In every part of our body, there are protection shields called “normal flora” that protect that area against infections and opportunistic microorganisms. The normal flora of the vagina is among these and tries to protect the vagina at varying rates at varying times, such as changing times of the menstrual cycle, reproductive period, menopause and pregnancy.
Discharge due to normal flora is the form of discharge that we call ‘physiological discharge’ in women and we do not give treatment.
2) small amount
3) it becomes odorless.
From time to time, we try to explain that this is a normal condition that should not be treated with women who perceive their physiological discharge pathologically and want to be completely dry. From time to time, on the contrary, the woman does not care about the discharge and finds it unnecessary to consult a doctor. Physiological acne most often occurs with normal hormonal changes (such as ovulation), vaginal secretion in sexuality, and physiological discharge in pregnancy.
Although personal hygiene is an objective situation and depends on the rules, perceiving or caring for the flow has often been a subjective (interpreted as a personal) behaviour. Here, vaginal discharge that we did not care about in time; When it can occur as a pelvic infection or affect the tubes, it can cause problems in various spectrum from chronic pain of the pelvic infection to blockages in the tubes.
Complaints in Vaginitis
The complaints we should consider are:
foul-smelling vaginal discharge
redness, burning, irritation of the vulva
burning or pain in sexual intercourse
bleeding after sexual intercourse
pain in the lower abdomen.
Types of Vaginitis
Let’s take a look at the subgroups of vaginitis:
1) the most common types of vaginitis are fungal infections. 70-75% of women can have one or more fungal infections once in their lifetime and 40-50%. The probability of women falling into the definition of a chronic fungal infection is actually a rare figure, not exceeding 5%.
The most common cause of mushroom discharge is candida albicans. The second factor is candida glabrata.
The most common reason is the reduction of lactobacillus in the vaginal flora that protect the vagina against microorganisms and saprophytes. Lactobacilli normally keep the vagina in acidic balance at ph: 4 and form the infection barrier of the vagina.
Risk factors that disrupt normal flora
using a pill
diabetes, thyroid and adrenal gland diseases
immune suppression (HIV positivity and immunosuppressive drug use)
wearing nylon underwear, tight pants
sitting with a wet swimsuit, etc.
Here, the natural mild hyperglycemia that occurs for the growth of the fetus in pregnancy and the glucose level in the vaginal mucosa increases in the diabetic patient and creates the medium for fungal formation.
The complaint of the woman is usually itching, discharge such as cheese, vulvar irritation caused by itching, burning at the beginning or end of urine, burning or pain in sexual intercourse, and edema in the external genital area from time to time.
On genital examination, it is easy to see the discharge that is tightly adhered to the vaginal wall, but the patient may not feel it as reflected discharge. On the other hand, since the mushroom in pregnant women has the chance to multiply in a very good environment, it can also discharge enough water to make the woman think that her water is coming.
Vaginal examination is usually sufficient in diagnosis. When considering the frequency of fungal infection, the examination of vaginal culture or direct preparation may not be done considering the high cost and time consuming feature. However, it should not be forgotten that more than half of the fungal infection may be accompanied by other microorganisms due to the deterioration of the flora and it should be taken into consideration in the treatment. The use of the laboratory in diagnosis can be evaluated in the case of mixed infection or infection missed treatment.
In the treatment, miconazole and clotrimazole derivatives are used. If the patient is virgo, oral antifungals and topical creams must be used. However, if it is not a virgin, the first option should be vaginal preparations. Vaginal treatment can be continued for about 1 week. The addition of oral and topical treatment to vaginal preparations should be decided based on the patient’s condition.
Co-treatment is controversial in treatment. However, many physicians prefer co-treatment. In fact, the fungus is not in the group of sexually transmitted diseases. However, co-treatment may be beneficial for the comfort of the couple and theoretically preventing the transmission.
The diagnosis of recurrent fungal infection must be made by the physician, because only 5% of women enter this definition. If she had a fungal infection diagnosed 4 times a year, we can tell the woman about chronic fungal infection. Its treatment is very difficult. But it benefits from repetitive treatments or suppressive fungal treatments. The biggest benefit is cutting the cow’s milk products and reducing the damage caused by lactose in the intestine. Considering that Candida infections start in the intestinal mucosa first. First, it is imperative to correct the environment in the intestine and provide long-term support from lactobacilli and Bifidobacterium for long-term recovery.
Here, especially chronic itching should not be confused with fungal infection. It should be remembered that precancerous lesions of the vulva can also occur with chronic itching in the years of dermatitis (eczema), allergies, lichen and especially menopause.
Trichomonas vaginitis is the second type of vaginitis we encounter in the clinic. It is also the second most common among sexually transmitted diseases other than viruses. Trichomonas is a microscopic parasite (protozoon). Although controversial, it is said that it can be transmitted from shared toilet, pool or furniture.
The main complaints of the patient are;
1) foul-smelling, yellow-green, foamy discharge,
2) vaginal burning
3) vaginal itching
4) Burning in sexual intercourse or bleeding after sexuality.
The infection can progress without any symptoms. Regardless of whether they have a complaint, they must be treated. Trichomonas can also cause infections that affect the tubes, as well as preterm birth and premature water supply during pregnancy.
Examination is often sufficient in diagnosis. In the examination, yellow-green discharge or foamy discharge, which cling to the vagina wall, can be easily observed. In long lasting trichomonas infections, ‘strawberry view’ can be observed in the cervix. Examination of the stream with saline can also be helpful in diagnosis.
The normal flora of the vagina deteriorates very much after the trichomonas infection and other sexually transmitted diseases can be added, especially if condoms are not used. Apart from these, trichomonasa can often accompany Gardnerella vaginitis.
In the treatment, metronidazole and its derivatives are used orally or vaginally or in combination.
Spousal treatment must be carried out taking into account the conditions of transmission.
Finally, let’s talk about bacterial vaginosis.
Typical complaints of bacterial vaginosis are gray-white discharge and typical foul-smelling discharge after sex (which is similar to the stinky fishy smell)
There are four parameters in the diagnosis:
1) the discharge is gray-white and can be easily separated from the vagina wall.
2) ph is above 5
3) whiff test is positive (fish smell when KOH is added to the stream)
4) clue cells (bacteria adhering to vaginal epithelial cells in wet preparate), which have replaced the lactobacils in the natural flora.
If lactobacies are sufficient, it is not possible to see gardnerella vaginitis, and gardnerella is not transmitted by sexual intercourse, so no co-treatment is required. Oral or vaginal or combined metranidazole is used for treatment.
Other factors of bacterial vaginitis other than gardnerella vaginalis are ureoplasma urealitikum, chlamidia, trachomatis, mycoplasma hominis and anaerobic bacteria. It can be transmitted by sexuality and co-treatment should be done. In the treatment, doxycycline, ampicillin and clindamycin are used.