Vulvovaginitis, a common if little understood problem

Maria Endah Hulupi, The Jakarta Post, Jakarta

Many women do not know the word vulvovaginitis even though they may be suffering from its symptoms: It is the most common cause of inflammation of women's genitalia.

"Most women with vulvovaginitis see doctors to treat this inflammation and as the infection can reoccur, many of them become frustrated and see different doctors for a permanent cure," said Forry Fortuna, an obstetrician with Jakarta Hospital in Central Jakarta.

"Seeing a doctor for proper diagnosis is highly recommended because the infection is triggered by different causes, but seeing different doctors for treating the flare-ups is not wise as this would hamper efforts to trace other possible factors that may trigger the condition."

Vulvovaginitis is inflammation of the vagina and vulva, commonly affecting women aged between 18 years to 40 years because this is the period when the cervix is more active in producing vaginal fluid.

The inflammation, which is not a sexually transmitted disease, can be caused by the fungus candida, bacterial and parasitic infections.

The normal, healthy vagina is a living environment for various good and bad bacteria and candida existing in balance.

Bacterial vulvovaginitis occurs after the balance in this environment is disturbed and gardnerella vaginalis outgrows "good" bacteria to trigger infections, while candida vulvovaginitis infection (also known as vaginal yeast infection) occurs because of an overgrowth of Candida albican or other types of candida.

Another cause of vaginitis is trichomoniasis, which can be spread through sexual contact.

Other factors that can trigger vulvovaginitis include failure to keep the vagina clean, allergic reaction, pregnancy, certain diseases (like diabetes mellitus), stress, certain types of contraception and antibiotics.

Overuse of spermicide and antiseptic douches also can kill good bacteria and enable candida to flourish.

Women with multiple sexual partners (or whose partner is promiscuous) are especially prone to bacterial vaginitis.

Forry also said that wearing tight clothing and pantyliners can encourage the growth of unaerobe bacteria (bacteria that live in the absence of oxygen), leading to vaginal inflammation as well.

Vulvovaginitis can lead to abnormal vaginal discharge, itching and irritation in the genital area, leaving the vagina and vulva with a reddish color. This condition is usually accompanied with pain during sexual intercourse and urination.

A change in vaginal pH can indicate the cause of the infection, pH lower that 4.5 indicates candidal infections, while 5-7 indicates bacterial infections.

Each infection may be indicated with different characteristics of the vaginal discharge.

Candida vulvovaginitis causes a milky white discharge of a thick consistency with a yeasty smell; Trichomoniasis is usually accompanied by a copious, foul-smelling yellowish or greenish discharge, while bacterial vaginitis causes a greenish discharge that sticks to the vagina lining.

"To determine the exact cause of the infection, a sample of vaginal discharge must be taken for further laboratory analysis," said Forry.

As a prevention, he advised women to be careful to maintain personal hygiene, particularly in the vaginal area, but not to overuse the antiseptic or vaginal solutions as there was the potential to disturb the balance of the vaginal flora.

He explained that it is better to change underwear more often and rinse the area with water three times everyday.

After defecating, clean the area by wiping from front to back to prevent transfer of bacteria from the anus to the vagina. Properly drying oneself after bathing and swimming as well as avoiding wearing tight clothing can also help prevent problems.

It is also important to balance a stressful routine with adequate sleep and hobby.

As abnormal vaginal discharge may also indicate another more serious illness, like cervical cancer, for example. Forry advised women aged 35 years old or older to undergo a pap smear to determine what was wrong with them.