VAGINA

Definition:

The vagina is the female organ that connects the uterus and cervix to the outside of the body.

Information:

The vagina is a muscular tube lined with mucus membranes. Its opening is between the urethra (where urine exits the body) and the anus.

The vagina allows for the flow of menstrual blood and for sexual intercourse, and is the passageway through which a baby is born. Inflammation of the vagina is known as vaginitis.

Vaginal Infections:

Infection of the vagina with one or more bacteria, yeast or protozoal organism.

Description of Vaginal Infections

Vaginal symptoms are among the most common reasons that women consult primary care physicians. Most women have a vaginal infection now and then, and many women have them often.

The vagina normally contains large numbers of organisms called Lactobacillus (or Acidophilus).Vaginal infection happen when other organisms grow and change the normal balance of organisms in the vagina.

A vaginal infection is present when the normal vaginal discharge changes color, becomes heavier or smells different, or if there is itching, burning, swelling, or redness around the vagina.
A normal discharge does not smell bad and is not accompanied by redness, swelling, or itching. Most vaginal discharges are normal. A vaginal discharge is often present at some stages in the menstrual cycle. This discharge may be most noticeable at the middle of the cycle, which is close to the time of ovulation.

The most common form of vaginal infection is called bacterial vaginosis. Women with this infection have a large number of organisms called Gardnerella Vaginalis, as well as many other organisms, in their vagina. If an infection is present, there will be a vaginal smell that is strongest after sexual intercourse, and perhaps an increased amount of thin vaginal discharge, which may be white or discolored.

A yeast infection, or Candida Vaginitis, is another common type of vaginal infection. If this is present, there may be larger amounts of thick, white discharge, or no discharge at all. Other common symptoms include itching, swelling, irritation or redness around the vaginal area.
Trichomonas vaginitis, which is sometimes called "trick," is the third most frequent vaginal infection. Like bacterial vaginosis, this infection often causes an increased amount of discharge, which may be discolored. Sometimes, the discharge smells different. Itching may be present but is less likely than with a yeast infection.

In about one of every three women with vaginal symptoms, the cause of the symptoms may be harder to find. An infection of other parts of the urogenital system may be present, such as gonorrhea, chlamydia or herpes. Low hormone levels, related to menopause, or an allergy may also cause vaginal infections

Causes and Risk Factors of Vaginal Infections:

Most vaginal infections have no apparent cause. They sometimes occur in times of stress or other illness. They also often occur (especially yeast infections) following a course of antibiotics taken for other reasons.

Some vaginal infections are a result of sexual intercourse, but the organisms covered in this topic area tend not to be ranked as seriously as other sexually transmitted diseases.

Symptoms of Vaginal Infections:

Symptoms can range from minimal discharge, odor or irritation, to copious discharge with substantial irritation and pain.

Diagnosis of Vaginal Infections:

These causes of vaginal infection can usually be easily diagnosed by your doctor in the office using simple techniques. Often, just the history and clinical presentation is enough to conclude which type of infection it is.

Treatment of Vaginal Infections:

The treatment for vaginal infections depends on the cause.
Bacterial vaginosis is often treated with a prescription medication called metronidazole (Flagyl, Protostat). This medication is taken by mouth. Sometimes it causes an upset stomach or nausea. If you drink alcohol while taking this drug, you may have nausea and vomiting. There are other medicines that may be taken by mouth for this infection, such as clindamycin (Cleocin), and there are also vaginal creams and gels.

A yeast infection is usually treated with creams and suppositories that are placed in the vagina. The length of treatment may vary from one to seven days. Some of these medicines are now available without prescription, such as miconazole (Monistat) and clotrimazole (Gyne-Lotrimin or Mycelex-G), and you may use then when you know you have a yeast infection. If the infection does not get better or comes back soon, you should see your doctor to make sure of the diagnosis and treatment.

Trichomonas vaginitis is also treated with metronidazole, taken by mouth. However, because this infection is often passed back and forth between sexual partners, it is necessary that the partner also take the medication to prevent it coming back.
Vaginal Cancer

Signs and Symptoms:

Vaginal cancer is a rare disease and makes up less than 3 percent of all gynecological cancers. There are four different types of vaginal cancer, including:
1. Squamous Cell Cancer: The most common type and usually occurs in the upper part of the vagina. It typically affects women between the ages of 50 and 70.
2. Adenocarcinoma: The second most common type and usually affects women between the ages of 12 and 30, although it occassionally occurs in women of all age groups.
3. Malignant Melanomas Sarcomas: Extremely rare forms of the disease.
It is important to know that even if you have had a hysterectomy, you can still develop vaginal cancer.

Risk Factors:

As with many cancers, the exact cause of vaginal cancer is not known for sure. However, some factors may increase a woman's risk for the disease, including:
1. Smoking
2. Age, women over the age of 50 are most commonly affected by squamous cell vaginal cancer
3. History of cervical cancer.
4. Having had a hysterectomy
5. History of genital warts caused by the human papilloma virus (HPV)
6. Having had radiation therapy to the pelvic area

In addition, research has shown that young women whose mothers took a drug known as diethylstilbestrol (DES) are at a higher risk for developing the disease. The drug DES was given to pregnant women between 1945 and 1970 to prevent them from having miscarriages.
In some cases, vaginal cancer may not cause any symptoms and is detected by an abnormal Pap smear. However, some common symptoms of the condition include:
1. Bleeding or discharge not related to menstrual periods
2. Difficult or painful urination
3. Pain during intercourse or in the pelvic area

Treatment:

Treatment for vaginal cancer typically involves surgery, radiation therapy and possibly chemotherapy. With surgery, some patients may need skin grafts and plastic surgery to make an artificial vagina. Some patients may need more than one type of treatment in combination.
At UCSF Medical Center, a team of cancer specialists and plastic surgeons work together to design the most effective treatment plan for your condition.

Surgery:

Surgery is the most common treatment for all stages of vaginal cancer. A doctor may remove the cancer using one of the following:

Laser Surgery: A narrow beam of light is used to kill cancer cells. It may be used for the very earliest stages of when the cancer has been confined to the place of its origin which is also known as in situ cancer.

Wide Local Excision: A type of surgery that removes the cancer and some of the tissue around it. A patient may need to have skin taken from another part of the body, or grafted, to repair the vagina after the cancer has been removed.

Vaginectomy: In some cases, an operation in which the vagina is removed may be recommended. When the cancer has spread outside the vagina, vaginectomy may be combined with surgery to take out the uterus, ovaries and fallopian tubes. This is called a radical hysterectomy. During these operations, lymph nodes in the pelvis also may be removed.

Exenteration: If the cancer has spread outside the vagina and the other female organs, the doctor may take out the lower colon, rectum or bladder -- depending on where the cancer has spread -- along with the cervix, uterus and vagina.

Radiation Therapy:

Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body, called external beam radiation therapy. Another form or radiation therapy, called internal radiation, works by placing materials that produce radiation, called radioisotopes, through thin plastic tubes into the area where the cancer cells are found. Radiation may be used alone, in combination with chemotherapy, or after surgery.

Chemotherapy:

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the vagina. Chemotherapy may be used in combination with radiation treatment, or alone.