Vaginitis is the most common reason for visits to the offices of obstetrics and gynecology physicians as well as constitutes a very large component of visits to primary care providers. Vulvovaginal discomfort does not usually create in a patient a sense of urgency, therefore, most of these patients are not going to present either to emergency departments or to urgent care centers or call physician offices for emergency consultations. However, with the effects of the Great Recession in the United States and with the increasing loss by patients of coverage for health care, there has been an increase in the number of patients presenting with these symptoms to urgent settings. Therefore, this chapter will briefly discuss some of the overall aspects of care of patients presenting with these conditions as well as the most common causes for these symptoms.

In the medical literature, the three most common causes identified as creating vulvovaginal discomfort are bacterial vaginosis, candidiasis, and trichomoniasis (1). Though these three conditions have been so described for quite a long time, currently, the most common cause of vulvovaginal discomfort in the United States is mucosal atrophy secondary to insufficient estrogen (2). This particular diagnosis will be seen increasingly in the next few years as the population of women in this country ages. Additionally, the result of the publication of the Women’s Health Initiative in 2002 lead to a 70% decline in the use of hormone replacement therapy in US postmenopausal women.

In approaching this problem, it should be understood that the term “itis” in vaginitis is probably a misnomer. “Itis” refers to inflammation. Very frequently, what is causing the symptoms in the patient’s vulvovaginal area is not an inflammation but a colonization or an abnormality in the bacterial flora of the vagina. Another concept that should be understood is that a lot of the symptoms are not arising in the vagina but in the vulva. The vulva in addition to being part of the urogenital system is also part of the integumentary system. Vulva is skin and any condition which can arise in the skin can also arise on the vulva.

One of the most common presentations of vulvovaginal atrophy due to estrogen deficiency is urethral meatal irritation, which the patient interprets as a urinary tract infection. Frequently, when these patients arrive at the care area, urine culture and urinalysis are negative. Other symptoms of estrogen lack are nonspecific sense of irritation as well as occasionally mild burning and some dyspareunia both intromissional as well as post coital. In the emergent setting, the patient should be reassured and a determination should be made as to whether the patient wants to be placed on systemic hormone replacement therapy or to be on localized therapy. There are multiple options for localized therapy (3,4,5). Estradiol vaginal tablets (Vagifem®) can be inserted vaginally twice weekly and can deliver 50 µ

Stay updated, free articles. Join our Telegram channel

Join