Vaginitis

VAGINITIS, or colpitis (vaginitis, colpitis), inflammation of the vagina, is caused by various microorganisms: gonococci, streptococci, staphylococci, the intestinal bacillus, and others; the role of Trichomonas vaginalis is not exactly established. Gonococcal inflammation is observed, mainly, in girls, the vagina of which is covered with delicate epithelium; in adults, gonorrheal inflammation of the vagina occurs significantly less often (more often when the mucous membrane is softened during pregnancy or with abundant discharge from the uterus). Inflammation of the vagina, in general, is favored by all those causes in which the intake of bacteria into the vagina increases—ruptures of the perineum, the use of insufficiently clean applicators, masturbation, swelling of infected discharges from the upper sections, fecal and urinary fistulas. Great importance also have chemical, thermal, and mechanical irritations: the use of strongly acting agents, too hot douches, poorly chosen pessary, foreign bodies in the vagina; in this case, not only is the biochemistry of the vagina disturbed, but also damage to its mucous membrane occurs, facilitating the penetration of infection. Certain importance also have a decrease in the general resistance of the organism—anemia, tuberculosis, cancer—and constitutional anomalies (infantilism). Inflammation affects either individual limited areas or diffusely involves the entire vagina. In vaginitis simplex the mucous membrane is sharply reddened, rough, with sharply expressed folds, sometimes granular to the touch. The epithelium is significantly desquamated, its covering thins; the submucous tissue is infiltrated, edematous. The vessels are tortuous and dilated; upon examination the mucous membrane easily bleeds. In some cases the inflammatory process proceeds exclusively on the surface of the papillae, and the wall of the vagina appears strewn with red points (vaginitis granularis); this form is observed more often in the climacteric period. In elderly women, significant desquamation of the epithelium is also found at places, formation of a granular surface, and, as a result, adhesions, mainly in the vaults of the vagina (vaginitis adhaesiva); shrinkage of the submucous tissue as a result of inflammation often leads to narrowing of the vagina (paravaginitis senilis). In V. yellowish purulent leucorrhea are observed, which, being abundant, strongly irritate the external genital organs; in women of advanced age the leucorrhea is often colored with blood (beware of cancer!).- Treatment of V.— douches with milk of lime, potassium permanganate, table salt, and others. Lubrication with Lugol's solution, a 2–5% solution of nitric acid argenti is recommended. Tampons with glycerin and ichthiol. Nassauer proposed blowing powder of white clay into the vagina. Good results are noted from the use of bacillosan (a mixture of lactic acid bacteria with sugar). In diphtheria of the larynx, as well as in severe infectious diseases, vaginitis with fibrinous and diphtheritic coating is sometimes observed, as a result of which stenoses of the vaginal canal of varying degrees may form. With significant damage to the vagina and penetration of infection deep into the connective tissue, the formation of abscesses is possible; such phlegmons may be accompanied by the separation of a significant part of the necrotized vaginal wall (vaginitis dissecans). Inflammation of the vagina can be caused by various fungi—most often thrush (Soor), in which white spots are observed on the diffusely reddened wall of the vagina. Often the cause of V. in children is the penetration of threadworms (Oxyuris vermicularis), the presence of which causes itching, scratching, which in a significant degree favors the development of the process. Rarely is vaginal inflammation caused by the tubercle bacillus. Primary sclerosis is often overlooked. In pregnant women a rare form occurs—emphysematous V. (colpohyperplasia cystica), with the formation on the mucous membrane of bluish-red vesicles, the size of a pea. Upon puncture of these vesicles gas is released. It is believed that this process is caused by a special anaerobic bacillus. After childbirth this disease heals spontaneously.