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Misunderstandings in the Treatment of Vaginitis

Vaginitis is the most common disease in women of fertile age. The vagina is the natural cavity in the female genitalia. It connects the vulva and the internal reproductive organs. It is the channel through which menstrual blood and secretion flow. It is also the channel for mature fetuses or the pleasure channel during sexual intercourse.

Under normal circumstances, the anterior and posterior vaginal walls are closed. The vaginal mucosa contains multiple layers of cells called stratified squamous cells. These cells are affected by the estrogen and progesterone secreted by the ovaries, undergo periodic changes and fall off after maturity. The exfoliated cells are slowly separated from the endometrial secretions, cervical secretions, and exudates in the vagina, forming a leucorrhea that is present in sexually mature women every day.  

Under normal circumstances, the vaginal discharge is white or colorless, no odor, and the amount is small. There is a small amount of coagulation on the underwear every day, and the amount will increase during the ovulation period, and it will be transparent, and the amount will be reduced after ovulation.

In addition to exfoliated cells containing the genital tract, the vaginal discharge also contains a variety of bacteria that are in peace with the human body, including

1. Gram-positive aerobic bacteria and facultative anaerobic bacteria, such as lactobacilli and non-hemolytic streptococcus;  

2. Gram-negative aerobic and facultative anaerobic bacteria, such as Gardnerella and Escherichia coli;

3. Obligate anaerobic bacteria, such as Peptococcus;

4. Mycoplasma and Candida; these together constitute the vagina  Microecology.  

Maintaining vaginal microecological balance depends on the secretion of estrogen, the number of Lactobacillus in the vagina, and the pH of the vagina. Under physiological conditions, estrogen causes vaginal epithelial cells to synthesize glycogen, and Lactobacillus vaginalis breaks down glycogen into lactic acid, so that the vaginal environment is acidic at pH ≤ 4.5, which is not conducive to the growth of harmful bacteria and plays a role in vaginal self-purification.

There are many factors that can break the balance of vaginal microecology, such as: frequent sexual intercourse, post-vaginal surgery or postpartum, vaginal and uterine cavity placement of foreign bodies, decreased estrogen levels after menopause, after wearing tight pants, body resistance decreased, long-term apply hormones and antibiotics.  

These factors cause the number of dominant bacillus-lactobacilli in the vagina to decrease, the pH value to rise, and the growth of non-pathogenic bacteria into pathogenic bacteria, causing vaginitis. The pathogenesis of vaginitis is the vaginal flora imbalance and the abnormal pathogenic microorganism invasion, resulting in the weakening of the body's defense function and the loss of balance of the vaginal micro-ecology.

How to treat vaginitis?

The important thing is to figure out what kind of vaginitis, that is, the diagnosis is clear and then treated, in order to achieve the effect of the drug to the disease.  During the clinical diagnosis and treatment, I found many incorrect treatment errors, which caused the symptoms of mild symptoms to be more serious after treatment, and the treatment period was prolonged, which increased the pain. Some common misunderstandings are,

Myth 1

When there is an increase in vaginal discharge, yellowing, odor, and genital itching, when you go to the pharmacy to buy medicine, oral anti-inflammatory drugs and vaginal medicine, the genital itching is heavier, and even the vulva is scratched. One have to see a doctor;self-medication is not the right way. Because the most common vaginitis is fungal vaginitis, trichomonas vaginitis and bacterial vaginosis, fungal vaginitis is caused by the proliferation of Candida albicans, antibiotics can not be used during treatment, and the more serious the use. Mainly because the antibiotics kill the bacteria in the body, the fungus will grow rapidly, so it will appear worse. Trichomonas vaginitis and bacterial vaginosis should be treated with metronidazole antibiotics. It is recommended to see a doctor promptly after illness, and the diagnosis is clear and re-treatment, and will not take a detour.

Myth 2

The problem of vaginal washing. Some people think that they wash their vagina once a day, even using their fingers into the vagina to pour out the secretions is a "good habit" for personal cleanliness and disease. It is not known that this destroys the vaginal micro-ecology and the self-purification of the vagina, but is prone to vaginitis. In addition, some people think that washing the vagina, flushing out the dirty things can cure vaginitis. The fact is that after vaginal inflammation, a large amount of secretions containing pathogenic microorganisms adhere to the vaginal wall or hidden in the crease of the vaginal mucosa, it is difficult to remove by rinsing, and the direction, strength and depth of rinsing are difficult to master. Improper self-operation will also cause pelvic inflammatory disease due to ascending infection. Therefore, the doctor does not advocate washing the vagina by himself. It is best to go to the professional department for vaginal washing and medicine by the nurse. This means that the pump can be drained and operated under direct vision. The direction, strength and depth of the flushing can be controlled without residue. The liquid remains in the body.  Self-vaginal medicine and flushing of the vulva are feasible.

Myth  3

Vaginitis is "not cured."  Wrong. Vaginitis is a common disease in women of childbearing age and is also a disease that is easy to treat. The reasons are: the vagina is a natural cavity, the local medication after the disease is better than the systemic drug, vaginal administration is rarely absorbed into the blood without systemic reaction. The drug melts in the vagina and directly interacts with the leucorrhea, and then gradually excretes with the vaginal discharge. In the process, the genital inflammation also has a therapeutic effect. The cause of recurrent vaginitis is that some people stop taking the medicine after the symptoms are relieved, and do not take the medication according to the course of treatment; life continues as normal during the medication; there is no regular review and consolidation treatment; for the "long-term cure" vaginitis, the husband and wife should be treated together; if necessary, to conduct secretion culture and drug sensitivity tests to find other mixed pathogens and targeted drugs. The onset of vaginitis is also related to clothing. It is beneficial to wear loose, breathable, cotton and linen quality clothes during treatment.

I hope that female friends will be healthy and happy every day.

IMC Gynecology Professor Zhao Yan