Vulvovaginal complaints are the most common gynecologic reason why women visit their healthcare providers. While BV (bacterial vaginosis), trichomonas and yeast account for approximately 90 percent of this diagnostic category, the remaining 10 percent may plague both the patient and provider if an accurate diagnosis is not achieved. While BV, yeast and trich have characteristic subjective and objective findings, a newer diagnosis has come to light and may be responsible for as much as five percent of vulvovaginal complaints.
The vagina is filled with prominent bacteria to keep the environment healthy. Known as lactobacilli, this species has a protective effect against the overgrowth of potentially infectious microorganisms by maintaining an acidic vaginal pH. A disruption in this vaginal equilibrium may occur however, if an overgrowth of lactobacilli occurs. This situation may then lead to symptoms such as thick, paste-like discharge, vulvar itch, painful urination and possibly slightly painful intercourse. The most interesting thing I think about this dilemma is that it occurs during the luteal phase of the menstrual cycle, which is the time from ovulation until menses begins.
Usually, these patients present with a lengthy history of these symptoms due to the fact that these conditions are frequently misdiagnosed as vulvar/vaginal yeast. The cure for yeast infections, whether ordered by a provider or taken by the patient in an over-the-counter medication, may actually make the situation worse. Therefore, it is imperative that the patient be seen and a physical exam be done, making sure to include a microscopic analysis of the vaginal discharge. Symptom relief is the goal of treatment and is achieved by restoring vaginal equilibrium.
While there is sparse scientific evidence regarding treatment regimens, significant clinical data has been published. These management strategies may include baking soda baths, baking soda douches, discontinuation of tampon use and over-the-counter medications or antibiotic prescription medication. It is imperative patient education involve an explanation of the possible causative factors and the impact that patient behavior will have on resolving this imbalance.
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