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That uncomfortable feeling

Vaginitis is a common occurrence. But if you ignore it, you run the risk of the infection becoming chronic

Sunanda has been feeling extremely uncomfortable for the past two days. She has developed a small amount of vaginal discharge but what is really distressing is the intense itching she has developed along with it.

The itching is particularly worse at nights. The skin outside seems to be inflamed and there is burning when water touches the area.

Sunanda is not alone. As many as one third of women will develop a vaginal infection (vaginitis) sometime during their lives. Vaginitis is an inflammation of a woman's vaginal lining.

Vaginitis affects women of all ages but is most common during the reproductive years. There are many possible causes, and the type of treatment depends on the cause.

It is normal to have a small amount of white discharge from the vagina. This keeps the tissue moist and healthy. Organisms, such as bacteria and Candida (a type of fungus), are always present in the vagina.

Vaginitis results when there is an overgrowth of these organisms.

Some factors that can precipitate an infection are antibiotics, changes in hormone levels, pregnancy, breastfeeding and menopause.

Vaginitis may cause itching, a bad odour, or a variable amount of discharge.

Diagnosis

The exact cause of the vaginitis is diagnosed by a direct examination and from smears of the discharge.

The common causes of vaginitis are fungal overgrowth (candidiasis), trichomonas infection or bacterial vaginosis.

Types of vaginitis

Fungal infection

Fungal infection is also known as candidiasis. It is one of the most common types of vaginal infection. A fungus called Candida is found in small numbers in the normal vagina.

However, when the balance of bacteria and Candida in the vagina is altered, the Candida may overgrow and cause symptoms.

Some types of antibiotics increase the risk of a fungal infection.

A woman is more likely to get fungal infections if she is pregnant or has diabetes.

The vaginal discharge usually is white, lumpy, and has no odour.

Fungal infections can be treated either by placing medication into the vagina or by taking an oral antifungal medication like fluocanozole.

Antifungal ointments containing a small amount of steroids may also be prescribed to decrease the intense itching associated with a fungal infection.

An antifungal powder may be prescribed for use in the groin area.

Trichomoniasis

Trichomoniasis is a condition caused by the microscopic parasite Trichomonas vaginalis.

Signs of trichomoniasis may include a yellow-grey or green vaginal discharge.

The discharge may have a strong odour.

There may be burning, irritation, redness, and swelling of the vulva. Sometimes there is pain and burning during urination.

Trichomoniasis usually is treated with a single dose of tinidazole by mouth.

Alcohol must be avoided for 24 hours after taking this drug because it causes nausea and vomiting.

It is very important that the partner is treated concurrently, to prevent the infection from recurring.

Bacterial vaginosis

Bacterial vaginosis is caused by overgrowth of certain bacteria which occur naturally in the vagina.

The main symptom is increased discharge with a strong odour.

The discharge usually is thin and dark or dull grey, but may have a greenish colour. Itching is not common, but may be present if there is a lot of discharge.

Metronidazole and clindamycin are the most commonly used antibiotics for treatment.

They can be prescribed as tablets or inserted into the vagina as a cream or gel. When metronidazole is taken by mouth, it can cause side effects in some patients. These include nausea and vomiting, and darkening of urine.

Alcohol must be avoided when taking metronidazole.

The combination can cause severe nausea and vomiting. With repeated infections, the gynaecologist might suggest treatment for the partner also.

Atrophic vaginitis

This condition is not caused by an infection but can cause a discharge and vaginal irritation.

It may occur any time when estrogen levels in the bloodstream are low such as during breastfeeding and after menopause. Symptoms include dryness and burning. Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream. A water-soluble lubricant also may be helpful during intercourse.

A vaginal infection is a common occurrence and does not mean that there was lack of hygiene.

It is better to avoid the use of powders and antiseptic solutions in that area.

Many women feel shy about seeing their gynaecologists about this problem immediately and then run the risk of ending up with a chronic infection.

Gita Arjun

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)

GITA ARJUN

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