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INFLAMMATORY AND INFECTIOUS DISORDERS (VULVITIS (SYMPTOMS (itching,…
INFLAMMATORY AND INFECTIOUS DISORDERS
CERVICITIS
DEFINITION
This is an infection and inflammation of the cervix caused by a variety of organisms introduced during sexual intercourse, childbirth, termination of pregnancy or abortion and insertion of vaginal pessaries.
ASSESSMENT AND COMMON FINDINGS
There is lower abdominal pain with backache.
Spotting or a heavy blood-stained mucopurulent vaginal discharge may be present, depending on the causal organism.
Pruritus may also be experienced if vaginitis is present, dyspareunia and dysuria.
On examination with a speculum, a mucopurulent discharge with or without bubbles may be seen.
The cervix will be red and oedematous.
NURSING MANAGEMENT
Obtain a cervical pap smear.
Encourage the patient to contact their sexual partner and for the partner to be put on treatment for the sexually transmitted infection.
Administer prescribed medication and emphasise the importance of completing the course of antibiotics.
Assist the patient in self-care, especially in maintaining their personal hygiene by:
Taking daily baths and cleansing of the genitals whenever necessary.
Keeping underwear clean and dry
Wiping from front to back after defaecation so that the vulva is not contaminated with faecal matter.
SYMPTOMS
Grayish or pale yellow vaginal discharge
Abnormal vaginal bleeding, such as bleeding after sex or between periods
Pain during sex
Difficult, painful, or frequent urination
Pelvic or abdominal pain or fever, in rare cases
RISK FACTORS
Had recent sexual intercourse without a condom
Recently had multiple sexual partners
Have had cervicitis before
TREATMENT
Depending on what organism is causing the infection, your doctor may prescribe:
Antibiotics
Antifungal medications
Antiviral medications
VAGINAL FISTULA
DEFINITION
is an abnormal opening that connects your vagina to another organ.
For example, a vaginal fistula can link your vagina to your:
Bladder
Ureters, the tubes that carry your pee from your kidneys to your bladder
Urethra, the tube that carries your pee down from your bladder and outside your body
Rectum, the lower part of your large intestine
Large intestine
Small intestine
CAUSES
Abdominal surgery (hysterectomy or C-section)
Pelvic, cervical, or colon cancer
Radiation treatment
Bowel disease like Crohn’s or diverticulitis
Infection (including after an episiotomy or a tear you had when you gave birth)
Traumatic injury, such as from a car accident
COMPLICATIONS OF VAGINAL FISTULA
Vaginal or urinary tract infections that keep coming back
Hygiene problems
Stool or gas that leaks through the vagina
Irritated or inflamed skin around your vagina or anus
An abscess -- a swollen clump of infected tissue with pus that could be life-threatening if it’s not treated
Fistulas that come back
TYPES OF VAGINAL FISTULA
Vesicovaginal fistula. Also called a bladder fistula, this opening occurs between your vagina and urinary bladder and is the type that doctors see most often.
Ureterovaginal fistula. This type of fistula happens when the abnormal opening develops between your vagina and the ducts that carry urine from your kidneys to your bladder (ureters).
Urethrovaginal fistula. In this type of fistula, also called a urethral fistula, the opening occurs between your vagina and the tube that carries urine out of your body (urethra).
Rectovaginal fistula. In this type of fistula, the opening is between your vagina and the lower portion of your large intestine (rectum).
Colovaginal fistula. With a colovaginal fistula, the opening occurs between the vagina and colon.
Enterovaginal fistula. In this type of fistula, the opening is between the small intestine and the vagina.
SYMPTOMS
Vaginal fistula isn’t created any pain sensation.
Urine as well as fecal material discharged through the vaginal route. Urine incontinence is common in case of vesicovaginal fistula and fecal incontinence is common in rectovaginal fistula.
Gas and foul smelling discharge are common with enterovaginal, colovaginal and rectovaginal fistula.
Frequent incidence of infection in the geneto-urinary organs.
DIAGNOSTIC PROCEDURES
For physical examination, doctors usually use a speculum for checking the internal wall of the vagina.
For leakage identification, using of dye is a common diagnostic measure.
Urine culture and urinalysis is conducted in the presence of infection.
Complete blood count requires identifying the signs of infection.
SURGICAL TREATMENT
Transvaginal
Catheterization done via urethral route and by using a speculum, the vagina is opened up and then fistula wall will be removed.
After completion suturing and special vaginal dressing is put into easy healing.
Transabdominal
Lower abdominal wall incision is conducted and after re-sectioning the connection between the vagina and associated organ is manipulated.
The abdominal wall suturing insertion of the catheter or stent may place in ureters for passage of urine.
VAGINITIS
DEFINITION
Vaginitis is inflammation of the vagina.
CAUSES
Bacterial vaginosis
is a change in the type of bacteria that normally live in the vagina, and it is the most common cause of an abnormal vaginal discharge or an unpleasant vaginal odor.
In bacterial vaginosis, normal Lactobacillus bacteria are replaced by other bacteria, including Prevotella, Mobiluncus, G. vaginalis, and Mycoplasma hominis.
In pregnant women, bacterial vaginosis can increase the risk of premature delivery.
Candida vaginal infections
also called vaginal yeast infections, typically are caused by the Candida albicans fungus.
Women tend to be more susceptible to vaginal yeast infections if their bodies are under stress from poor diet, lack of sleep or illness, or if they are pregnant, taking antibiotics or birth control pills or douching too often.
Women with diabetes or human immunodeficiency virus (HIV) are more likely to have recurrent yeast infections.
Trichomonas vaginitis
also called trichomoniasis, is a sexually transmitted disease (STD) caused by a microscopic one-celled organism called Trichomonas vaginalis.
Trichomonas causes inflammation of the vagina, cervix and urethra in women.
SYMPTOMS
Your vaginal discharge changes color, is heavier, or smells different.
You notice itching, burning, swelling, or soreness around or outside of your vagina.
It burns when you pee.
Sex is uncomfortable.
TREATMENT
The treatment for vaginitis depends upon its cause.
Infectious vaginitis is treated with antibiotic medications.
Bacterial vaginitis is treated either with oral antibiotics, intra-vaginal antibiotic creams, or injections (shots) of antibiotics.
Metronidazole (Flagyl) is the drug of choice for treating Trichomonas infections.
Vaginitis due to infections cannot be cured by home remedies.
PREVENTION
Vaginitis due to STDs can be prevented by practicing safe sex or abstinence.
It is not possible to prevent all cases of yeast infection or bacterial vaginosis.
Attention to hygiene practices and avoiding spread of fecal material to the vagina may help prevent vaginitis in young girls.
VULVITIS
ESSENTIAL HEALTH EDUCATION
Advise the patient to drink plenty of water to dilute the urine and reduce its irritation.
Advise the patient to wear absorbent cotton underwear and to change this daily and when necessary.
Emphasise the importance of wiping from front to back so that faeces is kept away from the vulva.
Teach the patient about good personal hygiene and how to keep the vulval area clean.
NURSING MANAGEMENT
An external application of low dosage steroid ointment when prescribed may be used.
Care is symptomatic- measures to relieve irritation should be employed, such as a sitz bath with a 1:30 dilution of Savlon to water at least twice a day.
DIAGNOSTIC TESTS
Blood tests may also be necessary in the case of systemic infections and suspected diabetes mellitus.
Routine urinalysis, including MCS
Skin scrapings in cases of dermatitis
Vulval swabs for MCS
DEFINITION
Is an infection and inflammation of the vulva that is secondary to conditions such as diabetes mellitus with glycosuria, enterobius vericularis (threadworm) and vaginitis caused by Trichomonas vaginalis.
CAUSES
Certain hygiene products, including:
colored or perfumed toilet paper
vaginal sprays or douches
shampoos and hair conditioners
laundry detergents
topical creams and medications
SYMPTOMS
itching, redness, burning, and swelling
soreness, and thickened or white patches
vaginal discharge
clear fluid-filled blisters
a scaly appearance
severe and prolonged itching
a burning sensation
DIAGNOSIS OF VULVUTIS
Clinical assessment usually starts with:
a medical history
a pelvic examination