Vaginitis examination

Vaginitis is a common disease in gynecological clinics. It is also an inflammation of the vaginal mucosa and submucosal connective tissue. Common vaginitis includes bacterial vaginitis, trichomonas vaginitis, candidal vaginitis, and senile vaginitis. It is more common in young girls and postmenopausal women. So, what are the examination methods for vaginitis?

Normal healthy women, due to anatomical and biochemical characteristics, have a natural defense function against the invasion of pathogens in the vagina. When the natural defense function of the vagina is damaged, pathogens can easily invade and cause vaginal inflammation. Young girls and postmenopausal women lack estrogen, have a thin vaginal epithelium, reduced intracellular glycogen content, and a vaginal pH of around 7. Therefore, their vaginal resistance is low and they are more susceptible to infection than adolescents and women of childbearing age.

Clinically, vaginitis is characterized by changes in the properties of leucorrhea and itching and burning pain in the vulva. Pain during sexual intercourse is also common. When the infection involves the urethra, there may be symptoms such as urinary pain and urgency. Common vaginitis includes bacterial vaginitis, trichomonas vaginitis, fungal vaginitis, and senile vaginitis.

Experts have studied 1,181 cases of vaginitis and found that 41% were bacterial, 27% were fungal, and 24% were trichomonal. Senile vaginitis occurs after menopause, oophorectomy, or pelvic radiation therapy, and its incidence rate is reported to be as high as 98.5%. Treatment of vaginitis requires some specialized drugs in this area.

Vaginitis is a common gynecological infectious disease caused by different causes. Common clinical cases include: candidal vaginitis, trichomonas vaginitis, bacterial vaginitis, senile vaginitis, nonspecific vaginitis, etc. The typical symptoms are as follows:

Candidal vaginitis: vulvar itching, vulvar and vaginal burning pain, increased leucorrhea with a tofu-dreg-like appearance, sometimes accompanied by frequent urination, painful urination, and painful sexual intercourse.

Trichomonas vaginitis: The amount of leucorrhea increases and is milky white or yellow, sometimes purulent, foamy and smelly. In severe cases, there is bloody leucorrhea, dysuria, frequent urination and hematuria.

Bacterial vaginitis: increased leucorrhea, grayish white, thin, foamy, congested vaginal mucosa, scattered bleeding spots, vulvar itching and burning pain, foul odor.

Senile vaginitis: increased leucorrhea, yellow and watery, purulent and smelly in severe cases, itching, dryness and pain in the vulva, distension in the lower abdomen, and when the urethra is affected, there are frequent, urgent and painful urination.

Nonspecific vaginitis: There is a feeling of falling and burning in the vagina, accompanied by pelvic discomfort and general fatigue. The vaginal discharge increases and is purulent, serous, and has a foul odor.

All types of vaginitis are accompanied by symptoms of increased vaginal discharge, frequent urination, urgency, and pain during urination. The vulva may have varying degrees of itching, burning, or pain. In the acute phase, there may be fever. Different types of vaginitis have different characteristics of vaginal discharge, which can be used as a basis for identification.

Gynecological examination: Through routine gynecological examination, possible sexual diseases are initially screened, and secretion samples are taken for necessary examinations.

Vaginal secretion examination: Check the cleanliness of the vagina and whether there is infection with fungi, trichomonas, or bacteria (clue cells, pus cells).

Vaginal secretion culture: Check which pathogen is causing the infection and provide doctors with accurate diagnosis basis.

Drug sensitivity test: detect which drugs the pathogens are sensitive to, so that targeted medication can be used to improve treatment effects.

Electronic colposcopy: It can magnify 50 times to accurately and clearly observe the relevant lesions in the vagina, cervix and other parts, and accurately select suspicious parts for live examination. It has a very high value for the early detection and early diagnosis of cervical cancer and precancerous lesions.

Internal examination: For women with sexual experience, obstetricians and gynecologists will use internal examination, that is, ask the female patient to lie on the examination table, take off her underwear, and then put her feet on a specific bracket. The doctor will then use the gloved index and middle fingers to gently insert into your vagina and touch the cervix. At the same time, he will use the other hand to press the abdomen to check whether the uterus is enlarged, or whether the ovaries are enlarged or have tumors.

General: Leucorrhea is a mixture of vaginal mucosal exudates, cervical and endometrial gland secretions, and its formation is related to the action of estrogen.

Amine test: The leucorrhea of ​​patients with bacterial vaginosis may have a fishy odor, which is caused by the amines in the leucorrhea being volatilized after being alkalized by potassium hydroxide.

Clue cells: Clue cells refer to the presence of many bacilli condensed at the edge of the vaginal epithelial cells of the patient. In the hanging drop smear, the edges of the vaginal epithelial cells are granular or stippled, making them unclear. These are clue cells. They are the most sensitive and specific sign of bacterial vaginosis. Clinicians can make a diagnosis of bacterial vaginosis based on a positive amine test and the presence of clue cells.

Chlamydia test: Take cervical mucus for testing, which can confirm bacterial vaginitis caused by mycoplasma infection. If you have it, especially those who have pain during intercourse, abdominal distension, have more than 2 sexual partners, and those who have not improved with continuous medication or have repeated attacks, you need to be checked.

Diagnosis Overview:

1. For non-specific vaginitis, take a smear of the secretions and examine it under a Gram staining microscope. Common pathogens can be found, but no fungi or Trichomonas are present.

2. For fungal vaginitis, take secretions for smear and use Gram stain. Under the microscope, you can find groups of Gram-positive, densely stained oval spores, or pseudohyphae and budding cells connected in chains or branches. The most reliable method is to perform fungal culture examination.

3. For trichomoniasis, take the secretion and mix it with a small amount of warm saline dripped on a glass slide, and examine it under a microscope. Active vaginal Trichomonas can be seen. If Trichomonas cannot be found in a special case, the culture method can be used instead, which has a high accuracy.

4. The discharge examination of senile vaginitis should be distinguished from that of trichomonas and fungal vaginitis. Pay attention to the size and shape of the cervix and uterus, the source of bleeding and the results of vaginal cytology. If necessary, perform a cervical or endometrial biopsy to rule out the possibility of uterine cancer.

Diagnostic criteria:

1. Vaginal discharge is grayish white, very sticky, even like paste, and uniform, but it is not purulent discharge, and the amount is uncertain.

2. The secretion has a particularly high amine content, so it has a fishy smell. During sexual intercourse or after activity, the smell is often aggravated due to the release of amines. Adding 10% potassium hydroxide to the secretion can also release the amine smell.

3. The pH value in vaginal secretions increases, with a pH range of 5.0-5.5, while the normal pH is 4.5-4.7.

4. Clue cells can be detected in wet smears of vaginal secretions.

Among the above four criteria, the diagnosis can be confirmed if three or more are met, and the fourth is emphasized as a necessary diagnostic criterion.

Identification:

1. Trichomonas vaginitis: There is also an increase in vaginal discharge and a special odor. However, if the discharge is taken as a microscopic plug, the number of white blood cells increases, but no clue cells are found. The diagnosis can be confirmed by finding active Trichomonas.

2. Fungal vaginitis: Most fungal vaginitis is caused by Candida albicans. Its clinical manifestations are sometimes difficult to distinguish from bacterial vaginosis, but the secretions of bacterial vaginitis have no amine odor, the pH value is greater than 4.5, and there are no wireless cells. Direct microscopic examination can detect yeast-like spores and pseudobacteria, and culture can detect Candida albicans.

Some special circumstances in life, such as long-term use of antibiotics and diabetes, can induce vaginal candida infection, but in many cases, candidal vaginitis can also be infected from the outside. When women have sexual contact with men with positive Candida culture, the infection rate is 80%; among men who have sexual contact with women with candidal vaginitis, about 1/2 of them will be infected. In other words, candidal vaginitis can be transmitted through sexual behavior, which is why when a woman suffers from candidal vaginitis, her spouse must also receive treatment at the same time. In addition, indirect contact transmission is also a transmission route for candidal vaginitis. Contact with toilets, bathtubs, bath seats, towels in public toilets, and the use of unclean toilet paper can cause transmission. When the number of Candida in the vulva and vagina of the infected person reaches a certain level, candidal vulvitis and candidal vaginitis can occur.

There are many types of female vaginitis, and they have similar symptoms. Gynecological examinations are needed to accurately determine the cause. Through routine gynecological examinations, possible diseases can be preliminarily screened, and secretion samples can be taken for necessary examinations. If vaginitis can be examined as early as possible, it will be helpful to understand the condition and treatment. Therefore, female friends should pay attention to it. Any disease should be prevented, examined and treated early.

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