Vulvovaginitis

//__Western Diagnosis__// A. inflammatory condition affecting the vaginal mucosa B. often secondarily involves vulva

Etiology
---Gardnerella vaginalis ---Chlamydia trachomatis ---Neisseria gonorrhoeae ---E. coli ---Trichomonas vaginalis ---Candida albicans ---human papilloma virus (HPV) ---herpes simplex ---Enterobius vermicularis
 * Bacteria** - most common cause
 * Protozoa**
 * Fungi**
 * Virus**
 * Pinworms**
 * Foreign bodies**

Signs and Symptoms
with or without vulvar irritation malodorous pruritic, irritated, painful no odor or sxs or sns a. white, gray, or yellow discharge b. foul or fishy odor c. mild pruritis or irritation d. mild vaginal or vulvar erythema a. moderate to severe vaginal pruritis and burning b. vaginal and vulvar erythema c. thick cheesy discharge a. white, yellow, or green discharge b. very malodorous c. severe pruritis d. vaginal erythema
 * Vaginal discharge**
 * Erythematous vaginal mucosa, vulva**
 * Physiologic**
 * Bacterial**
 * Candida**
 * Trichomonas**
 * Watery bloody discharge** - rule out malignancy

Diagnosis
1. wet prep 2. culture

Treatment
1. depends on cause 2. flagyl (metronidazole) for trich: serious side effects - seizures, peripheral neuropathy, CA. ---Trichomonas is very hard to get rid of however and a case can be made for it's use 3. doxycycline for Chlamydia [take in conjunction w/ vitamin C] 4. douches: vinegar, H2O2, acidophilus, herbal [generally not recommended now, excepting a boric acid insert] 5. Expedited partner therapy - additional prescription(s) for partner(s) given without appt. 6. Boric acid is best natural treatment vaginal insert 6mg, capsule 2x daily 7. Make sure woman is not wearing tight clothes around the area - esp. not polyester 8. Ensure they are using a mild detergent [did they recently change detergent?] what is the immune system status?

Studies: If patient is taking antibiotics in conjunction w/ 250mg. vitamin had dramatic influence on symptoms

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==**Definition:** == Inflammation and/or infection of the vagina with possible concurrent inflammation of the vulva.
 * IBIS:**

==**Etiology:** == Vaginitis typically occurs one of two ways: • the overgrowth of a normal part of the vaginal flora, or the introduction of a foreign microorganism through sexual relations » normal flora that can cause disease: yeast (often candida albicans): may also spread from the intestines or sexually; hemophilus vaginalis/gardnerella vaginalis: often called "nonspecific vaginitis". » foreign microorganisms: Trichomonas vaginalis, Neisseria gonorrhea. » in young girls it may be also caused by E. coli, strep, or staph, due to poor hygiene • reaction to an external agent causing allergic or chemical reaction


==**Nutrition:** == » acute: • increase fluids • short fruit or vegetable juice fast • raw fruit and vegetable diet » chronic: • elimination/rotation diet, rotation diet, rotation diet expanded
 * eating principles:**

• garlic, onions • foods rich in Zinc, Vitamins A, C, E, and B-Complex • foods that soothe the Liver and invigorate the Qi • for Damp-Heat, foods that clear Dampness and Heat • for Damp-Cold, foods that warm and rid Dampness • for Yin Xu (Deficiency), foods that nourish and tonify the Yin
 * therapeutic foods:**

fresh juices: • carrot and spinach (Walker, p. 144) • lemon (Walker, p. 144)

» Trichomoniasis: apply raw onion juice to affected parts (Chao-liang, Qing-rong, Bao-zhen, p. 22) » Leukorrhea: 2 oz. fresh string beans cooked with 2 oz. raw brown sugar in a little water. Eat once daily for 7-10 days. (Butt and Bloomfield, p. 146) • douche with yogurt or insert acidophilus into vagina and eat acidophilus or live yogurt once daily for yeast infections • boil a bulb of garlic, cool to lukewarm then douche with liquid (Ni, p. 37) • boil 30 g Job's Tears in 750 ml water with 30 g seeded red dates and 60 g sweet rice over low heat. Drink as soup to relieve white discharge due to weakness (Lu, p. 151) • boil 2 cuttlefish with 250 g lean pork in water, season with salt. Eat once once daily for 5 days to relieve white discharge. (Lu, p. 151) • boil 60 g hyacinth beans in water, add sugar as seasoning and drink as tea (Lu, p.151) • simmer the crushed shell of a fresh coconut in water. Wash the affected areas with this liquid three times daily (Yin-fang and Cheng-jun, p. 87) • make a small hole in an egg and insert 7 white peppercorns. Wrap in damp paper and steam until cooked. Discard shell and eat once daily for 5-7 days (Chao-liang, Qing-rong, Bao-zhen, p. 89)
 * specific remedies:**

• food intolerances • meat, alcohol, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar, cow's milk and other dairy products, white bread, refined foods, processed foods, catarrh-forming foods: tofu, ice cream
 * avoid:**

==**Botanicals** == • Achillea millefolium: antiseptic, internally and douche • Allium sativum: may insert entire clove into vagina and retrieve several hours later. Be careful not to nick the clove while peeling, as it could sting the vaginal tissue; twice daily for several days (Anderson Geller; Hughes BG, Lawson LD. Phytother Res 1991;5:154-158.) • Calendula officinalis: soothing antiseptic and vulnerary, promotes healing of inflamed vaginal mucosa. Specifically indicated for scanty flow and painful periods. Use a diluted tincture or hot flower infusions for douching, or Calendula salve to soothe external irritation (Nissim, p. 77) • Cinnamomum zeylanicum: antifungal action, especially bark (Quale JM, et al. Am J Chin Med 1996;24:103-109; Singh HB, et al. Allergy 1995;50:995-999.) • Echinacea spp.: especially with recurrent infections (Coeugniet E, Kuhnast R. Therapiewoche 1986;36:3352-3358.) • Hamamelis virginiana: bacteriostatic, soothes and tightens swollen tissues (Mowrey, p. 271-272) • Hydrastis canadensis: anti-microbial, congested uterine tissues and lowered resistance to infection. Use orally or vaginally (Felter, p. 417; Mowrey, p. 272) • Melaleuca alternifolia oil (Tea Tree). especially for trichomonal vaginitis (Pena EO. Obstet Gynecol 1962;19:793-795.) • Myrica cerifera: astringent, alterative; indicated for yeast vaginitis (Sherman) • Symphytum officinale (toxic): astringent, demulcent indicated for white vaginal discharge and genital infections. Soothes inflamed tissues (Nissim, p. 77) • Acidic herbs and preparations: cider vinegar, citrus limon, boric acid, diluted with hot water and used as a douche (Stansbury; Jovanovic R, et al. J Reprod Med 1977;36:593-597.)

==**Chinese Formulae** == • She Chuang Zi Chong Xi Ji: Trichomonas: for external washing or sitz bath twice daily (Yeung, p. 197; Bensky and Barolet, p. 468) • Tri-Snake Itch-Removing Pills (patent): Leukorrhea with pruritus (Fratkin, p. 117) • Tang Kuei and Eight Herb F.; Yu Dai Wan (patent); AK 10 (patent): Damp-Heat in the Lower Warmer with Xue Xu (Blood Deficiency): yellow discharge, weak constitution (Tang Kuei: Hsu, 1980, p. 618; Yu Dai: Zhu, p. 159) • Zhi Dai Fang: Damp-Heat in the Lower Warmer: thick, smelly, yellow leukorrhea, sometimes with blood (Dr. Lihua Wang, Portland, OR) • Yen Jia Wan: Damp Toxin: copious thick, yellow-green leukorrhea with pus and blood, very bad smell, burning pain and itching; lower abdominal pain, worse with pressure (Dr. Lihua Wang, Portland, OR) • Gentiana C. (Long Dan Xie Gan Wan) (available as patent); Gentiana 12 (patent): Liver and Gall Bladder Invaded by Damp-Heat: yellow foul-smelling discharge, red tongue with yellow coat, irritability (Gentiana C.: Hsu, 1980, p. 181; Yeung, p. 154; Dharmananda, 1986, p. 229; Bensky and Barolet, p. 96; patent: Zhu, p. 172; Gentiana 12: Dharmananda, 1990, p. 69) • Lotus Seed C.: Kidney Yin Xu (Deficiency) with Empty Fire Blazing: blood-tinged or watery white leukorrhea, weak constitution (Hsu, 1980, p. 164; Dharmananda, 1986, p. 306) • Anemarrhena, Phellodendron and Rehmannia F. (Zhi Bai Di Huang Wan): Kidney Yin Xu (Deficiency): vaginal discharge in older woman (e.g. post menopausal), slight pink color to discharge; feels burning pain in vaginal tract at night (Bensky and Barolet, p. 265; Yeung, p. 289; Hsu, p. 230). • Bupleurum and Peony F. (Dan Zhi Xiao Yao San or Jia Wei Xiao Yao San) plus lonicera (jin yin hua) and crytomium (guan zhong): Liver Qi Stagnation with Xue Xu (Blood Deficiency): white leukorrhea, dry mouth, breast distention or irregular menstruation (Hsu, 1980, p. 87; Yeung, p. 72; Dharmananda, 1986, p. 177; Bensky and Barolet, p. 148) • Wan Dai Tang: Spleen Distressed by Dampness: edema during menstruation or pregnancy, with profuse whitish or pale yellow leukorrhea, not foul-smelling and usually continuous; fatigue, loose stools, pale tongue with white coat (Bensky and Barolet, p. 369) • Chien Chin Chih Tai Wan (patent): Spleen Qi Xu (Deficiency) with Spleen Distressed by Dampness: leukorrhea, low back ache, fatigue, abdominal distention (Zhu, p. 246) • Kwei Ling Chi (patent); AK 9 (patent): Kidney Yang Xu (Deficiency): abdominal bloating or loose stools, fatigue, weakness after childbirth or illness, weakness in low back or legs, aversion to cold (Kwei Ling: Fratkin, p. 195) • Tang Kuei 18 (patent): Chronic leukorrhea (Dharmananda, 1990, p. 25) • Chin So Ku Ching: Golden Lock Tea (patent): Kidney Qi not Firm (astringes Yang): excessive sweating, diarrhea, copious leukorrhea (Fratkin, p. 191)

==**Acupuncture** == after assessing the person and palpating, consider these patterns: vaginitis/leukorrhea: Wind-Cold; Qi and Xue Xu (Blood Deficiency); Damp-Heat in the Lower Warmer; Kidney Qi Xu (Deficiency) and depletion of Lower Yuan (Original) Qi; Spleen Xu (Deficiency); Liver Qi Stagnation; dysfunction of the Dai Mai (Girdle Vessel); Shi (Excess) of the Ren Mai (Conception Vessel); attack of Cold and Damp candidiasis: Wind-Cold (pain without inflammation); Damp-Heat (pain with inflammation)

» illustrative combinations: • CV-6, GB-26 and Sp-6 for leukorrhea; also consider CV-4 and St-36 for Xue (Blood) and Qi Xu (Deficiency); and/or add Lv-2 and Sp-9 for Damp-Heat (Lee and Cheung, p. 339; Shanghai, p. 675) • CV-6, UB-27, CV-7, UB-33 for leukorrhea (Lee and Cheung, p. 339) • UB-30, GV-26, Sp-9 and Sp-6 for leukorrhea (Shanghai, p. 187) • St-25, CV-4 and Sp-6: treat leukorrhea (Finkelstein, p. 16) • CV-4 and Sp-6; or CV-6, St-29 and Kd-7; or CV-3 and zi gong for leukorrhea (Shanghai, p. 675) • CV-4, Sp-9, Sp-6, UB-31 and GB-26 for vaginal discharge due to Spleen Qi Xu (Deficiency) with Dampness (Jirui and Wang, p. 275) • CV-6, CV-3, UB-30, UB-23, Sp-6 and GB-35 for red and white discharge (Shanghai, p. 675) • GB-26, CV-2, CV-4, CV-6, Sp-6, UB-23, UB-30, PC-5 and GB-35 for red and white leukorrhea (Lee and Cheung, p. 339) • St-29, Kd-3, CV-6 and Kd-7 for trichomonas vaginitis (Shanghai, p. 189) • Sp-10, CV-2 and CV-3; GV-1, GV-2 and GV-4; UB-31, UB-32, UB-33 and UB-34; GB-26, St-25 and Lv-3; Lv-11, Sp-8 and Kd-12 for vaginal discharge (Mann, p. 148) • UB-32 and UB-30 stop vaginal discharge (Finkelstein, p. 46) • Lv-6 and Sp-6; CV-6, CV-3 and CV-2; TW-7 for postpartum vaginal discharge (Mann, p. 152) • zi gong and CV-3: treat infertility, uterine bleeding, and vaginal discharge (Ellis, et al, 1988, p. 404) • GV-26, CV-6 and CV-4: eliminate leukorrhea and nocturnal emission (Finkelstein, p. 67) • GV-26 and GB-27: capture and control Dai Mai (Girdle Vessel) and treats excessive leukorrhea and menses (Finkelstein, p. 67) • Lv-11, Lv-8, CV-1 and Sp-10 for senile vaginitis with itching of the vulva due to Heat in the Xue (Blood) resulting in internal Dryness (Jirui and Wang, p. 266) • CV-4, CV-3, St-29, St-28, Sp-6, Lv-5 and Lv-6 for menopausal syndrome; also consider Sp-8, Sp-9 and GB-26 with leukorrhea (Liu, p. 406) • Lu-7 and Kd-6: open the Ren Mai (Conception Vessel) for which vaginal discharges are a Shi (Excess) symptom • GB-41 and TW-5: open the Dai Mai (Girdle Vessel) for which leukorrhea is a symptom of dysfunction • St-31, St-30 and Lv-11; CV-3, GV-1 and CV-1; Ht-8, Kd-10 and UB-60 for pruritus vulvae (Mann, p. 149) • CV-3 and Sp-6: regulate the Qi function of the Lower Warmer and the function of the genital organs - Sp-6 sends Qi up; CV-3 sends it deep (Finkelstein, p. 84)

==**Homeopathy** == • Arsenicum album: acrid, burning, offensive, thin • Borax: like white of eggs, sensation as if warm water was flowing; pruritus • Calcarea carbonica: milky; burning and itching of parts • Calcarea phosphorica: like white of an egg, < morning • Carbo vegetabilis: thick, greenish, milky, excoriating • Helonias dioica: pruritus vulvae; parts hot, red, swollen, burn and itch terribly • Hydrastis canadensis: acrid and corroding, shreddy, tenacious; pruritus with profuse discharge • Kreosotum: yellow, acrid, odor of green corn • Mercurius vivus: excoriating, greenish and bloody • Natrum muriaticum: acrid, watery • Nitricum acidum: brown, flesh-colored, watery, or stringy, offensive • Pulsatilla: acrid, burning, creamy • Sepia: yellow, greenish with much itching • Sulphur: burning, excoriating

==**Subtle Support** == • notes: A, A#, B, C, C#, D, E, F, G, G#

• chords: A minor, C minor, D minor, D# minor, tonic (Gimbel, p. 116)

fungal: • Strauss' waltzes • La Paloma • Minuet in G • Schubert's Serenade • March of the Wooden Soldiers • Brahm's Lullaby • Schubert's Ave Maria • From the Land of the Sky Blue Water • Somewhere, Over the Rainbow (Heline, p. 18)


==**Mind/Body** == • Conditioned response of anxiety often aggravated by fear of genital cancer or STD; often aggravated by strict therapy of the gynecologist and the tacit or verbalized intimations that this may be a recurring disease. (Rossi and Cheek, p. 294) • Inhibitions or excesses about excesses of sexual activity. (Epstein, p. 190) • Inflammation: fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life. (Hay, 1984, p. 170-1) • Female problems represent a rejection of the feminine principle; denial of the self; rejecting femininity. (Hay, 1984, p. 165) • Anger at mate; sexual guilt; need for punishment. (Hay, 1984, p. 187)

Chinese psychophysiology: • Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. The Heat produced by Liver Stagnation may then transform the Dampness into Damp-Heat. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; manifests through the reproductive function and governs the process of passing on life to offspring; and displays the effects of sexual dissipation, overwork, aging, chronic debilitation or degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); has an intimate relationship with the genitals and Lower Warmer; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems. Wind can also be internalized after exposure to inclement, especially windy, weather and any concomitant influences of Damp, Cold, and/or Heat.

==**Integrative Therapies** == Vaginitis, an infection or inflammation of the vagina, is a very common ailment of women. Symptoms include an unusual amount of vaginal discharge and vaginal discharge that has an unusual color or odor. Symptoms also include itching or burning around the vagina. Painful urination is often related to vaginitis rather than to a bladder infection.

There are several different causes for vaginitis, including some serious conditions such as venereal disease. Other less severe causes are:

• Irritation due to chemicals (such as in contraceptive foams) or a tampon left too long. • Vaginal dryness, mainly in menopausal women but also possible in younger women. • Infections due to bacteria, yeast, or other microbes.

Always consult a physician to find the cause.

Treatment for vaginitis includes removing the cause and improving the condition of the vagina. Cleanse the vagina regularly with clear, non-soapy water, especially after sexual intercourse. Urinating after sex also helps to prevent infections. If the vaginitis is due to irritation, remove the source such as contraceptive foam or perfumed toilet paper and soaps. You may need to change to another type of birth control. Also, consider using pads rather than tampons.

THE FOLLOWING SUPPLEMENTS ARE USED FOR VAGINITIS AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Beta-carotene – 200,000 Units per day while symptoms last, then reduce to 100,000 Units per day for 1 month. 2. Vitamin C – 1,000 milligrams 4 times a day. 3. Vitamin E – 400 Units per day. 4. Zinc – 15 milligrams 2 times a day.

REGARDING THE PROPER DIET FOR VAGINITIS: Avoid sugar and sweets, such as pastries and candies. These upset the acid-base balance of the body, including the vagina, and can lead to infections.

HERBS USED FOR VAGINITIS: • Echinacea and Golden Seal – These can be taken as a tincture, which is a liquid herbal extract, using 2 parts Echinacea and 1 part Golden Seal. Take 1 teaspoon, 3 times a day in some water or juice. Or in capsule form, use 2 capsules of Echinacea and 1 capsule of Golden Seal 3 times a day.

ADDITIONAL MEASURES ARE AS FOLLOWS: 1. A woman with vaginitis should consider avoiding sex for a few days, since this could lead to possible reinfection or irritation of the vaginal tissue.

2. The following douche can be used twice daily: Betadine solution – Use 1 teaspoon per cup of water. This is used for most types of infections including trichomonas, chlamydia, gardenerella, and candida.

3. In stubborn cases, you can use any of the following: A) Prepare a douche by making an infusion of 1 part Golden Seal powder,1 part Echinacea, and 2 parts Yarrow flowers. Use 2 tablespoons of the herbal mixture per cup of water. Steep for 20 minutes. This douche is also used against most infections and should be alternated with betadine. B) White vinegar douche – Use 2 teaspoons of white vinegar per cup of warm water. C) Boric acid in a capsule can be inserted into the vagina once daily for 7 days. D) Take garlic by mouth – 2 capsules, 3 times a day. Chopped garlic can be added to a douche solution or used as a suppository by wrapping 1 clove of peeled garlic in white gauze and inserting it into the vagina for 12 hours. Remove sooner if irritation occurs. E) Lactobacillus powder – Take 1 teaspoon by mouth twice daily. As a douche, use 1 teaspoon per cup of warm water.

HOMEOPATHY: From the following homeopathic remedies choose the one that best matches your symptoms. Dissolve 3 pellets under the tongue 3 times a day until the symptoms improve. • Pulsatilla 12C: For white or yellow discharge that is not burning or irritating. This is commonly used for vaginitis during pregnancy. • Kreosotum 12C: For vaginal discharge that is burning, itching, and foul smelling. The discharge causes an irritation or rawness of the vagina. • Sepia 12C: This is another remedy for an offensive, smelly discharge and vaginitis before the period. The patient feels an uncomfortable weight or pressure in the lower abdomen, lacks interest in sex, and may be apathetic, indifferent, and moody.

Note: A wide range of homeopathic medicines can be helpful for women experiencing chronic or recurrent vaginitis and discharge. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

OTHER MEASURES FOR VAGINITIS INCLUDE: 1. If vaginitis recurs, it is recommended that the sexual partner also see a physician and be treated. 2. Wear cotton underwear instead of synthetic because it lets the air in and helps keep the skin dry. 3. If you know you have a systemic candida, or yeast, overgrowth in other parts of your body besides the vagina, please refer to the article on intestinal flora imbalance (candida albicans). 4. For menopausal women with vaginitis and vaginal dryness, apply vitamin E oil or progesterone oil twice daily. Also, take 400 Units of vitamin E per day by mouth. If you have other menopausal symptoms, you may want to refer to the article on menopause.