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Vulvovaginitis

Vaginal itching, burning, vaginal pain, soreness in the vaginal area, cutting, ripping, swelling of the vagina, lumps in and around vagina, ulcers in vagina and vaginal discharge - all these best describe vulvular discomfort. Teen girls or menopausal women - vulvovaginitis, irritating vaginal itch, troublesome vaginal burning causes emotional trauma to women of all ages. Women are more prone to urethral or vaginal infections at one point or another in their lives. So, feminine hygiene is a very important aspect of a woman's life. If compromised, it can lead to serious consequences.


A change in normal vaginal discharge could be due to one or a combination of these conditions.


  • Inflammation or infection of the vagina, vulvovaginitis.
  • Infections of the vagina, such as yeast infection, bacterial vaginosis trichomoniasis, human papillomavirus (HPV) or herpes.
  • Infection of the cervix (cervicitis)
  • An object in the vagina (like a forgotten tampon)
  • Sexually transmitted diseases such as chlamydia or gonorrhea can be a major cause of vaginal irritation.
  • Using certain antibiotics or douching.
  • Stress, illness and hormone changes can make the vagina more vulnerable to irritation.

Vaginoscopy

Vaginoscopy is a diagnostic procedure for inspecting the vagina. Also known as the 'no-touch procedure' Vaginoscopy is most commonly performed in children or more specifically young prepubescent girls.


A cystoscope is used for Vaginoscopy. The visuals aid in diagnosing anatomical abnormalities or lesions affecting the vaginal wall.


When do parents seek appointment ?

Parents seek appointment with doctors when their little girl complains of vaginal pain with or without foul smelling vaginal discharge. It could be due to an infection that is treatable. But there are instances linked to sexual abuse, congenital malformations, vulvar skin disease, vaginal neoplasms and presence of a foreign body. Discharge or bleeding may also be caused by trauma to the area or a sexually transmitted infection.

Health care professionals have a great degree of responsibility in assessing each patient and being sensitive to possible hidden or underlying concerns of parents regarding doubts of molestation. Likewise, clinicians educate the parents not to worry that Vaginoscopy may affect the child's virginity. There is no harm to the tissues including the hymen.


Vaginoscopy Indications

To a great extent, gynecological diseases in childhood and adolescent are primary reasons for unexplained pain or discharge or bleeding from vagina. When parents consult General Practitioner, the first line of treatment is prescribing medicines and tips to improve hygiene. If a clinical examination (pelvic exam) does not help, the family doctor or gynecologist would then recommend Vaginoscopy. Also, pelvic ultrasound, plain radiography and MRI are not always helpful in detecting and diagnosing.


  • Recurrent vulvovaginitis

  • Vaginal bleeding

  • Recurring genital infections

  • Foreign bodies

  • Tumors

  • Traumas after accidents and sexual crimes

  • Abnormalities (intersexuality, malformations)

  • Premature or delayed development

  • Gyneco-surgical diseases

  • Gyneco-urological diseases

Preparing for Vaginoscopy

In all, it takes one hour for the entire procedure. Examining the vagina through Vaginoscopy takes few minutes. Vaginoscopy is done in the operating suite under sedation or anesthesia. Post admission, topical anesthetic is applied to the vulva, about five minutes before inserting the vaginoscope. To reduce the anxiety or apprehension the child may have, the clinician takes simple yet effective proactive steps. For example, the child is informed that she will be able to see in the video monitor what that the doctor sees inside her body.


The operative procedure begins with surgical positioning of the patient on the operating table. Then the doctor in-charge will gently put the lubricated cystoscope into the vagina. All care is taken to prevent nil damage to the hymen. The doctor will look at the video monitor to see if there is anything abnormal. If any foreign object is stuck inside, the doctor can view the object with the cystoscope. A swab from the wall of the vagina is taken to test for infection. After the procedure is completed, polydine solution, an antiseptic combination is used to prevent urinary tract infection.

The result of the procedure and the swab test is reviewed by the surgeon. The consulting team includes pediatric urologist and gynecologist to determine the best plan of care for the child. The course of action is discussed with the parents of the young girl.


In terms of physical discomfort after Vaginoscopy, the bladder can be irritated. The child may express frequent need to urinate. It is best for the child to empty the bladder rather than 'holding' back. While urinating, for a few days it is normal to see a small amount of blood in the urine. The doctor would recommend the patient to drink plenty of water. The amount of water intake directly impacts the color of the urine. Unless specifically informed by the doctor, the child can resume normal activities the very next day.



Pelvic Floor Dysfunction

The cause for pelvic pain is often difficult to diagnose. Tissues around the pelvic organs might suffer increased or reduced sensitivity or irritation leading to pain in the area. Pelvic floor disorders can manifest as urinary incontinence or fecal incontinence. Typical pelvic disorders include interstitial cystitis, pelvic inflammatory disease or digestive disorders such as diverticulitis and colitis. Cystitis, irritable bowel syndrome, pelvic congestion and Vulvovaginitis> are other pelvic conditions that lead to pelvic pain. Infections, pregnancy and childbirth, incorrect posture, trauma or surgery can lead to pain in the pelvic area.


Symptoms in Women


  • Frequent urination with incomplete sensation
  • Pelvic pain
  • The feeling of incomplete bowel movement
  • Vaginal or rectal prolapse (sagging of the vagina or rectum)
  • Rectocele (protrusion of the rectum into the vagina)
  • Cystocele ( herniation of the bladder into the vagina)
  • Enterocele (a herniation of the intestine into the vagina)
  • Sigmoidocele (a herniation of the sigmoid colon into the vagina)


Symptoms in Men:


  • Urgency and frequency in urination
  • Pain in testes and pain on ejaculation
  • Reduced urinary flow
  • Levator Ani Syndrome (pressure and pain in the sacrum)
  • Constipation or strain during bowel movement

For constipation, low dose muscle relaxants are prescribed. Lifestyle changes in diet and physical activity are recommended. Rectal prolapse and rectocele may be treated through surgery. Cold laser involving a process wherein low-intensity laser light is applied to the tissue easing the pain and inflammation.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 15, 2019