TAILIEUCHUNG - DISORDERS OF THE VULVA AND VAGINA

Leukorrhea is a usually whitish vaginal discharge that may occur at any age and affects virtually all women at some time. Although some vaginal discharge (mucus) is physiologic and nearly always present, when it becomes greater or abnormal (bloody or soils clothing), is irritating, or has an offensive odor, it is considered pathologic. Pathologic discharge is often coupled with vulvar irritation. Commonly, the pathologic conditions are due to infection of the vagina or cervix. Other causes may include uterine tumors, estrogenic or psychic stimulation, trauma, foreign bodies (retained tampon), excessive douching (especially with irritating medications), and vulvovaginal atrophy (hypoestrogenism) | DISORDERS OF THE VULVA AND VAGINA COMMON VULVOVAGINAL INFECTIONS ASSOCIATED WITH LEUKORRHEA Leukorrhea is a usually whitish vaginal discharge that may occur at any age and affects virtually all women at some time. Although some vaginal discharge mucus is physiologic and nearly always present when it becomes greater or abnormal bloody or soils clothing is irritating or has an offensive odor it is considered pathologic. Pathologic discharge is often coupled with vulvar irritation. Commonly the pathologic conditions are due to infection of the vagina or cervix. Other causes may include uterine tumors estrogenic or psychic stimulation trauma foreign bodies retained tampon excessive douching especially with irritating medications and vulvovaginal atrophy hypoestrogenism . Vulvovaginal disorders constitute the major reason for office gynecology visits. These disorders are heavily influenced by the physiologic alterations summarized in Table 20-1. Estrogen and progesterone influence the nonkeratinized squamous epithelium of the vagina and vulva. Without hormonal influence the epithelium is thin and atrophic and contains little glycogen and the vaginal fluid has a high pH. By contrast with adequate estrogen and progesterone cellular glycogen content increases and the pH decreases partially due to breakdown of glycogen to lactic acid . During their reproductive lives most women harbor three to eight major types of pathogenic bacteria at any given time Table 20-1 . Physiologic vaginal secretions consist mainly of cervical mucus a transudate from the vaginal squamous epithelium and exfoliated squamous cells. Lesser amounts are contributed by the metabolic products of the microflora exudates from sebaceous sweat glands Bartholin glands and Skene glands and small amounts of 571 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. 572 TABLE 20-1 SUMMARY OF THE HORMONAL INFLUENCE VAGINAL pH AND USUAL PREDOMINANT VAGINAL ORGANISMS AT DIFFERENT TIMES Of a FEMALE S

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