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Tampons, condoms, neglected diaphragms, and irritating douches or deodorant sprays can upset the vagina's environmental balance and produce abnormal vaginal discharge. Hyperglycemia and antibiotics can also disturb this balance. However, infectious agents are the most common cause of vaginitis; these include Trichomonas and Candida. (See also bacterial vaginosis.) Characteristics of these types of vaginitis and medical treatment and nursing intervention are summarized in the accompanying table.
In regard to prescribed treatment, the patient should be instructed to take all of the medication exactly as prescribed; a follow-up examination and testing may be necessary. If the woman has a cervical Pap smear done while she has vaginitis, there may be an abnormal test result.
candidal vaginitis, candidal vulvovaginitis
Symptoms include a thick, curdlike adherent discharge; itching; dysuria; and dyspareunia. The vulva and vagina are bright red. History usually reveals one or more risk factors: use of oral contraceptives or broad-spectrum antibiotics; immune defects; diabetes mellitus; pregnancy; or frequent douching. Diagnosis is established by the presence of hyphe and buds on a wet smear treated with 10% potassium solution, a pH of 4.5 or less, and/or of growth of culture on Nickerson's or Sabouraud's media. Treatment may include the use of topical or oral antifungal agents, or both. Oral fluconazole, given once, or topical applications of miconazole, clotrimazole, butoconazole, or terconazole, given 3 to 7 days, promptly relieve symptoms. Recurrence of symptoms after treatment is often due to presence of candida species other than C. albicans, presence of a mixed infection, or reinfection. Either use of a different agent or a longer course of treatment (14 to 21 days) is indicated, as well as testing for hyperglycemia. Synonym: moniliasis