Vaginitis

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Also indexed as: Atrophic Vaginitis, Bacterial Vaginosis, Gardnerella Infection, Hormone-Related Vaginitis, Irritant Vaginitis, Trichomoniasis, Vulvovaginitis
Vaginitis, inflammation of the vagina, is responsible for an estimated 10% of all visits by women to their healthcare practitioners. The three general causes of vaginitis are hormonal imbalance, irritation, and infection. Hormone-related vaginitis includes the atrophic vaginitis generally found in postmenopausal or postpartum women and, occasionally, in young girls before puberty. Irritant vaginitis can result from allergies or irritating substances. Infectious vaginitis is most common in reproductive-age women and is generally caused by one of three types of infections: bacterial vaginosis (BV), candidiasis (yeast infection), or trichomoniasis. A healthcare professional should be consulted for the diagnosis and treatment of any vaginal infection.

Although it is a type of vaginitis, yeast infection is not discussed on this page. For specific information on yeast infections (i.e., vaginitis caused by Candida albicans), see the yeast infections article.

Checklist for Vaginitis

Rating Nutritional Supplements Herbs
  Lactobacillus acidophilus  
  Soy
Vitamin A
Vitamin E
Barberry
Echinacea
Goldenseal
Tea tree
 Reliable and relatively consistent scientific data showing a substantial health benefit.
 Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
 An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.
What are the symptoms of vaginitis? Hormone-related vaginitis is marked by dryness, irritation, thinning of the vaginal mucous membranes and painful intercourse. Irritant vaginitis is characterized by itching and soreness. Infectious vaginitis also itches and typically includes vaginal discharge that varies in color, consistency, and odor, depending upon the infectious organism. Discharge may range from scant to thick and white and may or may not be accompanied by a strong odor. Symptoms are often worse immediately after intercourse or the menstrual period.
Conventional treatment options: Conventional treatments vary with the cause of the vaginitis. Hormone-related vaginitis is commonly treated with estrogen replacement therapy, including conjugated estrogens (Premarin®) and ethinyl estradiol. Irritant vaginitis can be treated either by removal of the offending irritant or with an antihistamine agent, such as diphenhydramine (Benadryl®). Bacterial vaginosis and trichomoniasis are each commonly treated with metronidazole (Flagyl®).
Dietary changes that may be helpful: Food allergies are believed to be a contributory factor in some cases of recurrent irritant vaginitis.

In a controlled trial, women with recurrent BV or vaginal candidiasis ate 5 ounces (150 grams) of yogurt containing live Lactobacillus acidophilus daily.1 They had more than a 50% reduction in recurrences, while women who consumed pasteurized yogurt that did not contain the bacteria had only a slight reduction.

In another study, women who ingested 45 grams of soy flour per day showed an improvement in the estrogen effect on their vaginal tissue.2 That observation suggests that supplementing with soy may be helpful for preventing or reversing atrophic vaginitis.

Lifestyle changes that may be helpful: For irritant vaginitis, minimizing friction and reducing exposure to perfumes, chemicals, irritating lubricants, and spermicides can be beneficial.
Nutritional supplements that may be helpful: Lactobacillus acidophilus is a strain of friendly bacteria that is an integral part of normal vaginal flora. Lactobacilli help maintain the vaginal microflora by preventing overgrowth of unfriendly bacteria and Candida. Lactobacilli produce lactic acid, which acts like a natural antibiotic. These friendly bacteria also compete with other organisms for the utilization of glucose. The production of lactic acid and hydrogen peroxide by lactobacilli also helps to maintain the acidic pH needed for healthy vaginal flora to thrive. Most of the research has used yogurt containing live cultures of Lactobacillus acidophilus or the topical application of such yogurt or Lactobacillus acidophilus into the vagina. The effective amount of acidophilus depends on the strain used, as well as on the concentration of viable organisms.

Vaginal application of a proprietary Lactobacillus acidophilus preparation may help nonspecific vaginitis. In one trial, 80% of women with nonspecific vaginitis who used the preparation were either cured or experienced marked improvement in symptoms.3 In another trial, women who were predisposed to vaginal Candida infection because they were HIV-positive received either Lactobacillus acidophilus vaginal suppositories, the antifungal drug, clotrimazole (e.g., Gyne-Lotrimin®), or placebo weekly for 21 months.4 Compared to those receiving placebo, women receiving Lactobacillus acidophilus suppositories had only half the risk of experiencing an episode of Candida vaginitis—a result almost as good as that achieved with clotrimazole. In a preliminary trial, women with vaginal Trichomonas infection received vaginal Lactobacillus acidophilus suppositories for one year.5 Over 90% of them were reported to be cured of their clinical symptoms in that time.

Some doctors recommend vitamin E (taken orally, topically, or vaginally) for certain types of vaginitis. Vitamin E as a suppository in the vagina or vitamin E oil can be used once or twice per day for 3 to 14 days to soothe the mucous membranes of the vagina and vulva. Some doctors recommend vaginal administration of vitamin A to improve the integrity of the vaginal tissue and to enhance the function of local immune cells. Vitamin A can be administered vaginally by inserting a vitamin A capsule or using a prepared vitamin A suppository. Vitamin A used this way can be irritating to local tissue, so it should not be used more than once per day for up to seven consecutive days.

References:

1. Shalev E, Battino S, Weiner E, et al. Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent Candidal vaginitis and bacterial vaginosis. Arch Fam Med 1996;5:593–6.

2. Wilcox G, Wahlqvist M, Burger H, et al. Oestrogenic effects of plant foods in postmenopausal women. BMJ 1990;301:905–6.

3. Karkut G. Effect of lactobacillus immunotherapy on genital infections in women. Geburtshilfe Frauenheilkd 1984;44:311–4 [in German].

4. Williams A, Yu C, Tashima K, et al. Weekly treatment for prophylaxis of Candida vaginitis. Presentation. 7th Conference on Retroviruses and Opportunistic infections. Foundation for Retrovirology and Human Health in collaboration with the (US) National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention. January 30–February 2, 2000.

5. Litschgi MS, Da Rugna D, Mladenovic D, Grcic R. Effectiveness of a lactobacillus vaccine on Trichomonas infections in women. Preliminary results. Fortschr Med 1980;98:1624–7 [in German.]

6. Pena E. Melaleuca alternifolia oil: Its use for trichomonal vaginitis and other vaginal infections. Obstet Gynecol 1962;19:793–5.

7. Melchart D, Linde K, Worku F, et al. Immunomodulation with Echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245–54.

               

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