2 - The vagina

Summary

Vaginal inflammation

NON-INFECTIVE INFLAMMATION

Non-infective vaginal inflammation may complicate trauma, surgery, irradiation, the introduction of foreign bodies, the application of chemical substances or the wearing of a pessary. These factors are more likely to cause inflammatory changes at times of estrogen deficiency, for example after the menopause.

INFECTIVE INFLAMMATION

Most vaginal infections are sexually transmitted but it is far from certain how the infecting organisms become established in the vagina and overcome the dual threats posed by the normal vaginal flora and the acidity of vaginal fluids. It is probable that changes in estrogen or progesterone levels are an important factor in the establishment of an infection, in so far as estrogen deficiency or progesterone excess will result in diminished epithelial growth, a reduction in the supply of glycogen and restriction of the ability of lactobacilli to flourish, thus allowing invading organisms to gain ascendancy.

Bacterial vaginosis

The sexually transmitted Gram-negative bacillus, Gardnerella vaginalis, either acting singly or in combination with anaerobic organisms, is now recognised to be the cause of the vast majority of cases previously designated as ‘non-specific vaginitis’. Bacterial vaginosis is associated with a thin, watery, highly malodorous vaginal discharge but the organism is only a surface parasite and does not invade the vaginal tissues or evoke any inflammatory reaction.

Candidiasis

Candida albicans may exist in the vagina without causing any signs or symptoms.