Excerpt for Vulvovaginitis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions by , available in its entirety at Smashwords






The Condition,




Related Conditions


Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2015 Smashwords Edition

Published by Kenneth Kee at Smashwords.com


This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes the Vulvovaginitis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Vulvovaginitis)

This eBook is licensed for the personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

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Thank you for respecting the hard work of this author.


I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Condition) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

This autobiolographical account “A Family Doctor’s Tale” was combined with my early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.

From which many free articles from the blog was taken and put together into 700 amazon kindle books and some into Smashwords.com eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical conditions.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring you the latest information about a condition or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1


What is Vulvovaginitis?

Vulvovaginitis is a medical condition with acute inflammation of the vulva and vagina in females.

Vulvovaginitis or vaginitis can indicate the presence of swelling or infection of the vulva and vagina.

Vaginitis is a frequent problem that can affect women and girls of all ages.

What are the causes of Vulvovaginitis?

Vulvovaginitis is usually caused by the following:


1. Sexually transmitted infections such as gonorrhea, trichomonas and chlamydia.

The vagina normally contains both healthy bacteria and unhealthy bacteria.

a. Bacterial vaginosis (BV) infection happens when more unhealthy bacteria than healthy bacteria grow. BV may produce a thin, gray vaginal discharge and a fishy odor.

b. Trichomonas: A less common type of vaginitis is spread by sexual contact.

Symptoms in women are genital itching, vaginal odor, and a heavy vaginal discharge that may be green or yellow-grey in color.

2. Fungal infection such as candidiasis or yeast

Yeast infections are one of the most frequent causes of vulvovaginitis in women.

Yeast infections are frequently caused by the fungus Candida albicans.

Candida and the many other micro-organisms that normally grow in the vagina keep each other in check.

Occasionally the number of Candida germs becomes more, resulting in a yeast infection.

Yeast infections normally induce a thick white vaginal discharge, genital itching, and other symptoms.

3. Herpes simplex virus in recurrent cases: also known as genital herpes

4. Pediculosis pubis or lice: parasites on pubic area or bed sheets

5. Pinworm infection in children: more in children at anal and vulvar areas

6. Urinary infection such as cystitis (bladder infection)

7. Lack of cleanliness (poor hygiene)

Objects such as a lost tampon can also cause irritation, itching, and strong smelling discharge.


1. Clothings

2. Perfumes

3. Powders

4. Drugs

5. Feminine sprays

Chemical irritants:

Chemicals can cause itchy rashes in the genital area.

1. Vaginal douche

2. Detergents used to wash underwear

3. Bubble baths,

4. Soaps

Mechanical irritants:

1. Ill fitting underwear

Tight-fitting or nonabsorbent clothing, which leads to heat rashes

2. Inadequate sexual lubrication

3. Vaginal birth control

Spermicidal and vaginal sponges, which are over-the-counter birth control methods


Atrophic vulvovaginitis occurs after menopause with vaginal dryness and inflammation

Low estrogen levels in women following menopause can produce dryness in the vagina and thinning of the lining wall of the vagina and vulva.

These changes may result in or worsen genital itching and burning.

Generalized disorders:

Dermatological disorders such as lichen simplex

Other skin conditions such as psoriasis

Non-specific vulvovaginitis

Sometimes the exact cause cannot be found.

It occurs in all age groups, but is most frequent in young girls before menstruation, especially if they have poor hygiene of the genital area.

There is a foul-smelling, brownish-green vaginal discharge.

There is also irritation of the opening of the vagina and the labia of the vulva.

This disorder is frequently linked with excessive growth of E.coli germs that are normally found in the stool.

These bacteria are occasionally passed to the vaginal area by wiping from back to front from the rectum after passing feces.

Any irritated skin or mucosa tends to become infected than healthy skin or mucosa.

Many micro-organisms that produce infection grow well in a warm and damp environment, which can also result in a prolonged recovery from the infection.

Sexual abuse should be determined in young girls with unusual genital infections and repeated episodes of unexplained vulvovaginitis.

What are the symptoms of Vulvovaginitis?

Persons who has Acute Vulvovaginitis has the following


1. Vulvar and vaginal irritation and itch

Irritation and itching of the genital area

2. Discharge from vagina

Foul vaginal odor

3. Painful or frequency of urination

Discomfort or burning sensation when urinating

4. Excoriation of the inner lining of vulva and inflammation of the vulvovaginal area


1. The female vagina may show the presence of foul discharge

2. Redness and inflammation of the vulva

How is diagnosis of Vulvovaginitis made?

The doctor will perform a pelvic examination.

Diagnosis can usually be made by:

1. History of vulvar itch, associated painful urination, frequency of urination, or vaginal discharge

2. Vulva shows excoriation of lining and inflammation (redness and swelling)

There may be some red, tender swellings on the vulva or vagina.

3. Vulvar and vaginal swab to culture for bacteria and sexually transmitted diseases and the antibiotic most suitable for it.

A wet prep (examining vaginal discharge under a microscope) is normally done to identify a vaginal infection or excessive growth of bacteria or yeast.

Sometimes, a culture of the vaginal discharge may determine the germ that is causing the infection.

4. Biopsy of the suspicious vulvar lesions to exclude other causes of vulvar problem such as tumor

A biopsy (a tissue taken for testing) of the inflamed area on the vulva may be advised if there are no signs of infection.

If the woman has been diagnosed with a yeast infection in the past and know the symptoms, she can try treatment with over-the-counter products.

However, if the symptoms do not completely disappear in about a week, contact the doctor.

Many other infections have similar symptoms.

What is the treatment of Vulvovaginitis?


1. Appropriate Antibiotics and antifungal treatment are given for infections particularly after urine bacterial culture

Creams or suppositories (anti-fungal) are used to treat yeast or bacteria infections in the vagina.

A full course of appropriate antibiotics is given for bacterial infections.

If the bacteria are BV or trichomoniasis, the doctor may prescribe:

a. Antibiotic pills orally

b. Antibiotic creams that is inserted into the vagina

2. Antihistamine medicine for itch

3. Topical estrogen cream for postmenopausal atrophic vulvovaginitis

There are many other treatments for vaginal dryness.

4. Proper hygiene after sexual intercourse, urination, and bathing

5. Strong soaps should be avoided

6. Lubricants should be used during sexual intercourse

7. Weight should be reduced if obese

8. Underlying condition such as diabetes, allergic dermatitis, and other skin conditions should be treated.

9. Other medicines that may help is Cortisone cream

What is the prognosis of Vulvovaginitis?

Prognosis is normally good with medication.

Proper treatment of an infection is normally very effective.

Sexual partner may need to be treated.

Recurrence is quite common.

How is Vulvovaginitis prevented?

1. Keep the genital area clean and dry when there is vaginitis.

2. Avoid soap.

3. Just rinse with water to clean the body.

4. Soak in a warm, not hot, bath to help the symptoms.

5. Dry thoroughly afterward.

6. Avoid douching.

Many women feel douching make them cleaner but it may make her condition worse because it eliminates the healthy bacteria that line the vagina and help to protect against other germs.

Other tips are:

1. Avoid using hygiene sprays, fragrances, or powders in the genital area.

2. Use pads instead of tampons while there is an infection.

3. If a woman has diabetes, keep the blood sugar levels in good control.

4. Allow more air to reach the genital area.

This can be done by:

a. Wearing loose-fitting clothes and not wearing panty hose

b. Wearing cotton underwear or underwear that has a cotton lining in the crotch

c. Cotton increases air flow and decreases moisture buildup.

d. Not wearing underwear at night when sleeping

Girls and women should also:

1. Know how to properly clean their genital area while bathing or showering.

2. Wipe properly after using the toilet -- always from front to back.

3. Wash thoroughly before and after using the bathroom.

4. Always practice safe sex, and make the partner use condoms to prevent getting or spreading infections.

5. Vulvitis specifically refers to inflammation of the vulvar area.

The terms vulvitis, vulvovaginitis and vaginitis are used by gynecologists more or less interchangeably.

A large number of diseases are present under the use of this term.

Chapter 2


Vulvovaginitis is a general term referring to many types of vaginal infection which affect the vulvar and vaginal regions:

1. Vulvovaginal candidiasis

2. Atrophic vaginitis

3. Vulvar vestibulitis

4. Contact dermatitis

Vulvovaginitis, a medical term referring to many types of vaginal infection, is the most frequent gynecologic condition seen by doctors rendering primary care to women.

Discharge, burning, and pruritus are the most frequent symptoms, together with signs of vulvar irritation, such as erythema and excoriation of the vulvar skin.

Normally, the 3 classic entities of vaginitis are bacterial vaginosis, Trichomonas infection, and candidiasis.

The differential diagnosis for women with symptoms of vulvovaginitis is complicated.

Primary or secondary infections, skin irritants, or contact dermatitis may produce vulvar irritation.

The irritation from bodily fluids such as urine and normal vaginal secretions may produce symptoms when the environment is kept moist, as with tight-fitting or occlusive clothing.

Because each disorder produces a similar medical presentation, a careful history must be taken, an examination must be done, and the vaginal discharge should be examined.

Together with medical treatment, the patient must be encouraged to avoid risk factors and to make necessary changes in her ways.


The vulva, the external genitalia of the female, includes the labia majora and minora, the clitoris, and the vestibule of the vagina.

The skin of the vulva is sensitive to the vaginal environment and hormonal, metabolic, and allergic conditions.

It is composed of stratified squamous epithelium that contains hair follicles, sebaceous sweat glands, and apocrine glands.

During the reproductive years of a healthy woman's life, the vagina maintains a moist environment that is in constant fluctuation.

The secretion of an alkaline transudate from the vaginal epithelium and cervical glands maintains this moist environment with a pH ranging from 3.8-4.5.

Also, the vagina and its micro-flora form a unique, balanced environment that can change under pressure from external stimuli but returns to normal with removal of the stimuli.

It can vary in degree during sexual activity, pregnancy, and the menstrual cycle.

The vaginal epithelium consists of 3 cell layers; i.e., superficial, intermediate, and basal.

The cells in these layers are capable of storing glycogen under the influence of estrogen.

Glycogen is present in the fully mature cells in the superficial layer of the epithelium.

With higher levels of either exogenous or endogenous estrogen, all levels of the epithelium thicken as a result of glycogen storage.

With decreasing levels of estrogen, the layers become thin and atrophic.


In an adult woman's reproductive years, the bacterial flora of the healthy vagina contains numerous microorganisms, including aerobic and anaerobic gram-positive and gram-negative bacteria.

Lactobacillus and Corynebacterium predominate over other bacteria such as Streptococcus, Bacteroides, Staphylococcus, and Peptostreptococcus.

Lactobacillus and Corynebacterium produce lactic and acetic acid from glycogen, thus maintaining the low vaginal pH.

Further types of bacteria are kept in check by the acid-producing bacteria and are rarely pathogenic, but they may become pathogenic if the environmental balance is affected.

Vaginal pH may rise with age, menstrual cycle phase, sexual activity, contraceptive choice, pregnancy, the presence of necrotic tissue or foreign bodies, or the use of hygienic products or antibiotics.

Vulvovaginal candidiasis

Vulvovaginal candidiasis can be an acute, chronic, recurrent, or persistent condition that can affect the vulva, vagina, and adjacent crural regions.

The specific causative agent belongs to the genus Candida.

These organisms are found in almost all humans and many animals.

About 10-50% of reproductive-aged American women are considered opportunistic carriers.

The species C albicans is identified about 85-90% of the time.

A higher frequency of other Candida species, such as C glabrata, C tropicalis, and C krusei, has been reported.

The emergence of these other Candida species may possibly be due to widespread use of over-the-counter drugs, long-term use of suppressive azoles, and the use of frequent short courses of antifungal drugs.


Any host factor that affects the vaginal environment or vaginal secretions can play a role in the initiation of Candida vulvovaginitis.

Pregnancy is one of the most frequent predisposing factors.

Studies have shown that up to one third of pregnant women worldwide on any day can be affected.

The high levels of reproductive hormones and a rise in the vaginal environment’s glycogen content create a favorable environment for Candida species, providing an abundant source of carbon for candidal growth, germination, and adherence.

Also, the acidity of the pregnant vaginal flora can suppress the growth of other microorganisms that are naturally inhibitory to Candida

Even though the initial attachment of the organism occurs more readily at high pH values (6-7), the germ tube formation and the development of mycelia are favored by a low vaginal pH (< 5).


Older studies of women using high-dose estrogens in oral contraceptives found a higher vaginal growth by Candida.

The mechanism is believed to be similar to that found in pregnancy.

Newer oral contraceptives with a lower estrogen dose do not seem to predispose the patient to vulvovaginal candidiasis.

Other causes

Disorders linked with an altered immune response, such as acquired immunodeficiency syndrome (AIDS) and diabetes mellitus, also make women prone to Candida vulvovaginitis.

Antimicrobials are believed to predispose a patient to Candida by reducing the number of protective resident vaginal bacteria.

The most frequent offenders are broad-spectrum agents such as tetracycline, cephalosporins, and ampicillin-like medicines.

Tight-fitting undergarments are another potential factor in the development of vulvovaginal candidiasis.

A study showed Candida species in ejaculate fluid of partners of patients with recurrent Candida infections, but they suggested that the carrier rate may be low.

Traditionally, vulvovaginal candidiasis is not considered a sexually transmitted disease, because it occurs in celibate women, and Candida itself is considered part of the normal vaginal flora.

Recurrent vulvovaginal candidiasis

Even though most women with vulvovaginal candidiasis respond quickly to treatment, the recurrent form of the disease, defined as 4 or more episodes of infection per year, may occur (albeit in less than 5% of healthy women).

Predisposing factors for recurrent infection are present in only a minority of women

They are poorly controlled diabetes and immunosuppressive therapy.

Other factors that may predispose to recurrent infection are abnormalities in local vaginal mucosal immunity and genetic susceptibility.

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