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. An acidic environment (pH 3.8-4.2) inhibits the overgrowth of bacteria and other organisms with pathogenic potential. 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 trichomoniasis (15%-20%), bacterial vaginosis (40%-45%), and vulvovaginal candidiasis (20%-25%). 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:

• Mucopurulent cervicitis that may be related to Chlamydia trachomatis or Neisseria gonorrhoeae infection
• Herpes simplex virus (HSV)
• Atrophic vaginitis (found in lactating and post-menopausal women; related to a lack of estrogen)
• Vulvar vestibulitis
• Lichen simplex chronicus
• Lichen sclerosis
• Allergic reaction to commonly used items such as spermicides and vaginal deodorants
• Foreign bodies such as retained tampons