Genitourinary tract infections are among the most frequent disorders for which patients seek care from gynecologists. By understanding the pathophysiology of these diseases and having an effective approach to their diagnosis, it is possible to institute appropriate treatment of these conditions and reduce long-term complications.

Most of the types of vaginitis covered in this article mainly manifest as excessive vaginal discharge, pain, vaginal itching, and painful intercourse.  Chinese medicine relies on the nature of the vaginal discharge as a diagnostic tool. A large amount of vaginal discharge signifies deficiency of the Kidney and Spleen. Smelly, whitish or yellowish colour indicates dampness or dampness with heat; a green colour indicates Liver constraint. Deficiency of the Kidney, Spleen and Liver leads to the production of internal heat and dampness, which pours downward into the reproductive tract. Usually it is a Kidney and Liver deficiency that generates heat, while deficiency of the Spleen leads to dampness.  Therefore, vaginitis is generally due to damp-heat in the Liver channel, Spleen deficiency with dampness pouring down, or Liver and Kidney deficiency.  Often, treatment included both internal and external administration.  Here is a more detailed look into some of the most common infections.

 

Bacterial Vaginosis

Bacterial Vaginosis (BV) has previously been referred to as nonspecific vaginitis or Gardnella vaginitis.  It is an alteration of normal vaginal bacterial flora that results in the loss of hydrogen peroxide-producing lactobacilli and an overgrowth of predominantly anaerobic bacteria. It is the most common form of vaginitis inNorth America and it is not known what triggers the disturbance of normal vaginal flora, though it has been postulated that frequent sexual intercourse or use of douches plays a role.  Studies have shown an association of BV with significant adverse complications.  The diagnosis of BV includes some symptomatic exams that show a fishy vaginal odor, particularly noticeable following intercourse and vaginal discharge.

Chinese medicine differentiates syndromes into two different types:

  • Damp-Heat Pouring Downward: it manifests as excessive yellowish vaginal discharge with itching of the vulva and vagina with a red tongue and a slippery-rapid pulse.
  • Wet-Toxin Disturbance: this manifests as pus-like vaginal discharge that has a foul odor along with itching and swelling of the vulva and vagina with a red tongue and a rapid pulse.

Oral herbal teas are used for treatment as well as external application of herbal fumigations, washes and douches are also recommended, along with acupuncture.

 

Trichomonal Vaginitis

Trichomonal Vaginitis is caused by the sexually transmitted, flagellated parasite, trichomonas vaginalis.  The transmission rate is high: 70% of males contract the disease after a single exposure to an infected female, which suggests that the rate of male-to-female transmission is even higher.  Trichomonal vaginitis often accompanies BV, which can be diagnosed in up to 60% of patients with trichomonal vaginitis.

Diagnosis in western medicine suggests that local immune factors and the severity of the infections influence the appearance of symptoms though trichomonal vaginitis is often asymptomatic.  Signs and symptoms may include a profuse, purulent, malodorous vaginal discharge that may be accompanied by vulvar itch and in severe cases a patchy vaginal erythema and colpitis macularis (“strawberry” cervix) may be observed.

Chinese Medicine syndrome differentiation generally includes:

  • o Damp-Heat Accumulation: which manifests as serious pruritus vulvae (itch), burning sensation, excessive vaginal discharge that is a yellow-green-grey colour and foamy, with a foul odor, a reddish tongue and yellow coating, and a slippery-rapid pulse.
  • o Worm Invasion: manifesting as serious pruritus vulvae and vagina, excessive vaginal discharge that is grey-yellow in colour and a pus-like or foamy consistency, foul odor and a red tongue, with a thin yellow coating and a stringy-slippery pulse.

Oral administration of herbal teas along with external treatments including fumigation, washing and acupuncture are indicated.

 

Vulvovaginal Candidiasis

Candida albicans is responsible for 85% to 90% of all vaginal yeast infections.  It is estimated that as many as 75% of women experience at least one episode of vulvovaginal candidiasis (VVC) during their lifetimes. Almost 45% of women will experience two or more episodes. Factors that predispose women to the development of symptomatic VVC include: antibiotic use, pregnancy, and diabetes.  Some of the typical and most tell-tale symptoms ofVVCconsist of vulvar itch associated with a vaginal discharge that typically resembles cottage cheese. The discharge can vary from watery to homogeneously thick. Vaginal soreness, painful intercourse, vulvar burning, and irritation may be present with yeast infections.

Syndrome differentiations include:

  • o Damp-Heat Pouring Downward: manifested as excessive vaginal discharge that is yellow-white in colour and resembles cottage cheese, along with pruritus vulvae, yellow urination, a red tongue with a yellow greasy coating, and a soft-slippery pulse.
  • o Spleen Deficiency with Damp Disturbance: this is for acute or chronicVVC with excessive vaginal discharge that is dilute and watery in nature with vulvar and vaginal discomfort, a light red tongue and a thready pulse.

Orally administered oral teas as well as external herbal treatments such as fumigation, washing, sitz bath, vaginal douche and acupuncture are recommended.

 

Atrophic Vaginitis

Estrogen plays an important role in the maintenance of normal vaginal ecology. Women undergoing menopause, either occurring naturally or secondary to surgical removal of the ovaries, may develop inflammatory vaginitis, which may be accompanied by an increase in purulent vaginal discharge. In addition, they may note dyspareunia and post-coital bleeding resulting from atrophy of the vaginal and vulvar epithelium. Examination reveals atrophy of the external genitalia, along with a loss of the vaginal rugae. The vaginal mucosa may be somewhat friable in areas. Microscopy of the vaginal secretions shows a predominance of parabasal epithelial cells and an increased number of leukocytes.

Syndrome differentiation for atrophic vaginitis includes

  • o Damp-Heat Pouring Downward: manifestations include pruritus vulvar and vagina with a burning sensation, excessive vaginal discharge that is yellow dilute/watery, with a foul odor, a red tongue with a yellow greasy coating, and a soft-rapid pulse.
  • o Yin Deficiency of the Liver & Kidney: pruritus vulvae and vagina with a burning sensation, yellow vaginal discharge, a red tongue with less coating, and a thready-rapid pulse.

Oral administration of herbs as well as acupuncture, fumigation, washing, sitz bath and vaginal douches are indicated for treatment.

 

These are just a few of the reasons for abnormal discharge in women.

 

Caroline Prodoehl, R.TCMP.