Diseases of vagina

common vaginal diseases

1. Gynaecology Project Diseases Of Vagina Made By: Manju Verma (32) Neha Singh (36) Priyanka Kaushik (53) Purnima Rani (56)

2. This presentation is about the Diseases of the Vagina. A short review of the presentation will help to get a fair idea about all the common diseases of the vagina ( inflammatory. Cystic, Neoplastic conditions) Clinical presentation and pictures of various conditions are also included to make it very easy to diagnose the respective conditions in day-to-day clinical practice. NHMC INTERNS Dr. Manju Verma Dr. Neha Singh Dr. Priyanka Kaushik   Dr. Purnima Rani ABSTRACT

3. CONTENTS

4. BIOLOGY OF THE VAGINA

5. Anatomy of vagina and relations

6. Anatomy of vagina and relations

7. Structure of vaginal epithelium

8. Squamous cells are divided into

9. Cornified cell

10. Physiological changes in vaginal epithelium

11. Natural defence mechanism of the vagina against infection

12. Flora

13. Doderlein’s bacilli

14. Doderlein’s bacilli

15. Age pH Birth-2weeks Acidic 4-5 2 weeks till puberty Alkaline 6-8 Reproductive period Acidic 4-5 (4.5 is normal) Post menopausal Neutral or alkaline 6-7 Vaginal acidity Varies during menstrual cycle and different phases of life. Acidity is due to lactic acid Oestrogen gycogen from vaginal epithelial cells doderlein’s bacilli lactic acid

16. Certain times when pH is raised:-

17. Normal vaginal discharge

18. Component Sources

19. Features

20. Excessive normal vaginal secretion (LEUCORRHOEA)

21. Excessive normal vaginal secretion (LEUCORRHOEA)

22. INFLAMMATIONS OF THE VAGINA

23. Vaginitis  is an inflammation of the vagina. It can result in discharge, itching and pain, and is often associated with an irritation or infection of the vulva. It is usually due to infection. Symptoms Irritation and/or itching of the genital area Inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora , labia minora , or perineal area Vaginal discharge Foul vaginal odor Pain/irritation with sexual intercourse I nflammations of the Vagina (Vaginitis)

24. Types of Vaginitis

25. Specific Vaginitis

26. Trichomoniasis n

27. Trichomoniasis

28. Trichomoniasis

29. Trichomoniasis

30. Trichomoniasis

31. Trichomoniasis Strawberry Spots

32. Trichomoniasis

33. Candidiasis (Moniliasis) nucleus Epithelial cell hypha blastospores

34. Candidiasis ( Moniliasis ) Normally present in vagina in about 20-25% of females, without having any symptoms. Normal commensal in rectum/oral mucosa. Thrives in acid medium especially with abundance of carbohydrates. So, infection is more likely in Diabetes Pregnancy People using OCP Prolonged use of antibiotics Thyroid, parathyroid infection and HIV infection.

35. Candidiasis (Moniliasis)

36. Candidiasis (Moniliasis)

37. 39 Candidiasis ( Moniliasis ) Source : Health Canada, Sexual Health and STI Section, Clinical Slide Gallery Candidiasis Curriculum Clinical Manifestations

38. Gardnerella (Bacterial Vaginosis)

39. Gardnerella (Bacterial Vaginosis)

40. Gardnerella (Bacterial Vaginosis) Clinical Features Asymptomatic carriers- 50% of cases. Vaginal discharge- White, milky, non viscous discharge adherent to vaginal wall. Foul smelling (fishy odor) More pronounced after intercourse Non irritating Not much erythema and there is usually no associated dysuria. Diagnosis In wet smear: Presence of a homogenous white, non inflammatory discharge that coats the vaginal wall. The presence of ‘ Clue Cells ’ on microscopic examination. Pus cells- few or absent Doderleins bacilli- scanty/ absent 100 fold increase of other bacteria pH of the discharge is more than 4.5 Whiff test/ Amino test positive. CLUE CELLS Bacteria is non motile, short & adheres to the epithelial cells, and epithelial cells appear stippled/granular.

41. 43 Vaginitis Differentiation Vaginitis Curriculum Normal Bacterial Vaginosis Candidiasis Trichomoniasis Symptom presentation Odor, discharge, itch Itch, discomfort, dysuria, thick discharge Itch, discharge, 50% asymptomatic Vaginal discharge Clear to white Homogenous, adherent, thin, milky white; malodorous “foul fishy” Thick, clumpy, white “cottage cheese” Frothy, gray or yellow-green; malodorous Clinical findings Inflammation and erythema Cervical petechiae “strawberry cervix” Vaginal pH 3.8 - 4.2 > 4.5 Usually < 4.5 > 4.5 KOH “whiff” test Negative Positive Negative Often positive NaCl wet mount Lacto-bacilli Clue cells ( > 20%), no/few WBCs Few WBCs Motile flagellated protozoa, many WBCs KOH wet mount Pseudohyphae or spores if non- albicans species

42. Chlamydia infections

43. Chlamydia infections

44. Chlamydia infections Chlamydial   cervicitis  in a female patient characterized by  mucopurulent  cervical discharge,  erythema, and inflammation.

45. Chlamydia infections

46. Estrogen deficiency Vaginitis

47. Atrophic Vaginitis

48. Atrophic Vaginitis

49. Atrophic Vaginitis

50. Vulvovaginitis in Children

51. Vulvovaginitis in Children

52. Vulvovaginitis in Children

53. All varieties of vaginitis are included in which the primary cause is not essentially vaginal. Foreign body Infective conditions of cervix Fistula Malig Dis of genital tract Vaginitis medicamentosa Secondary Vaginitis

54. Rare Forms

55. CYSTS AND NEOPLASMS OF THE VAGINA

56. Vaginal Cysts Gartner’s cyst Lies on anterolateral vaginal wall Treatment: simple excision. Arise from remnants of mesonephric duct. Inclusion cyst Posterior surface of lower end of vagina Develops in episiotomy or surgical wounds. Treatment: simple excision. Cysts and Neoplasms of the Vagina

57. Bartholin’s cyst Infection of Bartholin’s Gland Protrudes into lower part of vagina. Treatment: Endometriotic cyst Posterior vaginal wall behind cervix. Bluish bulge or subepithelial irregular nodular mass. Treatment: surgical excision or danazole. Cysts and Neoplasms of the Vagina

58. Vaginal Neoplasm Can be primary or secondary. Primary Ca of vagina - least common of genital tract malignancies. Secondary Ca - of Cervix, bladder, urethra, vulva & lower bowel. M.C. type- squamous cell Ca. M.C. site of sq. cell Ca- upper third of posterior vaginal wall. C/F Watery vaginal discharge Post coital bleeding. Diagnosis: Schiller’s test, Colposcopic biopsy. Cysts and Neoplasms of the Vagina

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