Vaginitis is a term used to describe an infection or inflammation of the vaginal mucosa and is often associated with an irritation or infection of the vulva leading to vulvovaginitis, vaginal discharge, itching and pain. Vulvovaginitis refers to inflammation of both the vagina and vulva, the outer area of labial and skin surrounding the vagina. The presence of abnormal discharge, vulvovaginal discomfort, or both is required for the diagnosis of vaginitis.
Vaginitis is a diagnosis based on the presence of symptoms of abnormal discharge, vulvovaginal discomfort, or both. Discharge flows from the vagina daily as the body's way of maintaining a healthy environment. Normal discharge is usually clear or milky with no malodor. A change in the amount, color, or smell; irritation; or itching or burning could be due to an imbalance of healthy bacteria in the vagina, leading to vaginitis.
The term "yeast infection" is what most women think of when they hear the word vaginitis. However, a yeast infection is only one kind of vaginal infection. Vaginitis can be caused by several different organisms, sometimes at the same time, as well as by hormonal changes, allergies, or irritations.
Non-specific vaginitis (bacterial vaginosis) implies that any of several infecting organisms may have caused the infection. Vaginitis conditions can result from an infection caused by organisms such as bacteria, yeast, or viruses. In some cases, vaginitis results from organisms that are passed between sexual partners.
Vaginitis can also be caused by antibiotic use, diabetes, excessive alcohol, steroid use, a weakened immune system, abrasions of the vagina, or tight non-cotton underwear, as well as by irritations from chemicals in creams, sprays, or even clothing that are in contact with this area. Vaginitis may also be the result of a change in the normal balance of vaginal bacteria or from reduced estrogen levels after menopause.
THE AGE FACTOR & VAGINAL FLORA
The composition of vaginal flora changes with age, stress, hormonal influence, general health status, and sexual activity. The age of the patient affects the anatomy and physiology of the vagina.
- Pre-pubertal children have a more alkaline vaginal pH than pubertal and post-pubertal adolescents and women. The vaginal mucosa is columnar epithelium, vaginal mucous glands are absent, normal vaginal flora is similar to that of post-menopausal women (e.g., gram-positive cocci and anaerobic gram-negatives are more common), and labia are thin with a thin hymen.
- Pubertal and post-pubertal adolescents and women have a more acidic vaginal pH, stratified squamous vaginal mucosa, vaginal mucous glands, normal vaginal flora of lactobacilli, thick labia, and hypertrophied hymens and vaginal walls. Loss of vaginal lactobacilli appears to be the primary factor in the changes leading to bacterial vaginosis. Recurrences of vaginitis are associated with a failure to establish a healthy vaginal microflora dominated by lactobacilli.
THE VAGINAL BALANCE
It is normal for a small amount of clear or cloudy white fluid to pass from a woman's vagina. This keeps the tissue moist and healthy. The vagina holds organisms, such as bacteria and yeast, in balance so it can function normally. Some factors can upset this normal balance of the vagina:
- Changes in hormone levels.
- Sexual intercourse.
A change in the normal balance can allow either yeast or bacteria to increase and result in vaginitis. This causes the lining of the vagina to become inflamed. Vaginitis may cause itching, a bad odor, or a large amount of discharge.
Vaginitis is a common problem for women, affecting millions of women each year. It and can effect women of all ages, but most often occurs during the reproductive years. In the United States, vaginitis is common in adult women and uncommon in pre-pubertal girls. Vaginitis is one of the most common reasons for gynecologic consultation consisting of approximately 10 million office visits annually. Bacterial vaginosis accounts for 40-50 percent of vaginitis cases; candidiasis, 20-25 percent; and trichomoniasis, 15-20 percent.
FREQUENT SIGNS & SYMPTOMS
The symptoms of vaginitis vary depending on the cause. Vaginitis can be caused by bacterial or fungal infections, vitamin B deficiency, intestinal worms, or irritation from excessive douching or the use of such products as deodorant sprays. Infectious vaginitis is often caused by trichomonas, gonococci, or other sexually transmitted organisms. Other factors, such as poor hygiene and tight, non-porous clothing may contribute to the problem. Pregnancy, diabetes, and the use of antibiotics disturb the body's natural balance, creating an environment which infectious organisms can survive and thrive. Oral contraceptives also can produce vaginal inflammation.
In general, women with this condition may have itching, irritation, or burning and may notice an abnormal vaginal discharge. In general, these are symptoms of vaginitis:
- Vaginal discomfort, pain and/or itching of the genital/vulval area.
- Inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area. Change in vaginal color from pink to red.
- Abnormal vaginal discharge with a change in color, odor, or amount of discharge from the vagina. Vaginal discharge varies in color, consistency and odor depending on the infectious organism. Vaginal discharge may be thin and watery, occasionally tinged with blood.
- Foul, unpleasant vaginal discharge odor.
- Pain, discomfort or burning when urinating.
- Pain, discomfort and irritation during and/or after sexual intercourse. Discomfort may be worse after menstrual period.
- Light vaginal bleeding or spotting.
Additionally, you may have additional signs and symptoms depending on the type of vaginitis. Severity of the above symptoms varies among women and from time to time in the same woman. There are a several different kinds of vaginitis, each with their own causes and symptoms:
YEAST (CANDIDA) VAGINOSIS: Yeast infections of the vagina are probably the most familiar form of vaginitis. They occur when too much of the fungus Candida grows in the vagina. Yeast infections produce a thick, white discharge from the vagina that can look like cottage cheese. The discharge can be watery and often has no smell (odorless). Yeast infections usually cause the vagina and vulva (the area outside the vagina) to become very itchy and red. An antibiotic taken for a urinary tract infection can kill "friendly" bacteria that normally keep the yeast in balance; as a result, the yeast overgrows and causes the infection.
MoonDragon's ObGyn Information: Candidal Vaginitis
BACTERIAL VAGINOSIS: Bacterial vaginosis is the most common vaginal infection in women of reproductive age. It is caused by an overgrowth of bacteria that are usually present in the vagina. Bacterial vaginosis will often cause a thin, milky, grayish-white discharge from the vagina that may have a foul-smelling "fishy or fish-like" odor. The fish-odor may be more obvious (more noticeable) after sexual intercourse. Many women with bacterial vaginosis have no symptoms and only discover they have it during a routine gynecologic exam. Since bacterial vaginitis is caused by bacteria, treatment is usually with antibiotics.
MoonDragon's ObGyn Information: Bacterial Vaginitis
TRICHOMONAS VAGINOSIS: Trichomoniasis is a sexually transmitted disease that is caused by a single-celled organism that is a member of the protozoa family of microorganisms. Trichomonas is commonly called "trick" or "trich". When this organism infects the vagina, it can cause a greenish-yellow, sometimes frothy discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of vaginal itching, burning, and soreness of the vagina and vulva, as well as burning during urination. These symptoms may be worse after a menstrual period. Many women with trichomoniasis do not develop any symptoms. This type of vaginitis can be transmitted through sexual intercourse and is considered a sexually transmitted disease (STD).
MoonDragon's ObGyn Information: Trichomonal Vaginitis
CHLAMYDIAL VAGINOSIS: Chlamydia, a sexually transmitted disease, can cause vaginitis. Unfortunately, most women do not have symptoms. A vaginal discharge is sometimes present with this infection but not always. More often a woman might experience light bleeding especially after intercourse. chlamydial vaginitis is most common in young women under the age of 30 who have multiple sex partners. Chlamydia is considered a STD.
MoonDragon's ObGyn Information: Chlamydia
VIRAL VAGINOSIS: Viral vaginitis can be caused by herpes simplex virus that is spread by sexual intercourse. The primary symptom of herpes vaginitis is pain associated with lesions or sores. These sores are usually visible on the vulva or the vagina and can only be seen during a gynecologic exam. Herpes is a considered a sexually transmitted disease.
MoonDragon's ObGyn Information: Genital Herpes
NON-INFECTIOUS VAGINITIS: This form of vaginitis is usually caused by an allergic reaction or irritation the vagina in the sensitive skin around the vagina. Sensitivity to vaginal sprays, douches, spermicidal products, perfumed soaps, detergents, or fabric softeners can cause burning, itching, or vaginal discharge even if there is no infection.
MoonDragon's Health & Wellness: Allergies
ATROPHIC VAGINITIS: This type of vaginitis is also known as inflammatory vaginitis, vaginal atrophy, or urogenital atrophy, which is an inflammation of the vagina (and outer urinary tract) due to the vaginal tissues becoming thinner and drier (lack of vaginal lubrication) from reduced or lack of estrogen hormone levels. This is a condition primarily found after menopause (in post-menopausal women) and in those whose ovaries have been surgically removed, but sometimes can be caused by other circumstances. The symptoms include vaginal dryness, itching, burning or pain, especially with intercourse, and bleeding after intercourse, as well as pressure, white discharge, and malodorous discharge due to infection. The shrinkage of the tissues can be extreme enough to make intercourse impossible. This disorder can result in the formation of adhesions, sores, and cracks may occur spontaneously and high susceptibility to infection. Urinary symptoms include painful urination, blood in the urine, increased frequency of urination, incontinence, and increased likelihood and occurrence of infections.
MoonDragon's ObGyn Information: Atrophic (Post-Menopausal) Vaginitis
Although each of these types of vaginal infection can have different symptoms, it is not always easy for an individual to figure out what type of vaginitis she has - in fact, diagnosis can even be tricky for an experienced clinician. If everyone with vaginitis had exactly these symptoms, then the diagnosis would be fairly simple. However, it is important to realize that as many as 4 out of every 10 women with vaginitis may not have these typical symptoms. Part of the problem is that sometimes more than one type of vaginitis can be present at the same time. Often vaginitis is present with no symptoms at all.
Treatment depends on the type of vaginitis you have.
NORMAL VAGINAL DISCHARGE
Vaginitis causes vaginal discharge, which must be distinguished from normal discharge.
Normal discharge is common when estrogen levels are high. For example, during the first 2 weeks of life, female babies will often experience a vaginal discharge because maternal estrogen are transferred before birth (slight bleeding often occurs when estrogen levels abruptly decrease), and during the few months before menarche, when estrogen production increases. Normal vaginal discharge is commonly milky white or mucoid, odorless, and non-irritating; it can result in vaginal wetness that dampens underwear.
Discharge due to vaginitis is accompanied by itching (pruritus), redness (erythema) in the vaginal tissues and possibly the vulval area, and sometimes burning, pain, or mild bleeding. Pruritus may interfere with sleep. Painful urination (dysuria) or painful intercourse (dyspareunia) may occur. In atrophic vaginitis, discharge is scant, dyspareunia is common, and vaginal tissue appears thin and dry. Although symptoms vary among particular types of vaginitis, there is much overlap.
COMMON TYPES OF VAGINITIS - A COMPARISON
DISORDER TYPICAL SIGNS & SYMPTOMS CRITERIA FOR DIAGNOSIS MICROSCOPIC FINDINGS DIFFERENTIAL DIAGNOSIS Bacterial Vaginosis Gray, thin, fishy-smelling discharge, often with pruritus and irritation; no dyspareunia. Three of the following:
pH greater than 4.5.
Trichomonal vaginitis. Candidal Vaginosis Thick, white discharge; vaginal and sometimes vulvar pruritus with or without burning, irritation, or dyspareunia. Typical discharge.
pH less than 4.5
And microscopic findings.*
Budding yeast, pseudohyphae, or mycelia.
Best examined with 10% potassium (K) hydroxide diluent.
Contact irritant or allergic vulvitis.
Vulvodynia (burning discomfort, itching, throbbing or tenderness of the vulva).
Trichomonal Vaginitis Profuse, malodorous, yellow-green discharge, dysuria, dyspareunia; erythema. Identification of causative organism by microscopy* (occasionally by culture). Motile, flagellated protozoa, increased PMNs (polymorphonuclear neutrophils). Bacterial Vaginosis
Inflammatory Vaginitis Purulent discharge, vaginal dryness and thinning, dyspareunia, dysuria; usually in post-menopausal women. pH greater than 6; Negative whiff test; and characteristic microscopy findings. Increased PMNs, parabasal cells, and cocci; decreased bacilli. Erosive lichen planus.
*Culture is needed if microscopic findings are negative or symptoms persist.
The cause depends on the type of vaginitis you have and the causes of vulvovaginitis vary depending on the following:
- Age. Vulvovaginitis can affect women of all ages and is very common.
- Sexual activity (or abuse).
- Hormonal status.
- Immunologic status.
- Anatomy of the genital area.
- Underlying skin diseases.
Infectious vaginitis is most common in reproductive-age women and is generally caused by bacterial, candidal, trichomonas, gonococci or other sexually transmitted organisms, including Gardnerella, Escherichia coli (E. coli), Mycoplasma, streptococci, staphlyococci or others. E. coli bacteria normally inhabit the rectum and can cause infection if spread to the vagina. These infections are contagious.
Infectious vaginitis accounts for 90 percent of all cases in reproductive age women. Women with compromised immune systems (such as AIDS patients, cancer patients going through cancer therapy, or organ transplant patients) or women on long-term antibiotics for other illnesses may be more prone to various types of vaginal infections.
Pre-pubescent girls may also have infectious vaginitis, although the causes are different than those for women:
- Candidiasis: vaginitis caused by Candida albicans (a yeast).
- Bacterial vaginosis: vaginitis caused by Gardnerella (a bacterium).
- Other less common infections are caused by gonorrhea, chlamydia, mycoplasma, herpes, campylobacter and some parasites.
- Bacterial vaginosis: vaginitis caused by Streptococcus spp.
- Improper hygiene, which may introduce bacteria or other irritants from the anal region to the vaginal area.
- The PH balance in girls' bodies is not conducive to Candida albicans, so they are unlikely to contract a yeast infection.
Sexually Transmitted Diseases (STDs) can be a cause of vaginal discharge. Chlamydia and gonorrhea testing should be done whenever a sexually active individual complains of vaginal discharge even when the cervix appears normal.
Women who have diabetes develop infectious vaginitis more often than women who do not.
- BACTERIAL VAGINOSIS: Bacterial vaginosis and is the most common type of vaginitis. Bacterial vaginosis occurs when the natural balance of organisms in the vagina changes. The healthy vagina normally contains a variety of bacteria. Bacterial vaginosis results from an overgrowth of one of several organisms normally present in your vagina. One type of "good" bacteria, Lactobacillus, is particularly important. Lactobacillus keeps the vagina slightly acidic to reduce the growth of potentially harmful organisms. Usually, "good" bacteria (lactobacilli) outnumber "bad" bacteria (anaerobes) in your vagina. When Lactobacilli are replaced with different kinds of anaerobic bacteria and if anaerobic bacteria become too numerous, they upset the balance and bacterial vaginosis results resulting in an unpleasant vaginal odor develops and an infection (vaginitis) occurs. This type of vaginitis can spread during sexual intercourse, but it also occurs in people who are not sexually active. Women with new or multiple sex partners, as well as women who douche or use an intrauterine device (IUD) for birth control, have a higher risk of bacterial vaginosis.
- YEAST (CANDIDA) VAGINOSIS: Yeast infections occur when certain internal or external factors change the normal environment of the vagina and trigger an overgrowth of a microscopic fungus - the most common being Candiasis albicans. A yeast infection is not considered a sexually transmitted disease. Besides causing most vaginal yeast infections, C. albicans also causes infections in other moist areas of your body, such as in your mouth (thrush), skin folds and fingernail beds. The fungi can also cause diaper rash. Factors that increase your risk of yeast infections include:
- Medications, such as antibiotics and steroids (corticosteroids).
- Uncontrolled diabetes.
- Hormonal changes, such as those associated with pregnancy, birth control pills or menopause.
- Bubble baths.
- Vaginal contraceptives.
- Damp or tight fitting clothing, and synthetic (non-ventilating) fabric underwear.
- Feminine hygiene products, such as sprays and deodorants, do not cause yeast infections, but they may increase your susceptibility to infection.
- TRICHOMONAL VAGINOSIS: Trichomoniasis is a common sexually transmitted disease caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection. The organism usually infects the urinary tract in men, but often causes no symptoms in men. Trichomoniasis typically infects the vagina in women. It is the least common and comprises 3 to 5 percent of all vaginitis infections.
Non-infectious vaginitis is caused by irritation and inflammation of vaginal tissues by non-organism related factors and are not contagious.
- HORMONAL VAGINITIS: Hormonal vaginitis includes atrophic vaginitis usually found in post-menopausal women, women having had surgical removal of the ovaries, postpartum women (after childbirth), and sometimes it can occur in young girls before puberty. In these situations the estrogen support of the vagina is poor with thinning of the vaginal lining. Vaginal itching and burning may occur if the thin vaginal lining becomes irritated by a drop in your hormone levels. Oral contraceptives can also produce vaginal inflammation.
- IRRITATION / ALLERGY: Irritant vaginitis can be caused by allergies to condoms, spermicides, scented soaps, perfumes, douches, lubricants and semen. It can also be caused by hot tubs, abrasion, tissue, tampons or topical medications. Irritant vaginitis is the result of poor hygiene, or the use of vaginal hygiene products, contraceptives, and other products may cause an allergic reaction or contact dermatitis that irritate the delicate skin of your vulva and vagina. It can also be a result of non-ventilating clothing.
- FOREIGN BODY VAGINITIS: Foreign bodies (most commonly retained tampons or condoms, but may also include contraceptive devices such as a diaphragm or cervical cap) cause extremely malodorous vaginal discharges. Treatment consists of removal, for which ring forceps may be useful. Further treatment is generally not necessary.
RISK INCREASES WITH
Vaginitis is infectious or non-infectious inflammation of the vaginal mucosa, sometimes with inflammation of the vulva. Vaginitis is one of the most common gynecologic disorders. Some of its causes affect the vulva alone (vulvitis) or in addition (vulvovaginitis) or the vagina alone (vaginitis).
The most common causes and risks vary by patient age.
In children, vaginitis usually involves infection with GI tract flora (non-specific vulvovaginitis).
A common contributing factor in girls aged 2 to 6 years is poor perineal hygiene (such as wiping from back to front after bowel movements; not washing hands after bowel movements; fingering, particularly in response to itching).
Chemicals in bubble baths or soaps may cause inflammation.
Foreign bodies (such as tissue paper) may cause non-specific vaginitis with a bloody discharge.
Sometimes childhood vulvovaginitis is due to infection with a specific pathogen (such as streptococci, staphylococci, Candida, and occasionally, pinworm).
WOMEN OF REPRODUCTIVE AGE
In these women, vaginitis is usually infectious. The most common types are bacterial vaginosis, Candidal vaginitis and trichomonal vaginitis, which is sexually transmitted. Normally in women of reproductive age, Lactobacillus is the predominant constituent of normal vaginal flora. Colonization by these bacteria keeps vaginal pH in the normal range (3.8 to 4.2), thereby preventing overgrowth of pathogenic bacteria. Also, high estrogen levels maintain vaginal thickness, bolstering local defenses.
Factors that predispose to overgrowth of bacterial vaginal pathogens may include the following:
- An alkaline vaginal pH due to menstrual blood, semen, or a decrease in lactobacilli.
- Poor hygiene.
- Frequent douching.
In post-menopausal women there is usually, a marked decrease in estrogen causes vaginal thinning, increasing vulnerability to infection and inflammation.
Some treatments (such as oophorectomy, pelvic radiation, certain chemotherapy drugs) also result in loss of estrogen.
Decreased estrogen predisposes to atrophic vaginitis.
Poor hygiene (as may be seen in patients who are incontinent or bedridden) can lead to chronic vulvar inflammation due to chemical irritation from urine or feces or due to non-specific infection.
Bacterial vaginosis, candidal vaginitis, and trichomonal vaginitis are uncommon among post-menopausal women but may occur in those with risk factors.
WOMEN OF ALL AGES
At any age, conditions that predispose to vaginal or vulvar infection include fistulas between the intestine and genital tract, which allow intestinal flora to seed the genital tract, and pelvic radiation or tumors, which break down tissue and thus compromise normal host defenses.
Non-infectious vulvitis accounts for up to 30 percent of vulvovaginitis cases. It may result from hypersensitivity or irritant reactions to hygiene sprays or perfumes, menstrual pads, laundry soaps, bleaches, fabric softeners, fabric dyes, synthetic fibers, bathwater additives, toilet tissue, or, occasionally, spermicides, vaginal lubricants or creams, latex condoms, vaginal contraceptive rings, or diaphragms.
The following conditions increase the likelihood of infections.
- General poor health.
- Use of antibiotics, disturbing the body's natural balance, creating an environment in which infectious organisms can thrive.
- Use of oral or other hormone-based contraceptives.
- Hot weather, tight-fitting, non-ventilating clothing, especially underwear or any other condition that increases genital moisture, warmth and darkness. These foster the growth of microorganisms.
- Poor hygiene.
- Excessive douching.
- Poor diet. Vitamin B deficiency, a diet high in sugars (which can feed microorganisms) may contribute to the risk of infections.
- Diabetes mellitus.
- Infrequent bathing or unsanitary living conditions.
- Illness that has lowered resistance.
- HIV infection.
- Alcohol or drug use and abuse.
- Studies have shown that stress can also be a contributing factor.
Decrease intake of sweets (sugar), bread (yeast), and alcohol.
Eat yogurt or take acidophilus tablets, especially if you are taking antibiotics.
Practice abstinence or safe sex and avoid multiple partners. Practicing safe sex can help protect against sexually transmitted forms of vaginitis. Latex condoms, when used consistently and correctly, can reduce the risk of transmission of STDs.
Keep the genital area clean. Use plain, mild, unscented soap. Be sure sexual partner is clean.
Avoid perfumed or scented soaps, harsh soaps, or those with deodorant or antibacterial action.
Avoid sexual lubricants and spermicides if vaginitis is a problem.
Take showers rather than baths. Avoid hot tubs and whirlpool spas. Rinse soap from your outer genital area after a shower, and dry the area well to prevent irritation.
After urination or bowel movements, cleanse by wiping or washing from front to back (vagina to anus) to avoid spreading bacteria from the rectum to the vagina.
Do not sit around in wet clothing, especially a wet bathing suit.
Do not use or avoid the use of vaginal douches, deodorants, dyed or perfumed toilet tissue, scented soap or bubble baths because they can kill "good" bacteria, disrupting the normal balance of vaginal organisms or cause irritation.
Avoid excessive douching. Do not douche unless instructed by your health care provider or midwife for medical reasons. Your vagina does not require regular cleansing other than normal bathing. Repetitive douching disrupts the normal organisms that reside in the vagina and can actually increase your risk of vaginal infection.
Wear cotton underpants or pantyhose with a cotton crotch. If you often get yeast infections, you may want to avoid clothes that hold in heat and moisture, such as panty hose without a cotton lining, nylon panties, or tight jeans. If you feel comfortable without underwear, skip wearing underwear to bed. Yeast thrives in warm, moist environments.
Lose weight if obese.
If you have diabetes, adhere strictly to your treatment program.
Change tampons or pads frequently. Do not leave tampons or diaphragms in the vagina for long periods of time. Avoid scented or deodorized tampons and pads.
The prognosis for vaginitis is generally very good. Vaginitis is usually curable in 2 weeks with treatment.
Follow up care is rarely needed for usual cases of vaginitis. However, complicated cases of certain infections (such as gonorrhea or chlamydia) may require follow-up treatment with your health care provider.
If the vaginitis was caused by an STD, all sexual partners will need to be treated. If the patient was a child with an STD, sexual abuse evaluation will be done by a health care provider and child services may be called in for further evaluation and assessment.
Health care providers may provide patient education about preventive measures, proper hygiene, and toilet techniques, and STD prevention when appropriate. Patients may be reminded that douching can spread a vaginal or cervical infection into the uterus increasing the likelihood of pelvic inflammatory diseases (PID). Studies have also indicated that douching can be associated with endometritis. Patients may be educated about the use of topical creams for treatment of vaginitis (such as candidal vaginitis, bacterial vaginosis) as necessary.
Generally, vaginal infections do not cause serious complications.
Prior to treatment with any of the drugs that should not be used during pregnancy, your health care provider should determine possibility of pregnancy by using a pregnancy test. Many of the medications used to treat vaginitis should not be used during pregnancy.
- In pregnant women, however, both bacterial vaginosis and trichomoniasis have been associated with premature deliveries and low birth weight babies.
- Non-specific vaginitis has been associated with pre-term birth. The disorder should be carefully evaluated and treated when it occurs in pregnancy.
COMPLICATIONS ASSOCIATED WITH VAGINITIS
If left untreated, bacterial vaginitis may result in:
- Increased risk of pelvic inflammatory disease (PID).
- Pre-term birth.
- Premature rupture of membranes.
- Low birth weight.
- Intra-amniotic infections.
- Cervical intra-epithelial neoplasia (CIN).
- Post-gynecological surgery infections.
- Increased risk of sexually transmitted diseases (STDs).
Other vaginitis complications may include:
- Persistent discomfort in daily living.
- Superficial skin infection (from scratching).
- Complications of the causative condition (such as gonorrhea and candida infection).
- Infectious complications such as systemic disease resulting from the spread of microorganisms.
- Discomfort and decreased sexual pleasure with sexual activity.
- May indicate an underlying disorder, such as diabetes mellitus.
- Women infected with trichomoniasis or bacterial vaginosis are also at a greater risk of acquiring HIV and other sexually transmitted diseases.
DIAGNOSIS & TREATMENT
PREPARING FOR MEDICAL EVALUATION
First of all, do not be embarrassed if you need to contact your health care provider about a vaginal infection. Vaginal infections occur in millions of women of all ages and backgrounds. Regular check-ups and open discussions regarding your symptoms will go a long way toward maintaining good vaginal health. Your health care provider can perform simple tests to determine the type of vaginal infection and provide you with the best treatment.
If you are pregnant, keep in mind that vaginitis can affect your baby. Premature delivery and low birth weight of the baby are more common in women with bacterial vaginosis. Early diagnosis and treatment is important.
PREPARING FOR YOUR APPOINTMENT
Your health care provider needs to be able to observe and evaluate any vaginal discharge you may have. It is important to avoid using tampons and definitely do not douche before your appointment.
Also make a list of medications or supplements (nutritional and herbal) you are taking or any allergies you have.
SOME QUESTIONS TO ASK YOUR HEALTH CARE PROVIDER ABOUT VAGINITIS
Write down questions to ask your health care provider. Some basic questions include:
- What is the cause of the vaginitis?
- How can it be prevented and is there anything I can do to prevent vaginitis?
- What signs and symptoms should I watch out for?
- Do I need to take medicine?
- Will you prescribe any medication?
- Are there any special instructions for taking the medicine?
- Will the infection recur?
- What can I do if my symptoms return after treatment?
- Will a prescription be needed if the infection recurs?
- Are there any over-the-counter preparations that will treat my condition?
- Ask your healthcare provider if you need to have your sexual partner(s) evaluated and treated for infection. Some types of vaginitis can be transmitted from one person to another during sexual intercourse. It depends upon what type of vaginitis you have. You can be infected with a sexually transmitted disease and also have vaginitis. Each infection needs to be treated with different medications so it is important to visit your health care provider to determine if you have more than one type of infection.
In addition to the questions that you have prepared to ask your health care provider, do not hesitate to ask questions during your appointment at any time that you do not understand something.
QUESTIONS YOUR HEALTH CARE PROVIDER MAY ASK YOU
Be prepared to answer questions your health care provider may have, such as:
- What vaginal symptoms are you experiencing?
- How long have you had your symptoms?
- Do your symptoms seem tied to your menstrual cycle? Are they, for instance, more intense just before or just after your period?
- Do you notice a strong vaginal odor?
- Are you sexually active?
- Are you pregnant?
- Do you use scented soap or bubble bath?
- Do you douche or use feminine hygiene spray?
- What medications or vitamin supplements do you regularly take?
- Have you tried any over-the-counter products or home remedies to treat your condition?
MEDICAL HISTORY & PHYSICAL EXAMINATION
To help diagnose your condition, your health care provider may review your medical history and your history of vaginal infections and sexually transmitted diseases.
A pelvic exam will most likely be performed and a sample of cervical or vaginal discharge will be collected using a swab for laboratory analysis. This sample will be examined under a microscope to confirm what kind of vaginitis you have. Vaginitis is identified by checking vaginal fluid appearance, vaginal pH, the presence of volatile amines (the odor causing gas) and the microscopic detection of clue cells. New tests are now available to aid the practitioner in his or her diagnosis. The tests for vaginitis are simple and can be done right in your health care provider's office. To ensure the results of the test are accurate, do not douche or use any vaginal medications or spermicide before you see your health care provider.
Although your annual Pap smear is a very important test, it is not typically used as a test for vaginitis.
Aerobic and anaerobic bacteria can be cultured from the vagina of pre-pubertal girls, pubertal adolescents, and adult women. The overgrowth of normally present bacteria, infecting bacteria, or viruses can cause symptoms of vaginitis. Chemical irritation also can be a significant factor. Atrophic vaginitis is associated with hypoestrogenism, and symptoms include dyspareunia, dryness, pruritus, and abnormal bleeding.
The workup for patients with vaginitis depends on the risk factors for infection and the age of the patient.
Test for Candida albicans via a potassium hydroxide (KOH) preparation.
- As many as 30 percent of symptomatic candidiasis cases have false-negative KOH results.
- One drop of vaginal discharge is mixed with 1 drop of 10 percent KOH solution and covered with a coverslip.
- Branching hyphae and buds of Candida are visible.
- Gram stain or culture on Nickerson media and Sabouraud agar may enhance diagnosis.
- Papanicolaou tests (Pap smears) may have frequent false-positive results for yeast.
Motile trichomonads may be revealed by wet preparation (1 gtt [drop] of isotonic (0.9%) sodium chloride solution with 1 gtt [drop] of discharge). With trichomoniasis, more than 10 white blood cells (WBCs) per high power field (HPF) are seen on wet preparation. Diagnostic accuracy may be improved by culture on Diamond medium or Trichosel broth. The beta-tubulin (BTUB) fluorescence resonance energy transfer (FRET) polymerase chain reaction (PCR) system shows an improvement in assay time over other methods. This method offers improved accuracy over traditional PCR assays in urine samples and is comparable to the accuracy of vaginal swabs. Pap smears may reveal trichomonads but have a high false-positive rate.
Bacterial vaginosis is associated with an intense amine odor with the KOH preparation (the whiff test).
- On wet preparation, clue cells are seen with a paucity of WBCs.
- On Gram stain, clue cells are identified as epithelial cells covered by small gram-negative rods.
Gonorrhea vaginitis usually results in a purulent discharge.
- Obtain cultures of the vagina (pre-pubertal), cervix (pubertal, adult), oral pharynx, and rectum if gonococcal vulvovaginitis is suspected.
- Obtain cultures using a cotton-tipped swab and Thayer-Martin media on chocolate agar, incubated in a carbon dioxide-rich environment.
Test for chlamydial vulvovaginitis via culture in pre-pubertal girls and in patients who show signs of abuse or sexual assault.
- Obtain rectal chlamydia swabs.
- Nucleic acid amplification testing can be performed as a screen using cervical swabs of pubertal and adult women. Use of this form of testing in pre-pubertal children may be done for initial screening, but follow-up culture testing should be assured due to medical legal concerns.
- The use of nucleic acid amplification tests has been implemented by many office and emergency settings. Tests such as polymerase chain reaction (PCR) can be performed using swabs of the cervix or vagina or by collecting a urine sample. These tests are generally used to test for common sexually transmitted diseases such as chlamydia and gonorrhea, but utilization for the diagnosis of bacterial vaginosis has been studied and shown to be potentially more sensitive and specific than Gram stain and clinical diagnosis.
PHYSICAL EXAMINATION FINDINGS
Adults and children must be questioned regarding specific aspects of the symptoms of vaginitis. Vaginal bleeding in pre-pubertal females is always abnormal and merits full investigation. Essential information to obtain during the history is the onset of symptoms, previous occurrence, associated abdominal pain, trauma, and urinary or bowel symptoms. In adults, the most common reasons symptoms of vaginitis occur include Candida albicans, Trichomonas vaginalis, and bacterial vaginosis. When examining the symptoms, attention to these possible causes must be considered.
- CANDIDA VAGINITIS: Candidiasis is a fungal infection common in women of childbearing age that results in pruritus (itching), with a thick, watery, white, cottage cheese-like vaginal discharge. The discharge is irritating to the vagina and surrounding skin.
Patients often have a history of recurrent yeast infections or recent antibiotic treatment.
Symptoms of candidiasis often begin just before menses.
Precipitating factors include immunosuppression, diabetes mellitus, pregnancy, and hormone replacement therapy. Candidiasis is usually not contracted from a sexual partner. Seventy-five percent of all women have one episode of candidiasis in their lifetime. Recurrent episodes may indicate underlying immunodeficiency or diabetes.
If candidal vulvovaginitis is considered (rare in healthy pre-pubertal girls), the history should include recent antibiotic use, possible diabetes mellitus, immunosuppression, and underlying skin disease. Ask about a family history of mucocutaneous candidiasis. Mucocutaneous candidiasis refers to a condition (possibly chronic) caused by a fungus from the candida family that affect the skin, nails and mucous membranes.
Infectious causes of vaginitis may have the following specific physical findings:
- Candidiasis may present with a well-defined area redness of the vulva with satellite lesions surrounding the redness.
- The vulva, vagina, and surrounding areas may be swollen with abnormal redness of the skin, possibly accompanied by excoriations and fissures. A clumpy adherent discharge may be seen.
- ATROPHIC VAGINITIS: Atrophic vaginitis (also known as Senile Vaginitis) usually causes scant vaginal discharge with no odor, dry vagina and painful intercourse. These symptoms are usually due to decreased hormones usually occurring during and after menopause. In women with chronic vaginitis, atrophic vaginitis and hypoestrogenism (low estrogen levels) must be considered. Elicit an accurate menstrual history.
BACTERIAL VAGINOSIS: Bacterial Vaginitis (Gardnerella) usually causes a discharge with a fish-like odor. It is associated with itching and irritation, but not pain during intercourse. Typically, no underlying redness exists. Bacterial vaginosis can be diagnosed if 3 of the 4 criteria are present: increased vaginal pH (greater than 4.5), grayish white homogenous discharge, an amine smell with or without potassium hydroxide, and clue cells.
Bacterial vaginosis is asymptomatic in up to 50 percent of women. If a discharge is present, it is typically a homogeneous grayish-white or yellowish-white. Bacterial vaginosis is common in pregnant women and is associated with pre-term birth. Treating pregnant women that have a history of pre-term birth with symptomatic bacterial vaginosis early in pregnancy has been shown to decrease the incidence of pre-term birth.
HERPES: Herpes usually occurs as water blisters on the genital region, about one week after infection. There is tenderness, swollen glands, and fever. The water blisters are extremely painful and heal in about three weeks. However, herpes is usually an external infection and does not fall under the category of vaginitis.
TRICHOMONIASIS: Physical findings for trichomoniasis include a copious frothy discharge (white to greenish-yellow) and raised spots or dots of redness on the cervix and upper portion of the vagina (strawberry cervix). Trichomonas vaginalis can cause a profuse frothy discharge with a fish-like odor, pain upon urination, painful intercourse, and local pain, irritation, inflammation, and occasionally itching of the external genitals. Trichomoniasis is rare in pre-pubertal children. Sexual abuse should be suspected if symptoms are present.
Trichomoniasis is associated with risk factors for other sexually transmitted diseases (STDs); elicit a history of multiple sexual partners. Symptoms often peak just after menses. Trichomonas vaginalis is the most common non-viral STD in the world. Infection during pregnancy has been associated with pre-term deliveries and low birth weight infants.
VULVOVAGINITIS PRE-PUBERTAL CHILDREN: Vulvovaginitis has multiple non-venereal causes in pre-pubertal children; however, if a vaginal discharge suggests an STD, question all children (and/or their caretakers) regarding possible sexual abuse. Symptoms of vulvovaginitis in pre-pubertal girls generally include localized pain, painful urination, itching, redness and discharge.
Bacteria that can cause vulvovaginitis include streptococcal species (including group A streptococci), Escherichia coli, and Shigella sonnei. Symptoms (such as pharyngitis, diarrhea) may result from infections in areas of the body other than the vagina.
- A Shigella infection may result in a bloody vaginal discharge without symptoms of diarrhea.
- A patient with group A streptococcal infection may present with itching or painful bowel movements. A subtle discharge of pus may develop gradually.
- Perianal streptococcal dermatitis usually results in a beefy red perineal area that is swollen (edematous) and tender. Fissures (cracks or tears), drainage, and bloody spotting may be present.
Viral infections may cause symptoms of vulvovaginitis. Elicit a history of recent viral infections, including varicella. Herpes simplex viruses (HSVs) might be present, particularly HSV-1 transmitted by exposure, such as unclean hands (autoinoculation) from the mucous membranes of an infected mouth (oral mucosa). A history should be obtained of recurrent oral herpes or digital herpes in the caretaker of a child in diapers.
PINWORM INFECTION: Consider helminthic (parasitic worm) infections, such as Enterobius vermicularis pinworm or seatworm, a genus of intestinal nematodes found in the upper large intestine and occasionally in the female genitals and bladder. Infection is common in children, resulting in itching of the genital area. The practitioner should ask about contact with pinworm-infected children, itching (particularly at night), and vaginal pain. A patient with pinworms may present with few physical findings. Occasionally, there may be redness and scratch abrasions around the perianal area. In severe cases, eggs and/or dead female nematodes may be seen on examination of the anal area.
CONTACT DERMATITIS / FOREIGN BODIES: Questions should be asked to exclude the possibility of a foreign body in the vagina, chemical irritation (such as recent bubble baths, washing hair with shampoo while bathing, douching, feminine hygiene sprays), latex, semen, mechanical irritation, and poor hygiene.
- Vaginal foreign bodies in adults include forgotten tampons; in children, pieces of toilet tissue typically are found. Foreign bodies in the vagina commonly result in irritation and a persistent, foul-smelling, discharge composed of pus, serum and blood (serosanguineous).
- Contact dermatitis from unusual exposures may occur; ask about this possibility and about bathing patterns.
TRAUMA: Obtain a history of recent trauma to the vaginal area and a history of urination and bowel movement patterns and problems to exclude possible anatomic abnormalities (an example would be a rectovaginal fistula).
LICHEN SCLEROSIS ET ATROPHICUS: Lichen sclerosis et atrophicus is a chronic skin disease characterized by white flat papules and black hard follicular plugs. In advanced cases the papules tend to coalesce into large white patches of thin pruritic (itchy) skin. Lesions often occur on the torso and in the anogenital regions. Also called white spot disease. This may be seen in pre-pubertal children and in post-menopausal women. Symptoms of chronic fissures, pain, or itching are often present. Rectal fissures may lead to chronic constipation in children.
STD-RELATED CERVICITIS: Physical findings associated with cervicitis from STDs include excessive vaginal discharge, redness, and edema of the cervix.
OTHER CAUSES OF VAGINITIS: Cervical ectopy (displacement of the cervix) or eversion (turning outward or inside out) may cause discharge with no apparent infectious etiology. Physical findings associated with atrophy, dysplasia, and vulvar vestibulitis syndrome include localized atrophy or infection in skin and mucous membranes. Vulvar vestibulitis syndrome (VVS), also called vulval vestibulitis or vulvar dysesthesia, is a localized inflammation of the vestibule - the region immediately surrounding the opening of the vagina and the urethra.
CONVENTIONAL MEDICAL TREATMENT
The cause of the infection determines the appropriate treatment. The treatment must be specific to the type of vaginitis present. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (post-menopausal), a topical estrogen cream might be prescribed.
YEAST INFECTIONS: Yeast infection is caused by a fungus called Candida. It is found in small numbers in the normal vagina. However, when the balance of bacteria and yeast in the vagina is altered, the yeast may overgrow and cause symptoms. Some types of antibiotics increase your risk of a yeast infection. The antibiotics kill normal vaginal bacteria, which keep yeast in check. The yeast can then overgrow. A woman is more likely to get yeast infections if she is pregnant or has diabetes. Overgrowth of yeast also can occur if the body's immune system, which protects the body from disease, is not working well. For example, in women infected with human immunodeficiency virus (HIV), yeast infections may be severe. They may not go away, even with treatment, or may recur often. In many cases, the cause of a yeast infection is not known.
Yeast infections are usually treated with an anti-yeast cream or suppository placed inside the vagina. A health care provider can write a prescription for most yeast infection treatments. Yeast infections usually are treated with miconazole (Monistat), clotrimazole (Gyne-Lotrimin) and tioconazole (Vagistat). Yeast infections may also be treated with an oral antifungal medication, such as fluconazole (Diflucan).
Recurrent yeast infections (greater than 4 episodes per year) are sometimes treated with oral fluconazole (Diflucan) and itraconazole Sporanox), or vaginal clotrimazole (Mycelex, Gyne-Lotrimin, Femcare) for 6 months. It is recommended to abstain from sexual intercourse until treatment is completed.
The advantages of over-the-counter treatment for a yeast infection are convenience, cost and not having to wait to see your health care provider. The catch is you may be treating something other than a yeast infection. It is possible to mistake a yeast infection for other types of vaginitis or other conditions that need different treatment. Using the wrong medicine may delay a proper diagnosis and the most appropriate treatment, and can lead to complications.
Sometimes a woman thinks she has a yeast infection when she actually has another problem. There are several conditions that cause itching and burning, just like yeast. If there is another cause, it may be harder to find if a woman is taking medication for a yeast infection.
Although you can also buy medicine to treat yeast infections over-the-counter, it is a good idea to see a health care provider the first time you have symptoms of a yeast infection. Because this medicine will not cure other types of vaginitis, it is important to be sure you actually have a yeast infection before using these treatments.
BACTERIAL VAGINOSIS: The bacteria that cause bacterial vaginosis occur naturally in the vagina. Bacterial vaginosis is caused by overgrowth of these bacteria. Bacterial vaginosis is treated with an antibiotic that gets rid of the "bad" bacteria and leaves the "good" bacteria. Several different antibiotics can be used to treat bacterial vaginosis, but there are two that are most commonly used: metronidazole and clindamycin. They can be taken by mouth or inserted into the vagina as a cream or gel. Your health care provider may prescribe metronidazole (Flagyl, MetroGel) or clindamycin (Cleocin) as tablets or vaginal gels or creams. When metronidazole is taken by mouth, it can cause side effects in some patients. These include nausea, vomiting, and darkening of urine. Do not drink alcohol when taking metronidazole. The combination can cause severe nausea and vomiting. Usually there is no need to treat a woman's sex partner. But, if the woman has repeated infections, treatment of the partner may be helpful. Bacterial vaginosis often recurs. It may require long-term or repeated treatment. In most cases, treatment works in time. Sometimes when bacterial vaginosis keeps coming back it may mean that you have an STD. Your doctor may test you for other infections. There is no over-the-counter treatment for bacterial vaginosis, so it is important to see your health care provider for a prescription.
STD-RELATED VAGINOSIS: Sexually transmitted forms of vaginitis need to be treated by a health care provider right away. It is important to avoid sexual contact until you have been treated to prevent spreading the infection. A woman's sexual partner(s) will need treatment as well.
Trichomoniasis and Chlamydia are both treated by antibiotics. Trichomoniasis is a condition caused by the microscopic parasite Trichomonas vaginalis. It is spread through sex. Women who have trichomoniasis are at an increased risk of infection with other STDs. Your health care provider may prescribe metronidazole (Flagyl) or tinidazole (Tindamax) tablets. Trichomoniasis usually is treated with a single dose of metronidazole by mouth. Do not drink alcohol for 24 hours after taking this drug because it causes nausea and vomiting. Sexual partners must be treated to prevent the infection from recurring. Neither genital herpes nor HPV can be cured, but both can be controlled with the help of your health care provider and medications.
ATROPHIC VAGINITIS: This condition is not caused by an infection but can cause a discharge and vaginal irritation. It may occur any time when female hormone levels are low such as during breastfeeding and after menopause. Estrogen, in the form of vaginal creams, tablets or rings, can effectively treat atrophic vaginitis. A water-soluble lubricant also may be helpful during intercourse. This treatment is available by prescription from your health care provider.
NON-INFECTIOUS VAGINITIS: To treat this type of vaginitis, you need to pinpoint the source of the irritation and avoid it. Non-infectious vaginitis can be treated by stopping the use of the product that caused the allergic reaction or irritation. Possible sources include new soap, laundry detergent, sanitary napkins or tampons. Your health care provider may also be able to provide medicated cream to help reduce the symptoms until the reaction goes away.
It is important to remember that each type of vaginitis has a different treatment. Therefore it is very important to see a health care provider to be sure you are using the right treatment for your condition. Also, some kinds of vaginitis have no symptoms so it is important to have regular gynecologic exams.
Treatment of vaginitis may include sitz baths and instruction regarding proper toilet and hygiene techniques. Many women assume vaginal symptoms are the result of an STD, which is often not the case. A patient's idea of vaginal normalcy may be inaccurate and result in increased or unnecessary treatment seeking. If the patient shows no improvement, despite symptomatic or over-the-counter treatment, refer her for further workup of possible STDs and other infectious causes of vulvovaginitis.
EMERGENCY DEPARTMENT CARE
Usually, no active treatment is necessary in the ED. However, pre-pubertal girls with vulvovaginitis caused by a foreign body in the vagina may require sedation for removal of the foreign body.
Drugs used for infectious causes of vaginitis may be applied topically or require oral or parenteral administration.
ANTIFUNGAL AGENTS: Imidazole derivatives that exert a fungicidal effect by altering the permeability of the fungal cell membrane. Mechanism of action also may involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxides toxic to the fungal cell. Intravaginal and topical therapy with a variety of antifungals (eg, clotrimazole, miconazole, terconazole, tioconazole) is highly effective. Many of these preparations are now available over-the-counter. Various 1-, 3-, and 7-day regimens can be used. Cure rates of 90 percent are reported with longer courses.
Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak out, which results in fungal cell death. Metabolism occurs in the liver. Products available OTC are indicated. Recurrent infections usually are treated with intravaginal regimens for 10-14 days, followed by maintenance oral treatment for 6 months. Dual Pak is not for use in children. Dosing
200 mg vaginal suppository: Insert 1 qhs (at every bedtime) for 3 days.
2% cream: Insert 1 applicatorful (5 g) intravaginally qhs for 7 days.
100 mg vaginal suppository: Insert 1 qhs for 7 days.
Monistat Dual Pak: 1200 mg vaginal insert once plus 2% cream for external use.
Administer as in adults. Interactions May impair barrier contraceptives. Contraindications Documented hypersensitivity. Precautions Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus.
If sensitivity or chemical irritation occurs, discontinue use; use only externally; avoid contact with eyes; adverse effects include vaginal burning, irritation, and dyspareunia.
Broad-spectrum antifungal agents that inhibit yeast growth by altering cell membrane permeability, causing fungal cell death. The recommended duration of intravaginal therapy is generally 3-7 days. Dosing
500 mg tab: Insert 1 tab intravaginally once.
100 mg tab: Insert 2 tabs intravaginally qhs for 3 days.
Terconazole 80 mg vaginal supp: Insert 1 qhs for 3 days.
7-Day Therapy may also be used.
Interactions None reported. Contraindications Documented hypersensitivity. Precautions Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals.
Discontinue use if irritation or sensitization occurs; chronic or recurrent candidiasis may be a symptom of unrecognized diabetes mellitus or a damaged immune system (including HIV infection); persistently resistant infection actually may be due to reinfection (evaluate sources of reinfection); if patient does not respond, repeat microbiological studies to confirm diagnosis and to exclude other pathogens before reinstituting antifungal therapy; do not use creams in mouth or eyes
PO antifungal agent. While ease of use should be considered, direct cost may be a limiting factor. PO antifungals should not be recommended in pregnancy. Current recommendations are for a 7-day course of antifungal topical therapy. Synthetic, broad-spectrum, bis-triazole antifungal agent; highly selective inhibitor of fungal CYP450 and sterol C-14 alpha-demethylation. Dosing
150 mg PO once.
1-6 mg/kg/day, PO for 14-28 days, depending on severity of infection.
Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak out, which results in fungal cell death. Dosing
0.8% cream: Insert 1 applicatorful (5 g) intravaginally qhs for 3 days
80-mg vaginal suppository: Insert 1 qhs for 3 days.
0.4% cream: Insert 1 applicatorful (5 g) intravaginally for 7 days.
Administer as in adults. Interactions May impair barrier contraceptives. Contraindications Documented hypersensitivity. Precautions Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus.
If sensitivity or chemical irritation occurs, discontinue use; use only externally; avoid contact with eyes; high doses may cause fever or flulike symptoms.
Broad-spectrum antifungal agent that inhibit yeast growth by altering cell membrane permeability, which causes fungal cell death. Effective only for vaginitis caused by candidal organisms. Dosing
2% cream: Insert 1 applicatorful (5 g) intravaginally qhs for 3 days.
Administer as in adults. Interactions None reported. Contraindications Documented hypersensitivity. Precautions Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus.
If sensitivity or chemical irritation occurs, discontinue use; use only externally; avoid contact with eyes.
Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Dosing
6.5% ointment: Insert 1 applicatorful (5 g) intravaginally once.
Administer as in adults. Interactions None reported. Contraindications Documented hypersensitivity. Precautions Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus.
If sensitivity or chemical irritation occurs, discontinue use; use only externally; avoid contact with eyes.
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the clinical setting. The use of antibiotic combinations usually is recommended for the treatment of serious gram-negative bacillary infections. This approach ensures coverage for a broad range of organisms and polymicrobial infections, prevents emergence of bacterial subpopulations that may be resistant to one of the antibiotic components, and provides additive or synergistic effects. Antibiotic monotherapy is recommended, however, once organisms and sensitivities are known.
Third-generation cephalosporin that has broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. Arrests bacterial cell wall synthesis and inhibits bacterial growth by binding to 1 or more of the penicillin-binding proteins. Dosing
250 mg IM as single dose in uncomplicated gonococcal infections; depending on type and severity of infection, administer 1-2 g/day or divided bid; not to exceed 4 g/day. Dosing
Greater than 7 days: 25-50 mg/kg IV/IM as single dose; not to exceed 125 mg.
Infants and children: 125 mg IV/IM as single dose plus doxycycline.
For serious infection: 50-75 mg/kg/day IV/IM divided q12h; not to exceed 2 g.
Interactions Aminoglycosides increase nephrotoxic potential; probenecid increases effects by decreasing clearance. Contraindications Documented hypersensitivity. Precautions Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals.
Adjust dose in renal impairment; caution in breastfeeding women and allergy to penicillin.
(E.E.S., E-Mycin, Ery-Tab)
Indicated in treatment of infections caused by susceptible strains, including Staphylococcus aureus. Dosing
250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) PO q6h 1h ac or 500 mg q12h; alternatively, may use 333 mg q8h and increase up to 4 g/day, depending on severity of infection; if bid dosing is desired, recommended dose is 500 mg q12h; bid dosing is not recommended when administering doses greater than 1 g/day. Dosing
30-50 mg/kg/d (15-25 mg/lb/day) PO divided q6h; age, weight, and severity of infection determine proper dosage; when bid dosing is desired, half-total daily dose may be taken q12h; for more severe infections, dose may be doubled. Interactions May increase toxicity of theophylline and digoxin when used concurrently; may potentiate anticoagulant effects of warfarin. Contraindications Documented hypersensitivity, hepatic impairment. Precautions Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals.
Discontinue use if malaise, nausea, vomiting, abdominal colic, and/or fever occur.
(Cleocin, Clinda-Derm, C/T/S)
Inhibits bacterial protein synthesis by its action at the bacterial ribosome. Binds preferentially to the 50S ribosomal subunit and affects the process of peptide chain initiation. Intravaginal use is not recommended for pregnant women because it has been associated with an increased risk of pre-term delivery. Treatment of bacterial vaginosis with oral clindamycin during the second and third trimesters of pregnancy has been shown to reduce the occurrence of pre-term birth. Dosing
2% vaginal cream: 5 g qd for 7 days.
Alternatively, 300 mg PO bid for 7 days if pregnant.
Administer as in adults. Interactions None reported. Contraindications Documented hypersensitivity; regional enteritis; ulcerative colitis; antibiotic-associated colitis. Precautions Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals.
Avoid contact with eyes; vaginal cream contains ingredients that cause burning and irritation of the eye; in the event of accidental contact with the eye, rinse eye with copious amounts of cool tap water; may result in overgrowth of nonsusceptible organisms, particularly yeasts, in the vagina.
(MetroGel, Flagyl, MetroGel-Vaginal, Noritate Cream)
Active against various anaerobic bacteria and protozoa. Appears to be absorbed into the cells; the intermediate metabolized compounds that are formed bind DNA and inhibit protein synthesis, causing cell death. Indicated for treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis). Highly effective in treating trichomoniasis with one dose. Topical metronidazole is not effective therapy for trichomoniasis. Treatment of bacterial vaginosis with oral metronidazole during the second and third trimester of pregnancy does not reduce the occurrence of pre-term delivery. The numbers of T vaginalis cases with metronidazole resistance are increasing. Dosing
500 mg PO bid for 7 days.
Alternatively, 5 g intravaginally qd for 7 days of 0.75% vaginal gel.
250 mg PO tid for 7 days if pregnant.
T vaginalis: 2 g PO once.
Less than 12 years: Not established.
Greater than 12 years: Administer as in adults.
Interactions May potentiate the anticoagulant effects of warfarin, resulting in prolongation of PT. Contraindications Documented hypersensitivity. Precautions Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals.
Known or previously unrecognized vaginal candidiasis may present more prominent symptoms during metronidazole vaginal-gel therapy; more than 6% of patients have developed symptomatic vaginal candidiasis during or immediately after therapy.
A second-generation cephalosporin indicated for management of infections caused by susceptible gram-positive cocci and gram-negative rods. Many infections caused by gram-negative bacteria that are resistant to some cephalosporins and penicillins respond to cefoxitin. Dosing
1-2 g IV/IM q6-8h. Dosing
Greater than 8 years: Administer as in adults. Interactions Probenecid may decrease elimination and increase effects; aminoglycoside nephrotoxicity may potentiate effects in the kidney when used concurrently (monitor renal function closely). Contraindications Documented hypersensitivity. Precautions Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals.
Bacterial or fungal overgrowth of nonsusceptible organisms may result from prolonged use of antibiotics, possibly leading to secondary infection; take appropriate measures if superinfection occurs.
(Sulfa-Gyn, Femguard, Sulfa-Trip)
Exerts bacteriostatic action by competitive antagonism of PABA, an essential component of folic acid synthesis. Indicated for treatment of Gardnerella vaginalis vaginitis. Dosing
Tablet: Insert 1 tab intravaginally bid for 10 days and repeat prn.
Cream: Insert 1 applicatorful intravaginally bid for 4-6 days and 1/4-1/2 of an applicatorful bid thereafter; repeat prn.
Not established. Interactions None reported. Contraindications Documented hypersensitivity; kidney disease; breastfeeding. Precautions Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus.
Avoid contact of cream with eyes; use vaginal applicators with caution after the seventh month of pregnancy; use of this medication has been associated with Stevens-Johnson syndrome.
Used to treat mild-to-moderate infections caused by susceptible strains of microorganisms. Indicated for chlamydial and gonorrheal infections of the genital tract. Dosing
1 g PO once. Dosing
Day 1: 10 mg/kg PO once; not to exceed 500 mg/day.
Days 2-5: 5 mg/kg PO; not to exceed 250 mg/day.
Interactions May increase theophylline and digoxin concentrations and toxicity when used concurrently; may potentiate anticoagulant effects of warfarin; antacids containing aluminum and magnesium reduce peak serum levels but not absorption; concurrent use of cyclosporine may result in elevated cyclosporine concentrations with increased risk of toxicity (nephrotoxicity, neurotoxicity). Contraindications Documented hypersensitivity; hepatic impairment. Precautions Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals.
Local IV site reactions have been reported with the IV administration of azithromycin; bacterial or fungal overgrowth of nonsusceptible organisms may result from prolonged use of antibiotics, possibly leading to a secondary infection; take appropriate measures if superinfection occurs; can cause increases in hepatic enzymes and cholestatic jaundice (caution in patients with impaired hepatic function); not recommended for pneumonia in hospitalized patients or in patients who are elderly or debilitated; caution in patients with prolonged QT intervals.
Indicated for atrophic vaginitis resulting from diminished levels of circulating estrogens. A relative lack of estrogen also predisposes the vagina and vulva to infection.
Indicated for atrophic vaginitis and atrophic urethritis associated with menopause. Dosing
0.3-1.25 mg/day or more PO, depending on tissue response of patient.
Insert half to 1 applicatorful (2-4 g) topical preparation intravaginally qhs.
Cyclical administration consisting of 3 weeks of daily estrogen and 1 week off is recommended..
Disease state not seen in children. Interactions May reduce the hypoprothrombinemic effect of anticoagulants; coadministration of barbiturates, rifampin, and other agents that induce hepatic microsomal enzymes may reduce estrogen levels; an increase in the pharmacologic and toxicologic effects of corticosteroids may occur via inactivation of hepatic P450 enzyme; loss of seizure control has been suggested when administered concurrently with hydantoins. . Contraindications Documented hypersensitivity; known or suspected pregnancy; breast cancer; undiagnosed abnormal genital bleeding; active thrombophlebitis or thromboembolic disorders; history of thrombophlebitis, thrombosis, or thromboembolic disorders associated with previous estrogen use (except when used in treatment of breast or prostatic malignancy). Precautions Pregnancy C - X - Contraindicated; benefit does not outweigh risk.
Certain patients may develop undesirable manifestations of excessive estrogenic stimulation, (eg, abnormal or excessive uterine bleeding, mastodynia); estrogens may cause some degree of fluid retention (exercise caution); prolonged unopposed estrogen therapy may increase risk of endometrial hyperplasia.
Avoid overexertion, heat and excessive sweating. Delay sexual relations until after treatment. Keep clean and dry. Wear white cotton underwear which absorbs moisture and allows air to circulate. Avoid tight clothing and synthetic fabrics. Change into dry clothing as soon as possible after swimming. Do not spend prolonged periods of time in a wet bathing suit.
Centers for Disease Control and Prevention (CDC)
CDC-INFO Hotline (24 hours, 7 days a week)
STD information and referrals to STD Clinics
In English, en Espaņol
CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
American Social Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
HOLISTIC & NUTRITIONAL RECOMMENDATIONS
AT-HOME TREATMENT OF VAGINITIS
THINGS YOU CAN DO
At the first sign of any abnormal discharge or symptoms of vaginitis, such as burning or itching, contact your health care provider. Although vaginitis can cause discomfort, it almost always can be treated once the cause has been found.
There are a number of things you can do to lower the risk of getting vaginitis:
- Do not use feminine hygiene sprays or scented deodorant tampons.
- Do not try to cover up a bad odor. It could be a sign of infection that should prompt you to see your health care provider.
- Do not douche. It is better to let the vagina cleanse itself.
- Thoroughly clean contraceptive diaphragms, cervical caps, and spermicide applicators after each use.
- Use condoms during sex.
- Check with your health care provider about preventing yeast infections if you are prescribed antibiotics for another type of infection.
HOME REMEDIES & RECOMMENDATIONS
You will need prescription medication to treat trichomoniasis, bacterial vaginosis and atrophic vaginitis. If you know you have a yeast infection, you may go ahead with treatment on your own, taking these steps:
- Intravaginal imidazoles can be purchased over the counter and have proven efficacy for vaginal candidiasis. Patients may purchase and utilize these medications without a health care provider's advice or prescription and the choice of treatment can be based on personal preference since they appear to be equally effective. Vaginal anti-itch creams provide only symptomatic relief. Homeopathic treatments for vaginitis (boric acid, tea tree oil, live acidophilus, garlic) have not been well studied but may have some efficacy.
- Use an over-the-counter medication specifically for yeast infections. Options include one-day, three-day or seven-day courses of cream or vaginal suppositories. The active ingredient varies depending on the product: clotrimazole (Gyne-Lotrimin), miconazole (Monistat) or tioconazole (Vagistat). Some products also come with an external cream to apply to the labia and opening of the vagina. Follow package directions and complete the entire course of treatment, even if you are feeling better right away.
- Antibiotics or antifungals to treat infection. Metronidazole (Flagyl) is often used for treatment of bacterial vaginosis. Some health care providers prescribe the drug ketoconazole (Nizoral) for vaginitism with no apparent adverse side effects. Clotrimazole (Gyne-Lotrimin, Mycelex, and others), which is available without a prescription, is also used.
Apply a cold compress, such as a washcloth, to the labial area to ease discomfort until the antifungal medication takes full effect.
Soothing vaginal creams, topical ointments or lotions for non-specific forms of vaginosis may be recommended.
Atrophic vaginitis is often treated with prescription estrogen ointments. The use of these products increases the body's need for vitamin B-6. Vaginal absorption of synthetic estrogen may be dangerous to some women and may produce side effects. Natural progesterone cream applied to the vagina is beneficial for atrophic vaginitis.
Do not use corticosteroids or oral contraceptives until your condition improves. Oral contraceptives can upset the balance of microorganisms in the body.
Avoid iron supplements until the inflammation subsides. Infectious bacteria require iron for growth. If a bacterial infection is present, the body naturally "hides" iron by storing it in the liver, spleen, and bone marrow to inhibit the growth of the bacteria.
Do not douche unless prescribed for you. If you must douche, avoid sweet smelling douches. If douching provides relief, you can douche with plain water. Try douching with 2 capsules of garlic or with 1 cup of fresh garlic juice added to a quart of warm water. Alternate this treatment with acidophilus douches. Open 2 acidophilus capsules and add them to either 1 quart of warm water or to 1 cup of plain yogurt. You can also add 1 teaspoon of fresh garlic juice. The garlic fights infection while the acidophilus helps to restore normal flora and acid balance. added, or plain yogurt.
Herbal Remedies: Acidophilus Supplement Powder, Non-Dairy, 3 oz. Bulk
Herbal Remedies: Acidophilus, 3 Billion, NOW Foods, 90 Tabs
Herbal Remedies: Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps
Herbal Remedies: Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.
Herbal Remedies: Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.
Herbal Remedies: Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps
If urinating causes burning, urinate while bathing or urinate through a toilet paper roll or plastic cup with the bottom cut out or pour a cup of warm water over the genital area while urinating. This prevents urine from stinging inflamed skin.
Because cabbage leaves are used to treat sore nipples, mastitis, and many other kinds of "itis," Cabbage leaves can be placed on top of a maxi pad to treat vaginitis. You can experience complete relief from burning and itching within a couple of hours.
To relieve itching, open a vitamin E capsule and apply the oil to the inflamed area. You can also use vitamin E cream.
Herbal Remedies: Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels
Herbal Remedies: Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels
Herbal Remedies: Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
Herbal Remedies: Vitamin E Skin Cream With Bee Pollen & Manuka Honey, 100 gm
Herbal Remedies: Vitamin E Oil, 80% Mixed Tocopherols, Vegetarian, NOW Foods, 4 fl. oz.
Herbal Remedies: Vitamin E Oil, D-Alpha, Vegetarian, 32,000 IU, NOW Foods, 1 oz.
Some self-care techniques include vinegar douches or sitz baths in a solution of 1 teaspoon of vinegar for every gallon of water, and eating yogurt containing live acidophilus cultures.
Add 3 cups of pure apple cider vinegar to bath water to treat vaginitis. Soak in the tub for 20 minutes, allowing the water to flow into the vagina.
Herbal Remedies: Apple Cider Vinegar, Mother, Organic, Dynamic Health, 16 fl. oz.
Drink pure, quality water, preferably steam distilled water.
Keep clean and dry. Wear cotton underwear, which absorbs moisture and allows air to circulate. Avoid tight clothing and synthetic fabrics. Do not spend prolonged periods of time in a wet bathing suit.
MoonDragon's Health & Wellness: Kidney Disorders
MoonDragon's ObGyn Health: Cystitis
MoonDragon's ObGyn Health: Candida (Candidiasis - Yeast)
MoonDragon's ObGyn Health: Sexually Transmitted Diseases (STDs)
Aloe Vera is helpful for infections and is known for its healing effects. Aloe Vera juice can be applied topically to relieve the itching. It can also be taken internally or used as a douche.
Herbal Remedies: Aloe Vera Skin Gel, Herbal Aloe Force, Organically Grown Unprocessed Whole Raw Aloe Vera, 4 fl. oz.
Herbal Remedies: Whole Leaf Aloe Vera Juice, 99.7% Pure, Certified Organic, Nature's Way, 1 Liter
Herbal Remedies: Aloe Vera Juice, Herbal Aloe Force, Organically Grown, Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.
Herbal Remedies: Aloe Vera Juice, Certified Organic, NOW Foods, 32 oz.
Herbal Remedies: Aloe Vera Juice, Pure Aloe Force, Organically Grown, Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.
Herbal Remedies: Aloe Vanilla Mineral Sunscreen SPF 18, Alba Botanica, 4 fl. oz.
Herbal Remedies: Aloe Vera Gel & Juice, 99.7% Pure, Certified Organic, Nature's Way, 1 Liter
Barberry has remarkable infection-fighting properties. Barberry should not be taken internally during pregnancy.
Herbal Remedies: Barberry Root Extract Herb Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Barberry Microbial Defense, Nutra Medix, 1 fl. oz.
Herbal Remedies: Barberry Information
Herbal Remedies: Barberry Supplements & Products
Echinacea has antifungal properties and enhances the immune system. It can be taken internally or used as a douche.
Douche with infusions made from antiseptic herbs such as Calendula, Echinacea, Garlic, Goldenseal, fresh Plantain, St. Johns Wort, or Tea Tree oil, along with herbs such as Comfrey leaves, to soothe irritation. Echinacea and Goldenseal can also be taken internally. Note: Comfrey is recommended to be used externally only. Do not take Goldenseal internally on a daily basis for more than one week at a time, do not use it during pregnancy, and use it with caution if you are allergic to ragweed.
Herbal Remedies: Echinacea Immune Support Tea, Certified Organic, Yogi Tea, 16 Tea Bags
Herbal Remedies: Echinacea Tincture For Children, Orange Flavor, Alcohol Free, 100% Organic, 1 fl. oz.
Herbal Remedies: Echinacea Root Complex, Nature's Way, 180 Caps
Herbal Remedies: Echinacea & Goldenseal Supplement, Vegetarian, Herbal Remedies USA, 1000 mg, 60 Liquid VCaps
Herbal Remedies: Echinacea & Goldenseal Tincture, Nature's Way, Alcohol Free, 1 fl. oz.
Herbal Remedies: Echinacea & Goldenseal Supplement, Nature's way, 180 Caps
Herbal Remedies: Goldenseal Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Goldenseal Root, Nature's Way, 570 mg, 100 Caps
Herbal Remedies: Goldenseal Herb, Nature's Way, 400 mg, 180 Caps
Herbal Remedies: Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.
Herbal Remedies: Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps
Herbal Remedies: Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels
Herbal Remedies: Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs
Herbal Remedies: Every Day Garlic Supplement, Kwai, 30 Tabs
Herbal Remedies: Garlic Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps
Herbal Remedies: Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz.
Herbal Remedies: Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps
Herbal Remedies: Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 Caps
Herbal Remedies: St. John's Wort Tea, Caffeine Free, Yogi Tea, 16 Bags
Herbal Remedies: St. John's Wort Herbal Tea, 20 Tea Bags
Herbal Remedies: Tea Tree Essential Oil, 100% Pure, NOW Foods, 1 fl. oz.
Herbal Remedies: Tea Tree Antiseptic Ointment, 2 oz.
Herbal Remedies: Tea Tree Antiseptic Cream, 4 oz.
Herbal Remedies: Tea Tree Oil Antiseptic Solution (15% Water Soluble), 2 fl. oz.
Herbal Remedies: Tea Tree Supplements & Products
Herbal Remedies: Calendula Cream (Marigold), Nature Works, 4 fl. oz.
Herbal Remedies: Calendula Cream, Nelson's Bach, Organic, 1 oz.
Herbal Remedies: Calendula Gel, Califlora, Relief For First Aid & Sunburn, Homeopathic, Boericke & Tafel, 2.75 oz.
Herbal Remedies: Honey & Calendula Moisturizer, Kiss My Face, 16 oz.
MoonDragon's Health Therapy: Calendula Ointment Recipes
Calendula and vitamin A vaginal suppositories are soothing and healing to irritated tissues. Goldenseal suppositories are useful for all types of infection. Garlic suppositories can be used for treating yeast infections. You can make the suppositories using a clove of peeled garlic. Wrap gauze around the Garlic and insert inside the vaginal cavity. Every three to five hours, replace with a fresh suppository, and repeat for three to five days until the infection is gone. Garlic capsules can be used instead of the suppositories to treat yeast infections as well.
Tea Tree oil is good for vaginitis. Topical tea tree oil cream is effective against fungal infection, herpes blisters, warts, and other types of infections. Tea tree oil suppositories have been used successfully for vaginal yeast infections.
Herbal Remedies: Tea Tree Oil Suppositories, For Vaginitis, 6 Count
Herbal Remedies: Boiron Yeastaway Suppositories, Homeopathic Yeast Remedy, 7 Count
Meno-Fem from Prevail Corporation is a combination of traditional herbs and nutrients designed to combat the symptoms of menopause. It is helpful for vaginitis related to hormonal imbalance. (Note: I have not been able to find this product online so I have included similar products from Herbal Remedies used to balance hormones associated with menopause.)
Herbal Remedies: Female Estrogen With Progesterone Tincture, 2 fl. oz.
Female Estrogen With Progesterone formula is used mainly to promote hormonal balance. It does not contain hormones, however. It is effective for women who are experiencing menopause. It can also be used for acne, menstrual problems, morning sickness and osteoporosis. Suggested Dosage or Use: 6-12 drops, 3 times per day. Ingredients: Red Raspberry; Black Cohosh; Valerian; Blessed Thistle; Damiana, R/O Water, 12% grain Alcohol.
Herbal Remedies: Banyan Botanicals Women's Support, 500 mg, 90 Tabs
Women's Support is a balancing and revitalizing tonic for the female reproductive system. It rejuvenates and energizes the system, building the body's strength and stamina against debilitating factors such as disease, poor nutrition and aging. Nourishing to the blood and reproductive organs, Women's Support gently maintains the healthy production of female hormones, helping to regulate the menstrual cycle and ease the transition into menopause. This cleansing formula removes excess pitta from the system and relieves congestion of the blood and abdominal area. Soothing to the nerves and tissues, it calms mental agitations and muscular cramping experienced before and during menstruation. Shatavari, the main ingredient, is used as an aphrodisiac, and is believed to increase fertility and vitality. Take 1-2 tablets, once or twice daily, or as directed by your health practitioner.
Chamomile has antifungal properties. Caution: Do not take Chamomile on a regular basis as it can result in allergies. If you are allergic to ragweed, avoid Chamomile.
Herbal Remedies: Chamomile Flowers Herb, German Chamomile, Nature's Way, 350 mg, 100 Caps
Herbal Remedies: Chamomile Tea, Yogi Tea, Organic, Caffeine-Free, 16 Tea Bags
Herbal Remedies: Chamomile Tea, Caffeine Free, NOW Foods, 30 Tea Bags
Herbal Remedies: Chamomile Extract, Standardized, Nature's Way, 345 mg, 60 Caps
Herbal Remedies: Chamomile Tincture, 100% Organic, 2 fl. oz.
Cinnamon and Dandelion inhibit the growth of Candida albicans. They can be used as a douche or taken internally.
Herbal Remedies: Cinnamon Bark, NOW Foods, 600 mg, 240 Caps
Herbal Remedies: Cinnamon Bark Extract, Vegetarian, Herbal Remedies USA, 60 Liquid VCaps
Herbal Remedies: Dandelion Tea, NOW Foods, Organic, 30 Tea Bags
Herbal Remedies: Dandelion Root, Vegetarian, 540 mg, 180 VCaps
Pau D'Arco contains natural antibiotic agents and has a healing effect. It can be taken internally in capsule form or made into a tea, or used as a douche.
Herbal Remedies: Pau D'Arco Tea, Incan Purple LaPacho, 48 Tea Bags
Herbal Remedies: Pau D'Arco Extract, Incan Purple LaPacho, 100% Natural, 4 fl. oz.
Herbal Remedies: Pau D'Arco, Inner Bark, Nature's Way, 545 mg, 180 Caps
Herbal Remedies: Pau D'Arco Tincture, 100% Organic, 2 fl. oz.
No special diet. However, you should watch your diet and the foods you consume. Some foods can influence organism growth and your body's ability to fight an infection.
- Eat plain yogurt that contains live yogurt cultures, or apply yogurt directly to the vagina. This can help fight infection and soothe inflammation. Also consume brown rice, millet, and acidophilus.
- Consume fiber daily. Oat bran is a good source.
Herbal Remedies: Oat Bran Extract, Standardized 54% Beta Glucan, Vegetarian, Nature's Way, 60 VCaps
- Eat a diet that is fruit-free, sugar-free, and yeast-free. Avoid aged cheeses, alcohol, chocolate, dried fruits, fermented foods, all grains containing gluten (wheat, oats, rye, and barley), ham, honey, nut butters, pickles, raw mushrooms, soy sauce, sprouts, sugar in any form, vinegar, and all yeast products. Also eliminate citrus and acidic fruits (oranges, grapefruits, lemons, tomatoes, pineapple, and limes) from your diet until the inflammation subsides. then add them back slowly.
The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments Very Important Acidophilus As directed on label, 3 times daily, with meals. Has an antibacterial effect on the body. To replenish normal healthy bacteria. Use a non-dairy formula.
Acidophilus Supplement Powder, Non-Dairy, 3 oz. Bulk,
Acidophilus, 3 Billion, NOW Foods, 90 Tabs,
Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps,
Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.
Biotin 300 mcg daily, 3 times daily. Inhibits yeast.
Biotin Coenzyme, 100% Natural, Nature's way, 1000 mcg, 100 Sublingual Lozenges,
Biotin, TwinLab, 600 mcg, 100 Caps
Essential Fatty Acids As directed on label. Aids in tissue healing and needed for cellular protection.
Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 SoftGels,
Evening Primrose Oil With Gamma-Linolenic Acid (GLA), Barlean's, 1300 mg, 120 SoftGels,
Evening Primrose Oil, 100% Pure, NOW Foods, 4 fl. oz.,
Evening Primrose Oil, Cold Pressed, Nature's Way, 1300 mg, 120 SoftGels,
Evening Primrose Oil, Cold Pressed, Nature's Way, 500 mg, 250 SoftGels,
Essential Fatty Acids For Baby & Children, Organic, 8 fl oz.,
Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.,
Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps,
Barlean's Evening Primrose Oil With Gamma Linolenic Acid (GLA), 1300 mg, 120 SoftGels
Garlic (Kyolic) Fresh: 1-2 cloves
with meals 3 times daily
Kyolic: 1 capsule with meals 3 times daily.
Acts as a natural antibiotic. Enhances immune function. Has antifungal properties.
Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.,
Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps,
Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels,
Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs,
Every Day Garlic Supplement, Kwai, 30 Tabs,
Garlic Tincture, 100% Organic, 2 fl. oz.,
Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps,
Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz.,
Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps,
Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 Caps
Vitamin B Complex 50-100 mg of each B vitamin daily, with meals 3 times daily (amounts of individual vitamins in a complex will vary). Necessary for normal cell division and function. Important in the healing of skin tissue. Often deficient in people with vaginitis. Use a high potency formula. Regulates metabolism and promotes good health. A sublingual form is best.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Liquid Yeast B Complex, Twinlab, 16 Fl oz.,
Vitamin B-100 Complex, W/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps,
Vitamin B=50 Complex, W/ Coenzyme B-2, Nature's Way, 330 mg, 100 Caps,
50 mg 3 times daily, with meals. Especially important if using estrogen cream for treatment of atrophic vaginitis.
Vitamin B-6 (Pyridoxine), 100 mg, 100 Caps
Yeast-Gard As directed on label. Excellent antifungal agent. Reduces pain. Helpful Colloidal Silver Take orally or apply topically as directed on label. Acts as a natural broad spectrum antibiotic that subdues inflammation and promotes healing. Destroys bacteria, viruses, fungi, and parasites.
Colloidal Silver, Trace Minerals, 8 fl. oz.,
Colloidal Silver Liquid, Silva Solution, Super Strength Pro 50, 8 fl. oz.,
Colloidal Silver, Silva Pro 50 Spray, 2 fl. oz.,
Colloidal Silver Pump Spray, Silva Solution, 2 fl. oz.
Kyo-Dophilus Open up 3 capsules and dissolve in 1 quart warm water with 6 drops tea tree oil added to use as a douche. Replenishes friendly bacteria. L-Isoleucine
As directed on label, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B-6 and 100 mg vitamin C for better absorption. Good for fighting herpes and for tissue repair and healing of skin lesions.
Amino 1000 Complete, NOW Foods, 120 Caps,
Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs,
Branched Chain Amino Acids, Free Form, NOW Foods, 120 Caps,
L-Lysine, NOW Foods, 500 mg, 100 Tabs,
L-Lysine, Pharmaceutical Grade, Stable Tartrate Form, NOW Foods, 500 mg, 100 Caps,
N-Acetyl Glucosamine (N-A-G) As directed on label. Amino acid compound. Forms the basis of complex molecular structures that are key parts of mucous membrane tissue.
N-Acetyl Glucosamine (NAG), Allergy Research Group / Nutricology, 90 Caps
Oxy C-2 Gel
As directed on label. A useful antibacterial, antiviral, and antifungal. Vitamin A 25,000-50,000 IU daily.
If you are pregnant, do not exceed 10,000 IU daily.
Needed for tissue repair and immune function. Powerful antioxidants that aid healing.
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 SoftGels,
Dry Vitamin A & D, Nature's Way, 15,000 IU / 400 IU, 100 Caps,
Vitamin A, Fish Liver Oil, NOW Foods, 25,000 IU, 250 SoftGels
Carotenoid Complex (Betatene)
10,000 IU daily.
As directed on label.
An antioxidant and precursor of vitamin A. Needed by all cells for repair and rebuilding. Free radical scavengers and immune enhancers.
Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 SoftGels,
Multi-Carotene Antioxidant, Nature's Way, 60 SoftGels
2,000-5,000 mg daily, in divided doses. An antioxidant that is essential in the formation of collagen; promotes healing and tissue repair. Important for immune system stimulant.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 Tabs
Calcium 2,000 mg daily. Promotes healthy skin. Necessary for proper pH balance and potassium utilization. Also reduces stress on tissues. To Relieve Stress. Women need supplements of Calcium, Magnesium and Vitamin D nutrients at this time.
Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.,
Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.,
Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 Gelcaps
Magnesium 1,000 mg daily. To Relieve Stress. Women need supplements of Calcium, Magnesium and Vitamin D nutrients at this time. Works with calcium.
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.,
Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 Caps
Vitamin D 1,000 IU daily. Needed for calcium uptake. To Relieve Stress. Women need supplements of Calcium, Magnesium and Vitamin D nutrients at this time.
Vitamin D, NOW Foods, 2000 IU, 120 SoftGels,
Vitamin D, NOW Foods, 1000 IU, 180 SoftGels,
Dry Vitamin D, Nature's Way, 100% Natural, 400 IU, 100 Caps
Vitamin E 200-400 IU daily. Can be applied topically to the affected area 3 to 4 times daily. Powerful antioxidants that aid in healing. Purchase in oil or ointment form, or open a capsule to release the oil.
Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels,
Vitamin E Skin Cream With Bee Pollen & Manuka Honey, 100 gm,
Vitamin E Oil, 80% Mixed Tocopherols, Vegetarian, NOW Foods, 4 fl. oz.,
Vitamin E Oil, D-Alpha, Vegetarian, 32,000 IU, NOW Foods, 1 oz.
Zinc 30 mg daily. Do not exceed a total of 100 mg daily from all supplements. To increase immunity by boosting the immune system, cell division, enzyme activity, and needed for growth and healing of tissues. Promotes the proper utilization of Vitamin A. Also reduces severity of herpes outbreaks. Use zinc gluconate lozenges or zinc methionate (Optizinc) for best absorption.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps
VAGINITIS SUPPLEMENTS & PRODUCTS
Information and supplements for vaginitis, inflammation of the vagina.
Barberry Tincture, 100% Organic, 2 fl. oz.
Barberry is used for treating gallbladder disease, heartburn and indigestion and diarrhea. This herb can also be used to treat infections, parasites, psoriasis, and vaginitis.
Bhumy Amalaki Powder (Phyllanthus niruri), 100% Organic, 8 oz. Bulk
Bhumy Amalaki is employed for numerous conditions including blennorrhagia, colic, diabetes, dysentery, fever, flu, tumors, jaundice, vaginitis, and dyspepsia.
Boiron Yeastaway Suppositories, Homeopathic Yeast Remedy, 7 Count
Boiron Yeastaway Suppositories are for use for vaginal yeast infections in females 12 and over.
Candida Yeast, Nelsons Bach, Homeopathic, 84 Chewable Pills
Candida Yeast Nelsons Bach Homeopathic is for the temporary relief of symptoms of yeast infection or cystitis including white or yellowish vaginal discharge, itching and burning of genitalia not relieved by scratching, period arrives early.
Dong Quai Root Powder (Angelica Sinensis), 4 oz. Bulk
Dong Quai root (Angelica sinensis), referred to as the 'female ginseng', is rich in vitamins and minerals and is one of the most widely used herbs in traditional Chinese medicine. It is effective for female disorders such as menstrual disturbances, PMS and hot flashes due to its anti-inflammatory, analgesic, antiseptic, bactericidal and vasodilative effects. The herb is also used to regulate menstrual cycles, relieve menstrual cramps and alleviate symptoms related to PMS.
Echinacea & Goldenseal Tincture, Nature's Way, Alcohol Free, 1 fl. oz.
Echinacea promotes well being during cold and flu season, and supports the immune system, it is combined with other herbs traditionally used for the same purpose and to promote general well being.
FemRelief Feminine Homeopathic Relief Bath Powder, 2 Packets Per Box
FemRelief Homeopathic yeast infection remedy is a powder that you dissolve in 3-4 inches of bath water and then soak in it.
Goldenseal Root Tincture (Hydrastis canadensis), 100% Organic, 2 fl. oz.
Uses include Adrenal Glands; Eye Problems; Fainting; Gallbladder; Gallstones; Nephritis; Pancreatic Disorders; Peritonitis; Poison Ivy/Oak; Prostate Problems; Psoriasis; Pyorrhea; Quinsy,;Scarlet Fever; Spinal Meningitis (sometimes referred to simply as Meningitis); Spleen; Wounds.
Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple-Banana Flavor, 16 fl. oz.
Liquid Lactose Free Acidophilus Lactobacillus Plus Bifidu, Bulgaricus & Yucca Schidigera is also fortified with Organic Tahitian Noni Juice.
Samento Liquid Extract, 0.5% POA, 1 fl. oz.
Samento Uncaria Tomentosa is a Cat's Claw herb that may be beneficial in supporting the treatment of a wide range of immune system related conditions. Immune disorders may be the cause for various conditions such as cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.
Samento Uncaria Tomentosa, Extra Strength, 0.5% POA, 600 mg, 30 Caps
Samento is beneficial in supporting the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.
Silver Biotics Liquid, Silver Supplement, 8 fl. oz.
Silver Biotics was tested by researchers and was found to kill every strain of bacteria that it was tested against and that these bacteria, many of which have become resistant to antibiotics, cause many human ailments.
Tea Tree Oil Antiseptic Solution, (15% Water Soluble), 2 fl. oz.
Tea Tree Oil Antiseptic Solution can be used for mixing with water for douching, athletes foot, facial problems and bathing.
Tea Tree Oil Suppositories, 6 Count
Tea Tree oil suppositories for vaginal hygiene are recommended for the treatment of vaginal infections and itching.
Very Private Body Silk, 6 fl. oz.
This systemic moisturizer is a serious dry skin treatment; rebalances and reconditions even seriously dry, patchy, flaky-skin. FDA tested for safety. (FDA Safety Tested)
Very Private Intimate Moisture, 2 fl. oz.
For the most pleasurable, lasting intimacy. Eliminates vaginal dryness instantly. So natural, feels like a woman's own moisture, really protects delicate vaginal tissue. (FDA Safety Tested)
Very Private pH Balanced Body Wash, 6 oz.
The ultimate in safe and sensuous bodycare. Best of all it contains a bacteria and fungal protection system so each time you wash it helps protect the sensitive intimate area against common vaginal irritations. (FDA Safety Tested)
Vitamin E, D-Alpha Tocopherol, 400 IU, 100 Softgels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.
Witch Hazel Powder (Hamamelis Virginiana), 4 oz. Bulk
Witch Hazel can be taken internally for diarrhea and hemorrhage or externally as a rinse or gargle for sore throats.
Herbal Remedies: Vaginitis Information
Herbal Remedies: Vaginitis Supplements & Products
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of vaginitis or you have new vaginal concerns and you have had vaginal infections before, but these concerns seem different.
You have never had a vaginal infection and you need to establish the cause and to help you learn to identify the signs and symptoms.
Symptoms persist longer than 1 week or worsen, despite treatment.
Unusual vaginal bleeding or swelling develops.
You have had multiple sex partners or a recent new partner. You could have a sexually transmitted disease. The signs and symptoms of some sexually transmitted diseases are similar to those of a yeast infection or bacterial vaginosis.
You have completed a course of over-the-counter anti-yeast medication and your symptoms persist, you have a fever, or you have a particularly unpleasant vaginal odor. These are signs the infection may be from something other than yeast or from a resistant strain of yeast.
You probably do not need to see your health care provider if you have vaginal discharge or burning, irritation and you have previously had a diagnosis of vaginal yeast infections and your signs and symptoms are the same as before. You know the signs and symptoms of a yeast infection, and you are confident that you have a yeast infection.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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HERBS, OILS, & SUPPLIES
MoonDragon's Health & Wellness: Manufacturers & Distributors
Mountain Rose Bulk Herbs
Mountain Rose Herbs, Bulk Herbs A
Mountain Rose Herbs, Bulk Herbs B
Mountain Rose Herbs, Bulk Herbs C
Mountain Rose Herbs, Bulk Herbs D
Mountain Rose Herbs, Bulk Herbs E
Mountain Rose Herbs, Bulk Herbs F
Mountain Rose Herbs, Bulk Herbs G
Mountain Rose Herbs, Bulk Herbs H
Mountain Rose Herbs, Bulk Herbs I
Mountain Rose Herbs, Bulk Herbs J
Mountain Rose Herbs, Bulk Herbs K
Mountain Rose Herbs, Bulk Herbs L
Mountain Rose Herbs, Bulk Herbs M
Mountain Rose Herbs, Bulk Herbs N
Mountain Rose Herbs, Bulk Herbs O
Mountain Rose Herbs, Bulk Herbs P
Mountain Rose Herbs, Bulk Herbs R
Mountain Rose Herbs, Bulk Herbs S
Mountain Rose Herbs, Bulk Herbs T
Mountain Rose Herbs, Bulk Herbs U
Mountain Rose Herbs, Bulk Herbs V
Mountain Rose Herbs, Bulk Herbs W
Mountain Rose Herbs, Bulk Herbs Y
Mountain Rose Aromatherapy Oils
Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
Mountain Rose Herbs.com: Order Online
Accessories & Tools
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Body and Bath
Bottles, Jars & Containers
Green & Black Teas
Herbal Salves & Balms
Herbs for Pets
Incense, Resins and Candles
Medicinal Herb Seeds
Tea Brewing Supplies
Click Here To Visit Herbal Remedies Product Page
A Source For Medicinal & Ritual Herbs & Supplies
Aphrodisiacs Aromatherapy Bath & Body Care Bulk Herbs By The Pound Capsules, Tablets & Extracts Chinese Herbals Electronics Extracts First Aid Products Food Products, Mixes, Seeds, Snacks & More! Hair Care Products & Supplies Herbs & Oils, Kilo & Ton Hydroponics & Gardening Kava Products Kitchen & Housewares Mushrooms Musical Instruments Oral Care & Dental Products PC & IT - Computer Supplies & Assessories Skin Care, Cosmetics, & Gift Sets Smokes, Seeds, Cacti Spices, Salts, Sweeteners, & Seasonings Sports, Toys & Games Sweets, Candy, Chips & Snacks Stimulants Sedatives Teas & Coffees
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MoonDragon's Nutrition Information Index
MoonDragon's Health & Wellness: Nutrition Basics Index
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MoonDragon's Nutrition Therapy Index
MoonDragon's Alternative Health Information Index
MoonDragon's Aromatherapy Information Index
MoonDragon's Health & Wellness Index
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