Management of persistent vaginitis.

With vaginitis remaining a common condition that leads women to seek care, it is not surprising that some women develop chronic vulvovaginal problems that are difficult to diagnose and treat. With a differential diagnosis that encompasses vulvar disorders and infectious and noninfectious causes of vaginitis, accurate diagnosis is the cornerstone of choosing effective therapy. Evaluation should include a symptom-specific history, careful vulvar and vaginal examination, and office-based tests (vaginal pH, amine test, saline and 10% potassium hydroxide microscopy). Ancillary tests, especially yeast culture with speciation, are frequently crucial to obtaining a correct diagnosis. A heavy but normal physiologic discharge can be determined by excluding other causes. With vulvovaginal candidiasis, differentiating between Candida albicans and non-albicans Candida infection has important treatment ramifications. Most patients with C albicans infections can be successfully treated with maintenance antifungal therapy, usually with fluconazole. Although many non-albicans Candida, particularly Candida glabrata, may at times be innocent bystanders, vaginal boric acid therapy is an effective first choice for many true non-albicans Candida infections. Recurrent bacterial vaginosis, a difficult therapeutic challenge, can often be controlled with maintenance therapy. Multiple options, especially high-dose tinidazole, have been used for metronidazole-resistant trichomoniasis. With the aging of the U.S. population, atrophic vaginitis and desquamative inflammatory vaginitis, both associated with hypoestrogenism, are encountered frequently in women with persistent vaginitis.

Efficacy and safety of vaginal estriol and progesterone in postmenopausal women with atrophic vaginitis.

OBJECTIVE: The aim of this study was to assess the efficacy and safety of intravaginal estriol and progesterone on atrophic vaginitis in postmenopausal women. METHODS: Under a physician-sponsored Investigational New Drug application, 19 healthy postmenopausal women with atrophic vaginitis received vaginal suppositories containing estriol (1 mg) and progesterone (30 mg). The participants were instructed to insert one suppository intravaginally once daily for 2 weeks and thrice weekly for a total of 6 months. Vaginal pH, Vaginal Maturation Index, urinalysis, self-reported vaginal dryness, menopausal quality of life, and serum estriol and progesterone levels were measured at enrollment and after 3 and 6 months of suppository use. Endometrial biopsies were obtained at enrollment and at 6 months. After 2 weeks of therapy, six participants had serum estriol and progesterone measured. RESULTS: The Vaginal Maturation Index, vaginal pH, and vaginal dryness rating improved significantly at 3 and 6 months compared with baseline. Menopausal quality of life scores improved significantly in all domains, with the sexual subscale showing the most improvement. There were no cases of endometrial hyperplasia after 6 months of suppository use. Serum preinsertion estriol at week 2 and months 3 and 6 were similar to baseline levels. Serum preinsertion progesterone increased but returned to baseline preinsertion levels at month 6, and preinsertion levels were significantly less at month 6 compared with month 3. CONCLUSIONS: Intravaginal administration of a combination estriol and progesterone agent to women with atrophic vaginitis may represent a safe and effective alternative to systemic hormone replacement, although this study was not adequate to provide proof of efficacy given that it was uncontrolled.

Lactational atrophic vaginitis.

Atrophic vaginitis is typically associated with the hypoestrogenic state of menopause. However, lactation also decreases estrogen levels and can cause symptomatic urogenital atrophy. Discussion of this clinical phenomenon in the literature is minimal. A case report of atrophic vaginitis at 13 months postpartum is presented. Mechanisms of action, evaluation, and treatments for lactational atrophic vaginitis are reviewed with recommendations for further research on this topic.

[Experience with tantum rosa treatment for the prevention and management of radiation-induced proctitis and vaginitis in uterine and vaginal cancer]. / Opyt ispol'zovaniia preparata tantum roza pri profilaktike i lechenii luchevykh rektitov i vaginitov u bol'nykh rakom matki i vlagalishcha.

The investigation has been concerned with the efficacy of Tantum Rosa (Angelini Francesco, Italy) in the prevention (21) and therapy (87) of early- and late-onset radiation injuries of the rectum and vagina in patients exposed to radiation for cervical, uterine or vaginal carcinoma. Rectal tenesmus and pain subsided following 3-4 administrations at early stages of radiation rectitis. Intestinal discomfort was avoided when Tantum Rosa was used for prophylaxis. Therapeutic effect was reported after 7-10 administrations for moderate radiation vaginitis. Therapy for pannicular epithelite lasted less than two weeks.

The use and physical effects of intravaginal substances in Zairian women.

Women in Kananga, Zaire, sometimes insert substances into the vagina to enhance sexual pleasure. The objective of this study was to ascertain: 1) what intravaginal substances are used, 2) the prevalence and frequency of their use, and 3) the visible effects they produce on the female genitalia. Focus group discussions with women and men were conducted, and both prostitutes and non-prostitutes were interviewed individually about their sexual preferences and practices. The cervices and vaginae of eight women were inspected and photographed before and after the insertion of commonly used substances. It was found that Kananga residents preferred a "dry-tight" vagina during coitus. They named thirty substances (leaves and powders) that women insert to produce this sensation. Twenty-one of 50 prostitutes (42%), and 17 of 49 non-prostitutes (35%), had used such intravaginal substances. Inspection of the genitalia showed that five different leaves produced inflammatory reactions that lasted up to a week. These genital irritations might facilitate the transmission of pathogenic organisms. Investigators elsewhere should study the use of intravaginal substances and their relationship to sexually transmitted diseases.

High-energy proton beam radiation therapy for gynecologic malignancies. Potential of proton beam as an alternative to brachytherapy.

Fifteen patients with advanced gynecologic malignancies were treated with high-energy proton beam radiation therapy (RT) at the Particle Radiation Medical Science Center (PARMS), Tsukuba University, Japan, from 1983 to 1987. The potential of proton beam RT as an alternative to conventional brachytherapy was evaluated. Except for one local recurrence, 14 of 15 patients were locoregionally controlled for 15 to 57 months. Two-year local control rate and 2-year survival rate were 92.3% and 93.3%, respectively. Two cases of transient, radiation-induced proctitis (neither of which required surgical treatment) were the only complications despite a target dose that exceeded 8000 cGy in most cases. The results suggest that sharply localized, high-dose proton beam RT can produce an antitumor effect equivalent to that of conventional brachytherapy.

Cold wombs in balmy Honolulu: ethnogynecology among Korean immigrants.

Koreans attribute a wide variety of complaints to naeng, literally 'chill'. For women, a cold imbalance of the womb brings on a heavy vaginal discharge (also called naeng), can lead to sterility, and may precipitate other kinds of discomfort. Working in Korea, Dorothea Sich and her colleagues have described the folk etiology of naeng and some subtle transformations of the concept in cosmopolitan medical settings. I am less interested in describing the concept of naeng than in appreciating the complex interlayering of information and experience that shapes a Korean woman's sense of illness or well-being when she describes an intimate condition as naeng, and that may be lost in translation when she presents her condition to an American clinician. My informants were socialized as Korean women, they were veterans of a plural medical system in Korea, they were novices at seeking health care in Honolulu, and they were individuals, carrying the baggage of their own lives. These various dimensions emerge through interview data and, especially, through three detailed case studies. It is argued that a cookbook definition of cold wombs as folk illness would not explain the particular anxieties that naeng sufferers bring to a clinic; the vocabulary they use is vested with nuances that are personal as well as Korean, humoral as well as cosmopolitan.

Susceptibility of Gardnerella vaginalis to thiamphenicol: clinical experience with nonspecific vaginitis.

We compared the in-vitro activity of thiamphenicol against 100 strains of Gardnerella vaginalis with the activity of 11 other antimicrobial agents. The MICs for thiamphenicol ranged from 0.39 micrograms/ml to 6.25 micrograms/ml. The concentration at which 50% of strains were inhibited (MIC50) was 1.96 micrograms/ml, and the concentration at which 90% of strains were inhibited (MIC90) was 3.93 micrograms/ml. All strains were very susceptible to erythromycin, chloramphenicol, beta-lactam antibiotics, and clindamycin. Tetracycline and metronidazole were only moderately active. In an attempt to cure G. vaginalis-associated vaginitis with a single-dose treatment, we administered 2.25 g of thiamphenicol to 20 volunteers; 17 were clinically and bacteriologically cured. In two cases we observed that G. vaginalis was not eliminated immediately (i.e., at the first follow-up visit), but we saw a progressive disappearance of the strain without further treatment. In one case the treatment seemed to have failed but reinfection could not be ruled out. The results show that a single dose of thiamphenicol can cure G. vaginalis-associated vaginitis.

Bacterial vaginosis. An evaluation of treatment.

Various treatment regimens for bacterial vaginosis are reviewed. Orally administered metronidazole and tinidazole have been consistently successful, whereas widely variable results have been published from use of peroral ampicillin or tetracycline and from locally applied sulphonamide cream. The rationale for different treatments is discussed, with particular regard to the pathogenesis of the disease.