly on one side, and the acute phase shows redness and swelling of the lower part of the labia minora, accompanied by local pain. When the inflammation spreads deeper and the pain increases after abscess formation, the local skin is red, swollen, hot, and painful, and the fluctuating sensation can be palpated, and the diameter can be 3 cm to 6 cm. some patients have fever and other systemic symptoms, and the inguinal lymph nodes can show different degrees of enlargement. When the pressure inside the abscess increases, the skin on the surface becomes thin and the abscess breaks down by itself. If the hole is large, the abscess can drain by itself and the inflammation will subside quickly and heal; if the hole is small and the drainage is poor, the inflammation will not subside and may recur. Vestibular gland cysts manifest as vulvar foreign body sensation or discomfort during sexual intercourse, and unilateral or bilateral oval cysts are seen on examination. It can also form abscesses secondary to infection and recur.
Treatment
Vestibular adenitis is treated with systemic anti-infective drugs using sensitive antimicrobials. In the early stage, local hot compresses or sitz baths can be used to clear heat and detoxify herbs, or local irradiation with hydrogen-neon laser can be used for timely control.
3. Vulvovaginal pseudomycosis
Vulvovaginal pseudomonal yeast disease (VVC) is a common inflammatory disease of the vulva, often coexisting with vaginal pseudomonal yeast, the two together called VVC, according to statistics, about 70% of women have suffered from VVC at least once in their lives, and the incidence of VVC in pregnant women is higher than in non-pregnant women.
Etiology
Pseudomonas albicans is the causative agent in 80% to 90% of cases, a few can be caused by smooth Pseudomonas, near smooth Pseudomonas or Pseudomonas tropicalis, and in recent years, non-white Pseudomonas infection is increasing, and it is difficult to treat because it is not sensitive to many antifungal drugs, Pseudomonas albicans is a conditional pathogen, 10% to 20% of non-pregnant women and 30% of pregnant women have Pseudomonas in the vagina Clinical studies have shown that strain identification is only applicable to a small number of patients with ineffective treatment, and have demonstrated that the main factors associated with recurrence are sexual behavior, especially masturbation and cunnilingus.
Clinical manifestations
It is characterized by persistent vulvar itching with painful urination and painful intercourse. Examination reveals vulvar edema, vaginal mucosa edema, congestion, erythema, and vulvar scratches. The vaginal discharge is increased, white sticky bean curd-like or coagulated, and white membranous material is seen on the inner side of labia minora and vaginal mucosa, and redness and swelling of vaginal mucosa can be seen after erasing.
Diagnosis
The diagnosis of VVC is not difficult based on typical clinical manifestations and visual examination of vaginal secretions. However, in some atypical cases, vaginal secretion examination is necessary to confirm the diagnosis, for those suspected of carrying pseudofilamentous yeast or to understand the effect of treatment. The pathogenetic examination is the gold standard for confirming the diagnosis. The diagnosis is made if Pseudomonas aeruginosa is found in the secretions. The positive rate of finding budding and pseudofilamentous yeast under microscope with 10% KOH suspension is 70%; with Gram stain, the positive rate is up to 80%; culture method has more positive rate. And can identify sensitive antifungal drugs, but it takes 2 d to 3 d to confirm the diagnosis, can be used for refractory or recurrent VVC; for recalcitrant cases should actively look for a history of application of estrogen, antibiotics or immunosuppressive agents, and check blood sugar to exclude diabetes.
Treatment
Asymptomatic carriers generally do not require treatment. When a male partner is symptomatic, he should be tested and treated for Pseudomonas aeruginosa. The first step is to actively remove the causative agent, while giving antifungal treatment, especially the first episode or the first visit is the key period for standardized treatment. Generally, local application of antifungal drugs (ointment and other topical agents, vaginal suppositories) is the mainstay, refractory and recurrent cases need to be given oral antifungal drugs, as well as vaginal medication, commonly used vaginal drug of choice, miconazole nitrate suppositories (Dakonin) 200 mg, 1 time/night for 7 d, or 400 mg, 1 time/night for 3 d, or 1 200 mg, 1 time/d for 1 d, clotrimazole suppositories 150 mg, 1 time/d for 7 d. If symptoms do not improve, additional cycles of treatment will be given, while recurrent cases usually require 6 months of treatment. The treatment is mainly local and oral azoles are prohibited.
4. Vulvovaginitis in infants and children
Causes
Infants and children have poorly developed vulva and are susceptible to contamination. Low estrogen level, vaginal PN rising to 6-8, poor ability to resist infection, when poor hygiene habits, unclean vulva, urine and stool pollution, vulva injury or pinworm infection can cause inflammation. Infantile vulvovaginitis should be a non-specific infection. The common pathogens are staphylococcus, streptococcus, E. coli, etc. E. coli is the most common, accounting for 80%. Currently, Trichomonas, Pseudomonas albicans, Neisseria gonorrhoeae and pathogens, herpes virus, and human papilloma virus are also more common.
Clinical manifestations
The main symptom is increased vaginal discharge, which is purulent. It is most often seen by mothers who notice purulent discharge from their infants scratching the vulva and underwear. Examination: The vulva, clitoris, urethra and vaginal opening are seen to be congested and edematous, and sometimes purulent discharge is seen to flow from the vaginal opening.
Treatment
Keep vulva clean and dry, reduce abrasion, use 1:5000 potassium permanganate solution in sitz bath, 2 times/d～3 times/d, local treatment rub 40% purple band oil or choose sensitive antibiotic ointment to apply, or use pipette to put antibiotic drops into vagina, symptomatic treatment, give deworming treatment to patients with pinworms, if there is foreign body in vagina, it should be removed in time.