>VAGINITIS, an inflammation of the vagina that can result in discharge, itching and pain, is one of the most common gynaecological problems in Malaysia.
It affects one in five women here yet most Malaysian women don't even know what it is, or that if left untreated, vaginitis can cause pelvic inflammatory disease and infertility.
In pregnant women it can result in adverse outcomes such as premature delivery or low-birthweight infants.
More alarmingly women's susceptibility to certain types of vaginitis can be traced not only to their sexual behaviour but also to their use of medication, intrauterine devices (IUD) for birth control, contraceptives and feminine hygiene products.
Bacterial vaginosis, (the most common cause of vaginitis among women of childbearing age) can afflict women with new or multiple sex partners, or even people who are not sexually active. Women who douche or use IUDs for birth control were also found to have a higher risk getting bacterial vaginosis.
The risk of yeast infections, another form of vaginitis, is increased by the use of antibiotics, steroids, bubble baths, vaginal contraceptives, damp or tight fitting clothing and feminine hygiene products.
Conditions like uncontrolled diabetes and hormonal changes such as those associated with pregnancy, birth control pills and menopause also increased the risk of yeast infections.
These details were disclosed at a recent media conference held by Bayer Schering Pharma (Malaysia) to raise awareness of vaginitis as a common, treatable condition.
"The cause is usually a change in the normal balance of vaginal bacteria or an infection. It can also result from reduced estrogen levels after menopause," said consultant obstetrician and gynaecologist Dr Raman Subramaniam.
Symptoms may include change in colour, odour or amount of discharge from the vagina, vaginal itching or irritation, pain during intercourse, painful urination or light vaginal bleeding.
Dr Raman said that although vaginitis is a widespread female gynaecological problem in Malaysia, it was a challenge to diagnose because of myriad contributing causes, all with confusing symptoms.
"The problem with vaginitis is that the cause cannot always be determined on the basis of the symptoms or physical examination alone. Usually diagnosis involves examining a specimen of vaginal fluid under a microscope as well as culture."
The process is not only time-consuming but it also leaves the patient in discomfort for days while waiting for the lab results. Accurate diagnosis is also not easy when there are cases of mixed infections which make up approximately 30 per cent of all vaginitis cases. In such instances, prescribing a broad spectrum treatment which features combination therapies that target all three major contributing causes of vaginitis (bacterial vaginosis, trichomoniasis and vaginal yeast infection or candidiasis) can be useful as a first line approach to provide immediate and effective relief.
At the event, BayerSchering Pharma introduced a combination therapy for the treatment of vaginitis. In the form of a vaginal pessary containing anti-bacterial and anti-fungal ingredients, it targets all three major contributing causes of vaginitis.
Invited guest Professor Dr Jack Sobel, who is with the Department of Obstetrics and Gynaecology, Wayne State University School of Medicine, Detroit, the United States, said it is necessary for women to be aware of the three main contributing causes of vaginitis and their symptoms so they can seek early, appropriate treatment.
Red flags to watch out for, he said, depended on the type of vaginitis.
An abnormal fishy smelling vaginal discharge was a common symptom of bacterial vaginosis while a heavy, yellow-green or grey vaginal discharge was usually indicative of trichomoniasis, primarily an infection of the urogenital tract.
Apart from the dark discharge, other symptoms include discomfort during intercourse, vaginal odour, pain during urination, irritation and itching of the female genitalia and lower abdominal pain.
The last type of vaginitis, vaginal yeast infection, can be identifiable by a thick, whitish-grey discharge which is cottage-cheese like in nature and can be either watery to thick in consistency. Similarly, it results in pain during urination and/or intercourse as well as itching and irritation of the vagina.
Treatment of vaginitis, Dr Sobel said, usually depends on which type a woman has. Tablets, vaginal gels, or creams may be prescribed for bacterial vaginosis, while metronidazole tablets may be prescribed for trichomoniasis.
Atrophic vaginitis (which results from reduced estrogen levels after menopause) is usually treated with estrogen in the form of creams, tablets or rings.
For mixed infections, effective treatment depended on accurate diagnosis but combination therapy was the most viable option in such cases.
Prevention is better than cure. Consultant obstetrician and gynaecologist Dr Raman Subramaniam suggests the following to keep vaginitis at bay:
1. After a shower, rinse soap from the outer genitalia area carefully and dry the area well to prevent irritation.
2. Don't douche. Repeated douching disrupts the normal organisms that live in the vagina and can actually increase the risk of vaginal infection.
3. Insist that your partner uses a condom during sexual intercourse. This avoids infection spread by sexual contact.
4. Wear cotton underwear.
5. Avoid scented soaps, tampons, pads, anti-bacterial soaps as they could irritate the area.
6. After using the toilet, wipe from front to back to avoid spreading faecal bacteria to the vagina.
7. Avoid sharing baths, hot tubs and whirlpool spas with others.
This story was first published in The New Straits Times on Mar 31, 2008.
