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Chronic Vaginitis

The Never-Ending Vaginal Uncomfortable Symptoms
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Vaginitis is an umbrella medical term for ‘inflammation of the vagina’. It is commonly associated with abnormal vaginal discomfort symptoms such as itch, abnormal discharge, burning or pain sensation over the vagina. Chronic vaginitis occurs when the unusual vaginal symptoms occur more than 6 months.

Chronic vaginitis can be a frustrating journey for both patients and physicians. The condition brings in its wake frequent clinic attendees and a cost burden to patients and the healthcare system. With unresolved clinical symptoms, patients often default to medical follow-up at some point, leading to further poor diagnosis and management of the condition.  

This article strives to highlight the medical condition of chronic vaginitis that significantly affects many women’s quality of life and discuss the common practical pitfalls we face in the management of chronic vaginitis. It seeks to empower both patients and physicians to be more insightful of the condition and be proactive and compliant in treating the chronic condition.

Chronic vaginitis
Symptoms caused by chronic vaginitis can impact one’s quality of life and be the source of frustration and discomfort. 

What are the causes of chronic vaginitis?

We can broadly subdivide the causes of chronic vaginitis into infection-related causes versus non-infection-related causes. The top 3 common infectious causes of chronic vaginitis seen in child-bearing-aged ladies are:

  • Candidiasis: a fungal disease caused by yeast known as Candida. 
  • Bacterial vaginosis: also known as non-specific vaginitis, occurs due to an imbalance of bacterial growth in the vagina. 
  • Trichomonas parasitic infection: a sexually transmitted infection, commonly known as tric
Infection female reproductive system
Vaginitis can be caused by underlying infections of the reproductive system.

It is important to be cautious of possible concurrent infection with sexually transmitted diseases such as chlamydia, gonorrhoea, mycoplasma genetalium, herpes, HIV and etcetera. 

Non-infectious causes of chronic vaginitis are usually associated with background dermatological issues such as irritation secondary to topical use of chemical or douche materials, underlying health issues such as eczema and lichen planus, and hormonal changes secondary to menopause.

As each patient may have a different trigger or cause(s) for chronic vaginitis, it is worth seeing your trusted physician for further evaluation.

What is a normal healthy vaginal discharge?

Every female’s vaginal discharge may differ. It is worth noting your baseline (usual) discharge colour, consistency and volume since you were young. Vaginal discharge will be present in every woman. Generally, the discharge is usually colourless to whitish, with no abnormal odour and a healthy normal baseline volume. The discharge consistency can be more ‘albumin-like’ or ‘milky’ during the mid-cycle or ovulatory phase and slowly becomes slightly thicker towards the end of the menstrual cycle.

What are the abnormal vaginal symptoms that I should seek medical attention for?

Symptoms such as vaginal itchiness, vaginal odour, excessive vaginal volume discharge, yellow to greenish copious amount of vaginal discharge, painful intercourse, painful urination, pelvic or lower back pain, and fever may be suggestive of an underlying health condition yet to be addressed. 

In the long run,  unattended chronic vaginitis may develop complications of pelvic inflammatory disease with womb and fallopian tube inflammation and scarring, leading to infertility and chronic pelvic pain presentation.

Please seek medical attention before chronic vaginitis progresses into long-term health complications.

Vaginal discharge
Changes in the colour and consistency of vaginal discharge warrant medical intervention.

What are the common reasons associated with failure of treatment of chronic vaginitis?

1. Lack of clinical swab testing

This is one of the major common scenarios seen in chronic vaginitis or unresolved vaginitis. It is important to consider clinical vaginal swab tests to cast a broader net of diagnostic screening. Without swab testing, there may be a missed opportunity and a time lag in arriving at the correct diagnosis. Furthermore, a person can simultaneously have a few types of vaginal infections, which clinical swab testing can detect at early stages. 

It is unfortunately common for patients to repeatedly visit clinics in hopes of seeking a resolution to no avail. They are usually given various options of medications ranging from tablets to topicals to intravaginal pessaries during clinic visits, only to have their symptoms wax and wane.

Blind treatment may ease the symptoms temporarily by treating the surface infection, while the remaining infection(s) may linger and cause further recurrence of vaginal symptoms. If your symptoms are not recovering, do let your doctor know and consider vaginal swab testing to ensure the condition is managed appropriately.

vaginal swab test
Vaginal swab testing helps cast a broader net of diagnostic screening.

2. We live in a dynamic world 

With the evolution of time, relationships may not work out how we wish to. The new partner that you engage with may be carrying an undiagnosed infection from their previous partner without knowing- unless regular screenings have been done.

An unresolved history of vaginitis may be due to underlying concurrent infection, including sexually transmitted infection(s) that has yet to be addressed. In this situation, with appropriate testing and receiving proper treatment, the vaginitis will resolve. Sexual partners must be screened and treated to avoid reinfection between the couple.

Fortunately, it is becoming common practice to conduct medical checkups between couples and consider regular sexual health screening to address and treat any asymptomatic STIs.

3. The habit of ‘Doctor-Hopping’

This is another common scenario seen in the community. A patient may see Dr A due to convenience for her condition. Subsequently, when there is a resurfacing of similar symptoms, the patient will then consult Dr B, and if the symptoms are not better, a further consult with Dr C. 

The unspoken issue here: whenever the patient sees a new doctor, unless a proper history or examination is taken, the patient may be treated for that ‘snap-moment’ without taking into consideration the previous symptoms, tests that were offered or treatment that was received. This leads to poor patient care as there is no continuity of care. The constant change of medical providers reduces their ability to fully comprehend patients’ conditions, subsequently failing to provide the comprehensive care that patients deserve. 

It is ideal and advisable to stay with the same doctor you are comfortable with for the long-term management of the vaginitis condition. This will ensure better overall patient care and allow the best possible treatment to be offered to the patient.

doctor hopping
Doctor-hopping results in a lack of continuity of care.

4. Self-medicating

Given recurring and unresolved vaginal symptoms, a patient may opt for various complementary treatment methods. With the rise of social media and digital resources, there is a wide variety of street medications – that promise and guarantee a cure for vaginitis. 

It is important to discuss with your doctor before embarking on self-treatment, as complementary medications may lack clinical evidence and may not work. This may lead to spending excessively and unnecessarily on treatment that is not beneficial at all. Besides, certain over-the-counter products may even serve as an irritant and exacerbate further the symptoms of vaginitis. 

Societal implication of chronic vaginitis

Vaginitis is a medical condition frequently encountered in females. It is one of the causes that lead to frequent attendees in primary care or outpatient clinic settings. Poor management, poor patient insight, wrong diagnosis, and polypharmacy bring in its wake cost and time burden to patients and health care. Furthermore, without resolution of the symptoms, it can create stress and anxiety for the patient and tension in the relationship between couples as well. 

Can we resolve chronic vaginitis?

Thankfully, the treatment outcome for vaginitis is fair, and it is possible to abort and cure the symptoms.  Empowering and educating female patients on the expectation of normal vs abnormal vaginal health symptoms, the possible causes and pitfall triggers may improve the outcome of this condition. In patients who have exposure to possible vaginal infections, the role of vaginal swabbing is vital to consider to nip the cause(s) in the bud in delivering the proper treatment. Lifestyle triggers can be discussed between doctors and patients to reduce the chances of recurrence of vaginal infection.

References

  1. Sheppard C. Treatment of vulvovaginitis. Aust Prescr. 2020 Dec;43(6):195-199. doi: 10.18773/austprescr.2020.055. Epub 2020 Dec 1. PMID: 33363301; PMCID: PMC7738700.
  2. Schwebke JR, Gaydos CA, Nyirjesy P, et al: Diagnostic performance of a molecular test versus clinician assessment of vaginitis. J Clin Microbiol 56 (6):e00252-18, 2018. doi: 10.1128/JCM.00252-18
  3. Gaydos CA, Beqaj S, Schwebke JR, et al: Clinical validation of a test for the diagnosis of vaginitis. Obstet Gynecol 130 (1):181–189, 2017. doi: 10.1097/AOG.0000000000002090
  4. Hildebrand JP, Kansagor AT. Vaginitis. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470302/
  5. Nyirjesy P, Weitz V, Grody T, et al. Over-the-counter and alternative medicine in the treatment of chronic vaginal symptoms. Obstet Gynecol 1997;90:50
  6. Eschenbach, D, Glob. libr. women's med. Infectious vaginitis (ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10491

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