Blue Light-Emitting Diode Therapy for Chronic Vulvovaginitis Symptoms: A Series of Cases.

Objective: This pilot study aimed to evaluate the characteristic signs and symptoms of chronic vulvovaginitis after blue light-emitting diode (LED) treatment. Methods: Women with characteristic signs and symptoms of vulvovaginitis were interviewed to obtain clinical and sociodemographic data. They answered the Female Sexual Function Index (FSFI) and the World Health Organization Quality of Life (WHOQOL)-bref questionnaires. Women with a suspected diagnosis of vulvovaginitis underwent clinical examination by a gynecologist, followed by microbiological evaluation, potassium hydroxide testing, vaginal pH assessment, and collection of vaginal fluid for oncotic cytology and fungal culture. The study participants were instructed to return after 15 days to undergo the 405 nm blue LED treatment, which consisted of three biweekly sessions. After 28 days of treatment completion, the patients returned for clinical re-evaluation and reassessment of the FSFI and WHOQOL-bref scores. Results: All eight women reported improvement or cure of at least one characteristic sign or symptom of vulvovaginitis, and five showed improvement in total FSFI and WHOQOL-bref scores. Conclusions: Treatment with blue LED may improve or cure symptoms associated with vulvovaginitis, sexual function, and the global quality of life score. Clinical Trial registration: NCT03075046 dated March 9, 2017.

Efeito da suplementação de lactobacillus spp. no tratamento e prevenção de candidíase vulvovaginal e vaginose bacteriana / Effect of supplementation of lactobacillus spp. in the treatment and prevention of vulovo-vagandal candidiasis and bacterial vaginosis

Este artigo de revisão avaliou os benefícios do uso dos Lactobacillus spp. no tratamento das vulvovaginites, utilizando artigos experimentais com humanos entre 2005 e 2015, através da suplementação de Lactobacillus spp. via oral e intravaginal. Verificou-se que os Lactobacillus spp. têm a capacidade de restaurar a microbiota vaginal e, quando combinados com o tratamento convencional das vulvovaginites, apresentam melhores resultados na redução de recorrências das infecções e dos sintomas, aumentando a competência imunológica do hospedeiro. Além disso, podem ser utilizados por um longo período sem efeitos secundários prejudiciais, diferentemente da terapia padrão, representando uma opção otimista de tratamento alternativo.

This review article evaluated the benefits of the use of Lactobacillus spp. in vulvovaginitis treatment, using experimental articles with humans between 2005 and 2015, through the Lactobacillus spp. Supplementation oral and intravaginal. It was found that Lactobacillus spp. have the ability to restore the vaginal microbiota and, when combined with vulvovaginitis conventional treatment, show better results in the reduction of recurrence of infection and symptoms, increasing the immunocompetence of the host. Futhermore, Lactobacillus spp. can be used for a long period without harmful side effects, unlike the standard therapy, representing an option optimistic alternative treatment.

Vulvovaginitis and the treatment of asymptomatic partners: a systematic review and meta-analysis / Vulvovaginite e o tratamento de parceiros assintomáticos: uma revisão sistemática e metanálise

Treating sexual partners of women with vaginal candidiasis and bacterial vaginosis is a discussed topic. Despite the recommendations of international guidelines, doctors are still known to treat asymptomatic partners. Objective: To evaluate the influence of asymptomatic partner treatment inthe cure and recurrence of vulvovaginitis in women. Methods: The following databases were searched using Mesh terms: PubMed, Embase, SciELO and CINAHAL. The selection criteria included randomized clinical trials published from 1982 to 2012. Studies involving pregnant women were excluded.Methodological quality was assessed using Jadads scale. Review Manager 5.1 was used for statistical analysis. Results: Eight randomized clinical trials were included based on the chosen criteria: 1,088 women were enrolled. For bacterial vaginosis, the relative risk for cure was 1.00 (95%CI 0.95-1.05,p=0.13), and for recurrence 0.84 (95%CI 0.62-1.14, p=0.34). Vaginal candidiasis had a RR of 1.03 (95%CI 0.94-1.14, p=0.48) for cure, and 1.02 (95% CI0.77-1.33, p=0.91) for recurrence. Conclusion: Treatment of asymptomatic sexual partners of women with vaginal candidiasis or bacterial vaginosis does not affect the cure or recurrence rates and may increase the risk of side effects and unnecessary financial costs.

O tratamento de parceiros sexuais de mulheres com candidíase vaginal e vaginose bacteriana é um assunto muito abordado. Apesar das recomendações estabelecidas nos manuais internacionais, este tópico ainda é muito questionado por um grande número de médicos que prosseguem desobedecendo estes manuais. Objetivo: Avaliar a influência do tratamento de parceiros assintomáticos na cura e recorrência de vulvovaginite em mulheres. Métodos: Foi realizada busca com descritores específicos nas seguintes bases de dados: PubMed, Embase, SciELO e CINAHAL. No critério de seleção foram incluídos ensaios clínicos randomizados publicados no período de 1982 a 2012. Estudos envolvendo mulheres grávidas foram excluídos. Na avaliação qualitativa, utilizou-se a Escala de Jadad. A análise dos dados foi realizada por meio do programa estatístico Review Manager 5.1. Resultados:Oito ensaios clínicos randomizados foram selecionados: 1.088 mulheres foram escolhidas. Na vaginose bacteriana, o risco relativo para cura foi de 1,00(IC95% 0,95-1,05, p=0,13) e para recorrência foi de 0,84 (IC95% 0,62-1,14, p=0,34). A candidíase vaginal apresentou risco relativo de 1,03 (IC95% 0,94-1,14, p=0,48) para cura e de 1,02 (IC95% 0,77-1,33, p=0,91) para recorrência. Conclusão: O tratamento do parceiro sexual assintomático de mulheres com candidíase vaginal e vaginose bacteriana não afetaria as suas taxas de cura e recorrência, como também poderia causar efeitos colaterais e custos desnecessários.

Vulvovaginitis and the treatment of asymptomatic partners: a systematic review and metanalisis

Treating sexual partners of women with vaginal candidiasis and bacterial vaginosis is an issue in debate. Despite the present recommendations of the international guidelines to not to treat the asymptomatic sexual partners, this is a frequent practice between gynecologists. Objective: evaluate the influence of treating asymptomatic sexual partner of women with recurrent vulvovaginitis. Methods: databases searched: PubMed, Embase, Scielo and CINAHAL. Selection criteria: randomized clinical trials published from 1982 to 2012 were included. Studies involving pregnant women were excluded. Methodological quality was assessed using the Jadad scale. Data collection and analysis: Review Manager 5.1 was used for statistical analysis. Results: eight randomized clinical trials were included based on the chosen criteria: 1,088 women were enrolled. For bacterial vaginosis, the RR for cure was 1.00 (95%CI: 0.95?1.05) (p = 0.13), and for recurrence 0.84 (95%CI: 0.62-1.14) (p = 0.34). Vaginal candidiasis had a RR of 1.03 (95%CI: 0.94-1.14) (p = 0.48) for cure, and 1.02 (95%CI: 0.77?1.33 p = 0.91) for recurrence. Conclusion: treatment of asymptomatic sexual partners of women with vaginal candidiasis or bacterial vaginosis does not affect the cure or recurrence rates and may increase the risk of side effects and unnecessary financial costs.

Vulvovaginal candidiasis in Mato Grosso, Brazil: pregnancy status, causative species and drugs tests

Causative agent in majority of VVC is Candida albicans, but infection due to non-C. albicans is common. Use of empiric antifungal therapy in Brazil due to syndromic management of vulvovaginitis could act as risk factor for increase resistance among VVC causative agents. From Mato Grosso patients, 160 with culture-proved among 404 women who had clinical symptoms of VVC, were enrolled in this study. 70 non-pregnant women and 90 pregnant women were included. Candida albicans was the most prevalent, representing 72.9 percent in the non-pregnant group and 92.3 percent in the pregnant group. Differences in species distribution were noted between the two groups, being C. parapsilosis the second more prevalent species among non-pregnant women. Susceptibility testing revealed high susceptibility to fluconazole (except for C. krusei), itraconazole, ketoconazole, and amphotericin B regardless the species (C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei) analyzed.

Voiding dysfunction: another etiology of vulvovaginitis in young girls.

OBJECTIVE: To determine the prevalence of voiding dysfunction (VD) in patients with persistent vulvovaginitis (PVV), and to evaluate the clinical response of PVV in the treatment of VD. PATIENTS AND METHODS: Girls four years or older who consulted for PVV for at least one month and who did not respond to general measures. A physical examination was performed with visual inspection and colposcopy; vaginal samples for culture and vaginoscopy were carried out. On every patient urodynamic studies were performed. Girls who were diagnosed with VD were treated. A pediatric gynecologist did the follow-up; a successful response was considered when inflammatory symptoms and vaginal discharge ceased. RESULTS: Twenty patients were included, mean age 8.6 years (range: 4.6-14 years); 75% prepubertal symptoms lasted for 1.8 years; 19 (95%) had urodynamia, 10 (52.6%) had an overactive bladder, 8 (42.1%) external bladder sphincter dyssynergia, 1 (5.2%) hypotonic bladder, and 13 (65%) showed improvement. CONCLUSION: VD is an important cause when considering the etiology of PVV.

[Lactic acid and lactoserum in vulvovaginal infections]. / Acido láctico y lactoserum en infecciones vulvovaginales.

BACKGROUND: The discomfort of vaginal infection symptoms is a frequent cause of medical consultation. OBJECTIVE: To determine the degree of satisfaction reported by a group of Mexican patients used the combination lactoserum lactic acid and to the relief of vulvovaginal symptoms (odor, itching and burning) or not associated with infection and the safety of that combination when used for external genital hygiene daily. PATIENTS AND METHOD: Clinical observational, prospective, multicenter open and made with a group of Mexican women 18-60 years of age, residents in cities across the country with some or vulvovaginal symptoms: foul odor, itching, burning. All participants were told the application, once daily, 2.5 to 5 mL of shampoo, for 14-21 days. The patients rated the presence and severity of vulvar discomfort with visual analogue scale. The data were analyzed with Statistical Analysis System statistical package version 9.1, the quantitative variables by calculating the mean +/- standard deviation, categorical variables by calculating percentages. RESULTS: We included 559 patients who answered the questionnaires before and after treatment. The time-use shampoo study was variable, with less than seven days were 25 patients (4.5%), 8 to 14 days 123 patients (22.0%) of 15 to 21 days, 208 patients (37.3%) and 178 patients (31.9%) used it more than 21 days. The average time elapsed since the start of treatment until the disappearance of vulvar discomfort was 4.3 days, with a SD of 3.1. In symptomatic patients the average was 4.2 days (SD 3.3), while in asymptomatic patients was 4.4 days (SD 3.0), virtually the same between groups. At the time of the final visit, 92.2% of patients reported "feeling of cleanliness" in the genital area, 91.7% "fresh feeling" and 93.9% "general feeling of wellbeing". 97.2% felt that the product is "user friendly", 94.9% considered it "soft and gentle to the skin" and 95.2% described it with "pleasing aroma". CONCLUSIONS: Shampoo daily female external genital hygiene, the reason for this study is useful in the disappearance of the symptoms associated with infection or vulvovaginal.

Microbiota vaginal: manejo das vulvovaginites no climatério / Vaginal microbiota: management of vulvovaginitis in climacteric

A menopausa é um fenômeno fisiológico na vida das mulheres, decorrente da falência ovariana. Como consequência, o hipoestrogenismo é responsável por vários sintomas, incluindo aqueles provenientes da atrofia urogenital. A mucosa vaginal torna-se fina e ressecada, podendo causar desconforto vaginal, ardor, prurido, ressecamento e dispareunia. Na pós-menopausa, o hipoestrogenismo pode ser responsável por mudanças na microbiota e no pH vaginal, predispondo à ocorrência de quadros de vulvovaginite atrófica. Os autores revisam o tema enfatizando a importância do diagnóstico correto dos sintomas urogenitais no climatério, assegurando que a terapia adequada seja instituída. Estudos controlados confirmam que a utilização de baixas doses de estrógenos por via vaginal é eficaz no tratamento da atrofia genital, devendo ser mantida até que os sintomas sejam atenuados. O uso associado de progestagênios não tem indicação absoluta, quando os estrógenos estão sendo utilizados em baixas doses por via vaginal. Os dados da literatura são insuficientes para recomendar a necessidade de vigilância anual do endométrio para mulheres assintomáticas que fazem uso de estrógenos apenas pela via vaginal. A paciente com antecedentes de neoplasias hormônio-dependente deve ter indicação de hormonioterapia individualizada e de acordo com o risco-benefício.

Menopause is a physiological phenomenon in women's lives, as a result of ovarian failure. As a result, the hypoestrogenism is responsible for many clinical symptoms, including those from the urogenital atrophy. The vaginal mucosa becomes thinner and dry, which can result in vaginal discomfort, dryness, burning, itching, and dyspareunia. In post-menopause, the hypoestrogenism can still be responsible for changes in vaginal pH and vaginal microflora, predisposing the occurrence of atrophic vaginitis. The authors review the topic emphasizing the importance of the correct diagnosis of urogenital symptoms in climacteric women, ensuring the appropriate therapy. Randomized controlled trials have confirmed that the use of local vaginal estrogen in low doses is effective in the treatment of genital atrophy, and should be maintained until the symptoms are mitigated. The combined use of progestagens has no absolute indication when estrogens are used vaginally in low doses. Data are insufficient to recommend annual endometrial surveillance in asymptomatic women using vaginal hormonal therapy. For women with a history of hormone-dependet cancer, the indication of vaginal estrogens, even at low dose must be individualized according to the risk-benefit assessment.

Vulvovaginitis bacteriana en la prepúber / Bacterial vulvovaginitis in prepubertal girl

Considerando la alta incidencia de vulvovaginitis en la consulta de ginecología pediátrica y de adolescentes, y los aspectos únicos de la microbiología y endocrinología de la paciente prepúber se presenta una revisión de la literatura con lo más relevante de los últimos 5 años, en lo que se refiere a epidemiología, etiología, diagnóstico y tratamiento de la vulvovaginitis bacteriana específica de la niña prepúber. No existe claridad acerca de la microflora vaginal normal, lo cual dificulta en gran medida la interpretación de muestras. De acuerdo con la evidencia actual podemos decir que ante la vulvovaginitis específica de la prepúber debemos tener en consideración como principales agentes causales: patógenos respiratorios, epidérmicos y entéricos; higiene defectuosa, cuerpos extraños, irritantes, enfermedades dermatológicas vulvares, defectos anatómicos y abuso sexual. Streptococcus hemolitico del grupo A y Haemophilus influenzae son patógenos prevalentes.

Allergic vulvovaginitis.

LEARNING OBJECTIVES: The reader of this review will learn about the different clinical forms of allergic vulvovaginitis. This specific and important chapter has not been previously summarized and described in the medical literature. Vaginal mucosa is also able to show an allergic response similarly to the nose, eyes, lungs, and skin. Physicians should be familiarized with this kind of manifestation in order to make the proper diagnosis and evaluation of this entity. DATA SOURCES: MEDLINE searches were undertaken since 1966 for citations of any kind of allergic vulvovaginitis. Relevant reviews and articles identified in this process were surveyed for additional and earlier citations. Textbooks of medicine, gynecology, dermatology, and infectious diseases have also been consulted. Old medical textbooks and journals of allergy and internal medicine were recovered from the Division of History of the Medicine of the Faculdade de Medicina da Universidade Federal de Minas Gerais (Federal Medical College), Belo Horizonte, Brazil. CONCLUSIONS: A great variety of allergens are able to provoke allergic reactions in the female genital tract. The immunology of the vagina, the influence of hormones, menstrual cycle, and psychologic factors are also highlighted in this review. A possibility of vaginal hyperreactivity is proposed in this text. Adequate management provides important relief of symptoms in the majority of cases.

Alergia vulvovaginal por ácaros em crianças: relato de casos, tratamento e revisäo de literatura / Allergic vulvovaginitis caused by house dust mite in children: cases report, treatment and review of literature

A autora chama atençäo para a possibilidade de os ácaros domiciliares serem causadores de sintomas vulvovaginais, relatando três casos de crianças alérgicas, nas quais se excluíram causas infecciosas desses sintomas. Reaçöes alérgicas podem ocorrer em qualquer superfície cutâneo-mucosa, inclusive na vulva e vagina. Antígenos como alimentos, drogas, sêmem, látex, Candida albicans e polens já foram descritos como sendo capazes de desencadear estas reaçöes. Desde o início do século, autores relatam a participaçäo dos polens na gênese de vulvovaginites, mas näo ainda a de ácaros. Por outro lado, os ácaros domiciliares säo responsáveis por sabidas manifestaçöes alérgicas no nariz, olhos, pulmöes e pele, näo havendo portanto razäo de excluí-los de uma sensibilizaçäo vaginal. A resposta vaginal nas doenças alérgicas tem sido tremendamente negligenciada e subinvestigada, havendo necessidade de um maior número de estudos e um adicional interesse por parte dos pesquisadores

Vulvovaginitis en niñas / Vulvovaginitis in children

Las infecciones del tracto genital en las niñas premenárquicas se limitan casi exclusivamente a vulva y vagina, siendo ésta la patología de consulta más frecuente en ginecología infantil. La edad de presentación más común es entre los 2 y 7 años. Si bien no representa una afección grave, los resultados terapéuticos no son siempre exitosos. Para enfocar esta patología se requiere que el profesional conozca las diferentes manioblas para el estudio, como así también disponer de tiempo para lograr una comunicación adecuada con la paciente, sus padres o familiares

Vulvovaginites: Aspectos Dietéticos e Bioquímicos / Biochemical and Nutritional Aspects of Vulvovaginitis

A vulvovaginite, expressäo de diversas patologias que acometem o trato genital inferior feminino, é conhecida desde Hipócrates e Soranus como importante manifestaçäo de distúrbios potencialmente graves para a saúde genital e sistêmica das mulheres. Vários trabalhos já enfocaram com muita ênfase, os aspectos microbiológicos destas doenças, porém pouca coisa tem sido feita em funçäo dos fatores coadjuvantes que poderiam favorecer ou dificultar a instalaçäo das mesmas. Neste artigo säo enfocados os aspéctos bioquímicos e nutricionais do conteúdo vaginal fisiológico, dando uma descriçäo dos achados mais frequentes, bem como as possíveis interaçöes com a microflora. Os mecanismos de proteçäo ou de facilitaçäo do corrimento vaginal säo apontados, estressando a importância dos aminoácidos e imunoglobinas, secretadas principalmente a nível local. O conhecimento de tais aspectos, pode servir como chave importante para o ginecologista estabelecer uma correlaçäo entre os achados clínicos e laboratoriais e conseqüentemente elucidar a açäo fisiopatogênica em determinados casos, base fundamental para o perfeito diagnóstico e tratamento

Vulvovaginitis en niñas / Vulvovaginitis in children

Las infecciones del tracto genital en las niñas premenárquicas se limitan casi exclusivamente a vulva y vagina, siendo ésta la patología de consulta más frecuente en ginecología infantil. La edad de presentación más común es entre los 2 y 7 años. Si bien no representa una afección grave, los resultados terapéuticos no son siempre exitosos. Para enfocar esta patología se requiere que el profesional conozca las diferentes manioblas para el estudio, como así también disponer de tiempo para lograr una comunicación adecuada con la paciente, sus padres o familiares(AU)

Vulvovaginites / Vulvovaginitis

As autoras abordam de modo prático os aspectos de diagnóstico e tratamento das vulvovaginites. Fazem considerações a respeito da sua classificação e de sua frequência, nas diferentes idades da mulher. Dissertam sobre os tipos mais comuuns, as causadas por C. albicans, por T. vaginalis e por G. vaginalis. Descrevem a conduta no seu diagnóstico e tratamento

Vulvovaginites alérgicas / Allergic vulvovaginitis

A mucosa vaginal estß imunologicamente apta a responder a um estímulo alergênico. Uma variedade de antígenos envolvidos nessas reaçöes, os mecanismos, as conseqüências e o tratamento säo revistos, consideradando-se também a influência dos fatores hormonais emocionais, e dos irritantes inespecíficos.