Diseases of the Vagina

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The most important diseases of the vagina are infections (vaginitis).

The vagina can become infected by the same agents that cause vulvitis, e.g. herpes simplex virus, HPV, Candida albicans, Gardnerella vaginalis.
The vagina has an abundant natural bacterial flora, the principal organism in which is Lactobacillus acidophilus. This produces lactic acid by the breakdown of glycogen in the surface vaginal epithelium, thereby creating an acid environment in which most other organisms cannot proliferate. However, this barrier only works effectively against bacteria. Infective vaginitis is usually sexually transmitted, presenting with vulvovaginal soreness and discharge.

Trichomonas vaginalis is a common cause of vaginitis in young women and is usually sexually transmitted. The vaginal mucosa becomes red and inflamed, with a frothy white discharge on its surface.
Gardnerella vaginalis is a very common cause of non-specific vaginitis, commonly associated with a thin, milky white vaginal discharge.

Herpes simplex produces erosive vaginal lesions, and the organism may be transmitted to the fetus during passage through the birth canal. Usually, there are associated vulval herpetic lesions.

Candida albicans is a normal commensal in the vagina, but its proliferation is usually suppressed by the normal vaginal flora. Clinical infection can occur when the vaginal flora is destroyed, e.g. by antibiotics. White plaques of fungal hyphae develop on an inflamed vaginal mucosa, and there is vaginal discharge associated with severe vulval irritation. Infection may be severe in patients with diabetes mellitus.

Less common causes of vaginal infection include the gonococcus (usually secondary to gonococcal cervicitis),  Mycoplasma, and HPV (usually associated with extensive vulval and perineal condylomata which extend up the vagina at a late stage), and some forms of staphylococci. Staphylococci are usually introduced into the vagina with a tampon, and proliferation of bacteria in a neglected or retained tampon may lead to production of bacterial exotoxins, giving rise to the toxic shock syndrome.

Primary tumours of the vagina are very rare

Primary tumours of the vagina in adults are exceptionally rare, but the vagina is frequently the site of metastases, particularly from malignant tumours of the cervix, endometrium and ovary. Vaginal bleeding after hysterectomy for uterine or ovarian malignancy should always be investigated and biopsied because of the frequency of metastatic tumour in the residual vaginal vault.

The main primary vaginal tumours are squamous-cell carcinomas and, even more rare, adenocarcinomas. Clear-cell carcinoma of the vagina is seen in women exposed in utero to the synthetic oestrogen diethylstilboestrol, preceded by replacement of normal vaginal epithelium by glandular epithelium, termed vaginal adenosis.

In childhood the vagina may be the site of development of rhabdomyosarcoma, which macroscopically appears as a polypoid, gelatinous mass protruding into the vagina.
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