Introduction

Vaginal Environment

The vagina is a dynamic ecosystem that normally contains approximately 10⁹ bacterial colony-forming units per gram of vaginal fluid. The normal vaginal discharge is clear to white, odorless, and of high viscosity. The normal bacterial flora is dominated by lactobacilli, but a variety of other organisms, including some potential pathogens, are also present at lower levels. Lactobacilli convert glycogen to lactic acid. Lactic acid helps to maintain a normal acidic vaginal pH of 3.8 to 4.2. Some lactobacilli produce H₂O₂ (hydrogen peroxide), which kills bacteria and viruses.

Vaginitis

Vaginitis is usually characterized by a vaginal discharge, vulvar itching and irritation, and a vaginal odor. The three most common diseases diagnosed among women with these symptoms include bacterial vaginosis (40%-45%), vulvovaginal candidiasis (20%-25%), and trichomoniasis (15%-20%). In some cases, the etiology may be mixed, and there may be more than one disease present.

Other causes of vaginal discharge or irritation include the following:

• Normal physiologic variation
• Allergic reactions, e.g., spermicides, deodorants
• Herpes Simplex Virus (HSV)
• Mucopurulent cervicitis--may be related to Chlamydia trachomatis or Neisseria gonorrhoeae infection
• Atrophic vaginitis--found in lactating and post-menopausal women and related to a lack of estrogen
• Vulvar vestibulitis, lichen simplex chronicus, and lichen sclerosis (especially pruritis)
• Foreign bodies, e.g., retained tampons
• Desquamative inflammatory vaginitis

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