Vaginal cancer

Definition

Vaginal cancer refers to an abnormal, cancerous growth in the tissues of the birth canal (vagina).

Description

Vaginal cancer is rare and accounts for only 1% to 2% of all gynecologic cancers . In the United States, there are approximately 2, 000 cases of vaginal cancer diagnosed, and approximately 600 deaths, each year. Vaginal cancer can be either primary or metastatic. Cancer that originates in the vagina is called primary vaginal cancer; if cancer spreads to the vagina from another site, it is called metastatic cancer. Eighty-percent of vaginal cancers are metastatic. Metastatic cancers carry the name of the primary cancer site. For instance, cancer that has spread from the cervix to the vagina would be called "metastatic cervical cancer, " not "vaginal cancer."

The vagina is a short tube that extends from the outer female genitalia (vulva) to the opening to the uterus (cervix). It serves to receive the penis during sexual intercourse, as an outlet for shed tissue and blood during menstruation, and as a passageway for a baby during childbirth. Most cancers are located in the upper third of the vagina.

Squamous carcinoma is the most common type of vaginal cancer and accounts for 85% of cases. Infrequent types of vaginal cancer include adenocarcinomas , melanoma , and sarcomas . Adenocarcinoma is usually found in young women (ages 12 to 30 years) while squamous cell cancer (squamous carcinoma) is usually found in older women (ages 60 to 80 years). Although vaginal melanoma can afflict adult women of any age, women are on average in their fifties at the time of diagnosis.

Demographics

Vaginal cancer is most common in women who are between the ages of 60 and 80.

Causes and symptoms

Cancer is caused when the normal mechanisms that control cell growth become disturbed, causing cells to grow and divide without stopping. This is usually the result of damage to the genetic material of the cell (deoxyribonucleic acid, or DNA). The cause of vaginal cancer is not known.

Symptoms of vaginal cancer appear when the cancer has become more advanced. Approximately 20% of vaginal cancer cases are asymptomatic (produce no symptoms) and are diagnosed following an abnormal Pap test . Symptoms of vaginal cancer include:

• abnormal vaginal bleeding or discharge
• pain during intercourse
• pain in the pelvic area
• difficult or painful urination
• constipation

Diagnosis

The diagnosis of vaginal cancer is made by physical examination and laboratory analysis of tissue samples. During the physical examination, the physician will place one or two fingers into the vagina and press down on the lower abdomen with his or her free hand to feel (palpate) the reproductive organs and any masses. During a routine speculum examination, the physician will obtain a sample of cervical and vaginal cells (using a swab, brush, or wooden applicator) for laboratory analysis (Pap test).

A special magnifying instrument, called a colpo-scope, may be used to view the vagina. Additionally, the surface of the vagina may be treated with a dilute solution of acetic acid, which causes some abnormal areas to turn white. Squamous carcinoma and adenocarcinoma usually appear as a growth on the surface of the vagina. Squamous carcinoma may present as an open sore (ulcer). Adenocarcinoma may lie deeper so that it is not visible and detected only by palpation. Vaginal melanoma appears as a brown or black skin tag (polypoid), growth attached to the vaginal wall by a stem (pedunculated), nipple-like growth (papillary), or fungus-like growth (fungating). Sarcomas often appear as a grape-like mass.

If any area appears abnormal, a tissue sample (biopsy ) will be taken. The biopsy can be performed in the doctor's office with the use of local anesthetic. A small piece of tissue, which contains the suspect lesion with some surrounding normal skin and the underlying skin layers and connective tissue, will be removed. Small lesions will be removed in their entirety (excisional biopsy). The diagnosis of cancer depends on a microscopic analysis of this tissue by a pathologist.

Chest x rays and routine blood work are commonly employed in the diagnosis of any cancer. Endoscopic examination of the bladder (cystoscopy ) and/or rectum (proctoscopy) may be performed if it is suspected that the cancer has spread to these organs.

Treatment team

The treatment team for vaginal cancer may include a gynecologist, gynecologic oncologist, radiation oncolo-gist, plastic surgeon, gynecologic nurse oncologist, sexual therapist, psychiatrist, psychological counselor, and social worker.

Clinical staging, treatments, and prognosis

Clinical staging

The International Federation of Gynecology and Obstetrics (FIGO) has adopted a clinical staging system for vaginal cancer that is used by most gynecologic oncologists. Vaginal cancer is categorized into five stages (0, I, II, III, and IV) that may be further subdivided (A and B) based on the depth or spread of cancerous tissue. The FIGO stages for vaginal cancer are:

• Stage 0. Cancer is confined to the outermost layer (epithelium) of vaginal cells and is called carcinoma in situ or vaginal intraepithelial neoplasia (VAIN).
• Stage I. Cancer is confined to the vagina.
• Stage II. Cancer has spread to the tissues near the vagina.
• Stage III. Cancer has spread to the bones of the pelvis, local lymph nodes, and/or other reproductive organs.
• Stage IV. Cancer has spread to the bladder, rectum, or other parts of the body.

Treatments

The treatment of vaginal cancer varies considerably and depends on the type of cancer, stage of cancer, and the patient's age and overall health. Surgery is the most common treatment for vaginal cancer. Radiation therapy and chemotherapy are often used as adjuvant therapy to complement the surgical treatment.

SURGERY.

The amount of tissue removed depends upon the stage and type of cancer. The local lymph nodes may also be removed (lymphadenectomy). Laser surgery, which destroys the cancerous cells, may be used in the treatment of stage 0 vaginal cancer. With a wide local excision, the cancerous tissue and some surrounding healthy tissue is cut out. Wide local excisions may require skin grafts to repair the vagina.

For more extensive cancer, the vagina may be removed (vaginectomy). Following vaginectomy, skin grafts and plastic surgery are used to create an artificial vagina. Vaginal cancer that has spread to the other reproductive organs would be treated by radical hysterectomy in which the uterus, fallopian tubes, and ovaries are removed. Cancer that has spread beyond the reproductive organs may be treated by pelvic exenteration , in which the vagina, cervix, uterus, fallopian tubes, ovaries, and, as necessary, the lower colon, bladder, or rectum are removed.

Surgical complications include urinary tract infection, wound infection, temporary nerve injury, fluid accumulation (edema) in the legs, urinary incontinence , falling or sinking of the genitals (genital prolapse), and blood clots (thrombi).

RADIATION THERAPY.

Radiation therapy may be used as the sole treatment of vaginal cancer or as an adjuvant therapy to aid surgery. Radiation therapy uses high-energy radiation from x rays and gamma rays to kill the cancer cells. Radiation given from a machine that is outside the body is called external radiation therapy. Radiation given internally is called internal radiation therapy or brachytherapy. Sometimes applicators containing radioactive compounds are placed inside the vagina (intracavitary radiation) or directly into the cancerous lesion (interstitial radiation). External and internal radiation may be used in combination to treat vaginal cancer.

The skin in the treated area may become red and dry and may take as long as a year to return to normal. Fatigue , upset stomach, diarrhea , and nausea are also common complaints of women having radiation therapy. Radiation therapy in the pelvic area may cause the vagina to become narrow as scar tissue forms. This phenomenon, known as vaginal stenosis, makes intercourse painful.

CHEMOTHERAPY.

Chemotherapy is not very a very successful treatment of vaginal cancer and is generally reserved for patients with advanced disease. Chemotherapy uses anticancer drugs to kill the cancer cells. The drugs are usually given by mouth (orally) or intravenously. They enter the bloodstream and can travel to all parts of the body to kill cancer cells. Generally, a combination of drugs is given because it is more effective than a single drug in treating cancer. For vaginal cancer, anticancer drugs may be put into the vagina (intravaginal chemotherapy).

The side effects of chemotherapy are significant and include stomach upset, vomiting, appetite loss (anorexia ), hair loss (alopecia ), mouth or vaginal sores, fatigue, menstrual cycle changes, and premature menopause. There is also an increased chance of infections.

Prognosis

Survival is related to the stage and type of vaginal cancer. The five-year survival rates for squamous carcinoma and adenocarcinoma of the vagina are: 96%, stage 0; 73%, stage I; 58%, stage II; 36%, stage III; and 36%, stage IV. With a five-year survival rate of less than 20%, melanoma has a poor prognosis. Vaginal cancer most commonly spreads (metastasizes) to the lungs, but may spread to the liver, bone, or other sites.

Alternative and complementary therapies

Although alternative and complementary therapies are used by many cancer patients, very few controlled studies on the effectiveness of such therapies exist. Mind-body techniques such as prayer, biofeedback, visualization, meditation, and yoga have not shown any effect in reducing cancer but can reduce stress and lessen some of the side effects of cancer treatments.

Clinical studies of hydrazine sulfate found that it had no effect on cancer and even worsened the health and well-being of the study subjects. One clinical study of the drug amygdalin (Laetrile) found that it had no effect on cancer. Laetrile can be toxic and has caused death. Shark cartilage, although highly touted as an effective cancer treatment, is an improbable therapy that has not been the subject of clinical study.

The American Cancer Society has found that the "metabolic diets" pose serious risk to the patient. The effectiveness of the macrobiotic, Gerson, and Kelley diets and the Manner metabolic therapy has not been scientifically proven. The Food and Drug Administration (FDA) was unable to substantiate the anticancer claims made about the popular Cancell treatment.

There is no evidence for the effectiveness of most over-the-counter herbal cancer remedies. However, some herbals have shown an anticancer effect. Some studies have shown that polysaccharide krestin (PSK), a substance from the mushroom Coriolus versicolor, has some effectiveness against cancer. In a small study, the green alga Chlorella pyrenoidosa has been shown to have anti-cancer activity. In a few small studies, evening primrose oil has shown some benefit in the treatment of cancer. Herbals can disrupt conventional treatment; patients must discuss herbal use with their physician.

For more comprehensive information, the patient should consult the book on complementary and alternative medicine published by the American Cancer Society listed in the Resources section.

Coping with cancer treatment

The patient should consult her treatment team regarding any side effects or complications of treatment. Vaginal stenosis can be prevented and treated by vaginal dilators, gentle douching, and sexual intercourse. A water-soluble lubricant may be used to make sexual intercourse more comfortable. Women with a reconstructed vagina will need to use a water-soluble lubricant during sexual intercourse. Many of the side effects of chemotherapy can be relieved by medications. Women may wish to consult a psychotherapist and/or join a support group to deal with the emotional consequences of cancer and vaginectomy.

Clinical trials

As of 2001, there are no clinical trials underway that were specific for vaginal cancer. Women should consult with their treatment team to determine if they are candidates for any ongoing studies.

Prevention

Risk factors for vaginal cancer include:

• Diethylstilbestrol (DES). Young women whose mothers took DES during pregnancy are at a higher risk of developing vaginal cancer, particularly clear cell carcinoma. Between 1945 and 1970, DES was prescribed to pregnant women who were at risk of miscarriage.
• Cervical cancer . Women with a history of cervical cancer have a high risk of developing vaginal cancer.
• Hysterectomy. Up to half of all patients with vaginal cancer have had a hysterectomy. Their vaginal cancer may actually represent an earlier spread from the cervix.
• Chronic irritant vaginitis. Chronic irritation to the vagina, particularly from use of a vaginal pessary, is associated with vaginal cancer. A pessary is an instrument that is placed into the vagina to support the uterus or prevent pregnancy (contraception).
• Vaginal adenosis. This condition, in which cells that resemble those of the uterus are found in the vaginal lining, places a woman at a higher risk of developing vaginal cancer.
• Human papilloma virus (HPV) infection. Infection by this sexually transmitted virus, the cause of genital warts, increases a woman's risk of developing squamous carcinoma.
• Smoking. There appears to be an association between tobacco use and vaginal cancer.

All women, even those who have had a hysterectomy or are past menopause, should get an annual pelvic examination and Pap test. Women who had a hysterectomy because of cancer may benefit from more frequent Pap tests. The earlier that precancerous abnormalities or vaginal cancer are detected, the better the prognosis. Women whose mothers took DES during pregnancy and those with vaginal adenosis should be screened regularly. Women can reduce the risk of contracting HPV by avoiding sexual intercourse with individuals who have had many sexual partners, limiting their number of sexual partners, and delaying first sexual activity until an older age. Avoiding tobacco products may reduce a woman's risk of developing vaginal cancer.

Special concerns

Of special concern to women undergoing treatment of vaginal cancer is the effect surgery and/or radiation therapy will have on sexual functioning. Women of childbearing age may worry about their fertility and whether or not they will be able to bear children. Depression , due to the affects of surgery on body image and sexuality , may occur. Complications, both short term and long term, following extensive surgical treatment of vaginal cancer are not uncommon.

See Also Cystoscopy; Fertility issues

Resources

BOOKS

Bruss, Katherine, Christina Salter, and Esmeralda Galan, eds. American Cancer Society's Guide to Complementary and Alternative Cancer Methods. Atlanta: American Cancer Society, 2000.

Eifel, Patricia, Jonathan Berrek, and James Thigpen. "Cancerof the Cervix, Vagina, and Vulva." In Cancer: Principles & Practice of Oncology. DeVita, Vincent T., Samuel Hellman, and Steven Rosenberg, eds. Philadelphia: Lippincott Williams & Wilkins, 2001.

Garcia, Agustin, and J. Tate Thigpen. "Tumors of the Vulva and Vagina." In Textbook of Uncommon Cancer. Raghavan, D., M. Brecher, D. Johnson, N. Meropol, P. Moots, and J.Thigpen, eds. Chichester, UK: John Wiley & Sons, 1999.

Primack, Aron. "Complementary/Alternative Therapies in the Prevention and Treatment of Cancer." In Complementary/Alternative Medicine: An Evidence-Based Approach. Spencer, John, and Joseph Jacobs, eds. St. Louis: Mosby, 1999.

PERIODICALS

Creasman, William, Jerri Phillips, and Herman Menck. "The National Cancer Data Base Report on Cancer of the Vagina." Cancer 83 (September 1998): 1033-40.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA30329. (800) ACS-2345. <http://www.cancer.org>.

Cancer Research Institute. 681 Fifth Ave., New York, NY10022. (800) 992-2623. <http://www.cancerresearch.org>.

Gynecologic Cancer Foundation. 401 North Michigan Ave., Chicago, IL 60611. (800) 444-4441 or (312) 644-6610.<http://www.wcn.org/gcf>.

National Institutes of Health, National Cancer Institute. 9000Rockville Pike, Bethesda, MD 20982. (800) 4-CANCER.<http://cancernet.nci.nih.gov>.

Belinda Rowland, Ph.D.

KEY TERMS

Adjuvant therapy

—A treatment that is intended to aid the primary treatment. Adjuvant treatments for vaginal cancer are radiation therapy and chemotherapy.

Biopsy

—Removal of a small piece of tissue for microscopic examination. This is done under local anesthesia and removed by either using a scalpel or a punch, which removes a small cylindrical portion of tissue.

Colposcope

—An instrument used for examination of the vagina and cervix. The instrument includes a light and magnifying lens for better visualization.

Intracavitary radiation

—Radiation therapy for vaginal cancer in which a cylindrical container holding a radioactive substance is placed into the vagina for one or two days.

Metastasis

—The movement of cancer cells from one area of the body to another. This occurs through the blood vessels or the lymph vessels.

Pelvic exenteration

—Surgical removal of the organs of the pelvis which includes the uterus, vagina, and cervix.

Squamous cells

—Scale-like cells that cover some body surfaces and cavities.

Vaginectomy

—Surgical removal of the vagina. An artificial vagina can be constructed using grafts of skin or intestinal tissue.

QUESTIONS TO ASK THE DOCTOR

• What type of cancer do I have?
• What stage of cancer do I have?
• What is the five-year survival rate for women with this type and stage of cancer?
• Has the cancer spread?
• What are my treatment options?
• How much tissue will you be removing? Can you remove less tissue and complement my treatment with adjuvant therapy?
• What are the risks and side effects of these treatments?
• What medications can I take to relieve treatment side effects?
• Are there any clinical studies underway that would be appropriate for me?
• What effective alternative or complementary treatments are available for this type of cancer?
• How debilitating is the treatment? Will I be able to continue working?
• Are there any restrictions regarding sexual activity?
• How is a vaginal reconstruction performed?
• How will a vaginal reconstruction affect sexual functioning?
• Are there any local support groups for vaginal cancer patients?
• What is the chance that the cancer will recur?
• Is there anything I can do to prevent recurrence?
• How often will I have follow-up examinations?

Vaginal Pain

Definition

Pain in the vaginal canal is usually associated with an underlying medical and/or psychological condition.

Description

Vaginal pain is experienced usually during vaginal manipulation or sexual intercourse. Approximately 50-85% of the causes are due to organic (medical) conditions. However, it is typical for the medical condition to be compounded by psychological issues such as depression and problems associated with sexual identity. The primary entity concerns dyspareunia, a vaginal pain experienced during sexual intercourse. The vagina has three physiological functions: an outflow duct for menstrual discharge, to receive the penis during sexual intercourse, and as the birthing canal. The overall prevalence for dyspareunia is 20% (15% of women and 57% of men). A significant percentage of breast cancer and hysterectomy patients demonstrated sexual dysfunction.

Causes and symptoms

The causes can be categorized as organic, due to a medical condition and/or psychological difficulties. Medical conditions can include chronic diseases, minor ailments, breast cancer, and medications. Psychological cause can be related to physical or sexual abuse. Pregnancy and hormonal changes (decreased estrogen) have significant negative impact on sexual activity, desire, and satisfaction. Dyspareunia can be divided into three types of pain: superficial, vaginal, and deep. Superficial pain is associated with attempted penetration. This is usually caused by changes in anatomy, irritative condition, or vaginismus. Vaginal pain is associated with friction, indicating a problem with lubrication and/or arousal disorders. Deep pain is related to thrusting and is indicative of pelvic disease or an inability for pelvic relaxation.

KEY TERMS

Anthrax— An infectious disease caused by a type of bacterium. The disease can be passed from animals to people and usually is fatal. Symptoms include sores on the skin.

Antibody— A type of protein produced in the blood or in the body tissues that helps the body fight infection.

Bacteria— Tiny, one-celled forms of life that cause many diseases and infections.

Cholera— An infection of the small intestine caused by a type of bacterium. The disease is spread by drinking water or eating seafood or other foods that have been contaminated with the feces of infected people. It occurs in parts of Asia, Africa, Latin America, India, and the Middle East. Symptoms include watery diarrhea and exhaustion.

Encephalitis— Inflammation of the brain, usually caused by a virus. The inflammation may interfere with normal brain function and may cause seizures, sleepiness, confusion, personality changes, weakness in one or more parts of the body, and even coma.

Feces— The solid waste that is left after food is digested. Feces form in the intestines and pass out of the body through the anus. Also called stool.

Guillain-Barré syndrome (GBS)— A disease of the nerves with symptoms that include sudden numbness and weakness in the arms and legs, sometimes leading to paralysis. The disease is serious and requires medical treatment, but most people recover completely.

Immune system— The body's natural defenses against disease and infection.

Immunization— A process or procedure that protects the body against an infectious disease. A vaccination is a type of immunization.

Inflammation— Pain, redness, swelling, and heat that usually develop in response to injury or illness.

Meningitis— Inflammation of tissues that surround the brain and spinal cord.

Microorganism— An organism that is too small to be seen with the naked eye.

Organism— An individual of some type of life form, such as a plant, an animal, or a microorganism.

Plague— A highly infectious disease that can be fatal if not treated promptly. The bacteria that cause plague mainly infect rats, mice, squirrels, and other wild rodents. The disease is passed to people through fleas. Infected people can then spread the disease to other people.

Seizure— A sudden attack, spasm, or convulsion.

Tuberculosis— An infectious disease that usually affects the lungs, but may also affect other parts of the body. Symptoms include fever, weight loss, and coughing up blood.

Typhoid fever— An infectious disease caused by a type of bacterium. People with this disease have a lingering fever and feel depressed and exhausted. Diarrhea and rose-colored spots on the chest and abdomen are other symptoms. The disease is spread through poor sanitation.

Virus— A tiny, disease-causing particle that can reproduce only in living cells.

Yellow fever— An infectious disease caused by a virus. The disease, which is spread by mosquitoes, is most common in Central and South America and Central Africa. Symptoms include high fever, jaundice (yellow eyes and skin) and dark-colored vomit, a sign of internal bleeding. Yellow fever can be fatal.

Diagnosis

The diagnosis must be pursued with diligence and in a comprehensive manner. A careful history and physical examination is essential. Procedures that can be used include surgical investigation (laparoscopy ) and treatment of the underlying cause(s).

Treatment

Treatment is directed at diagnosing the underlying condition, which can be medical and/or psychological cause(s). Treatment can include surgery, hormonal therapy (replacements), psychotherapy, and pain control protocols.

Prognosis

The prognosis depends on the primary cause. If treatment is aggressively pursued and patient compliance is satisfactory the overall outcome is favorable.

Prevention

There are no precise preventive measures since the condition can result from normal aging and/or progressively worsening psychological disease.

Resources

BOOKS

Goroll, Allan H., et al. Primary Care Medicine. 4th ed. Lippincott, Williams & Wilkins, 2000.

Ryan, Kenneth J., et al, editors. Kistner's Gynecology & Women's Health. 7th ed. Mosby, Inc., 1999.

KEY TERMS

Laparoscopic surgery— A surgical procedure to correct or diagnose an underlying disease.

vagina is the Latin word for ‘sheath’, which makes an interesting comparison with the alternative word for a condom. From this same root, the term ‘invaginated’ means ensheathed, or turned in on itself, like the finger of an empty glove introverted into the space for the hand. Comparably, the vagina is a tube which can be considered as part of the outer surface of the body that has been introverted, forming a passage to and from the uterus and lined with an epithelium continuous with that of the vulva, which is in turn continuous with the skin.

The opening of the vagina at the vulva is initially partly covered by a thin fold of membrane known as the hymen. This normally has a central perforation, which is extended when torn by tampon use or during the first sexual intercourse. Once torn the hymen becomes an irregular ring of tissue round the vaginal opening. From the opening, the vagina extends upwards and backwards for about 10 cm and joins the cervix of the uterus at right angles so that the front wall is shorter than the back wall. The passage is roughly H-shaped in cross section, with the walls normally in close contact with each other. Around the epithelial cell lining the wall is formed of connective tissue and muscle. The muscle coat is rather thin but is nevertheless very strong. The wall is folded; this allows for expansion and stretching during sexual intercourse, and much more so in childbirth. The vagina is also richly supplied with blood vessels which become engorged during sexual arousal, assisting the opening of the passage.

While the vagina helps to support the uterus it also provides a receptacle for the penis, an entrance for sperm, and an exit for menstrual flow and for the products of conception. Because the vagina is in continuity with the inside of the uterus and in turn with the Fallopian tubes, which lead to the peritoneal cavity, an important function is the prevention of infection from the outside world. Living in the vagina are Döderlein's bacilli (named after a German gynaecologist). These are quite normal inhabitants and ferment the glycogen (which provides glucose) in the vaginal wall to lactic acid. Thus the vaginal environment is acidic, a pH of 3.8–4.5 compared with the normal pH of 7.4 found in most body tissues. This highly acidic environment helps to prevent the growth of many microorganisms which could otherwise invade the upper parts of the reproductive tract. As a consequence, when the number of these bacilli is reduced, or the availability of glucose changes, a woman becomes susceptible to vaginal infections which cause inflammation and discharge — vaginitis. For example, antibiotics can kill off the friendly bacteria in the vagina so that it becomes an ideal environment for the fungus, candida albicans, to flourish. Candidiasis (thrush) develops. Diabetes and sex hormones can alter the amount of glucose available in the vagina and so disturb the acidic environment. Thus oral contraceptives and pregnancy, for example, can make women prone to vaginal infections.

Sex hormones not only alter the acidic environment of the vagina but also alter the activity of the vaginal epithelium. When oestrogen levels are high the epithelial cells become keratinized or cornified, an effect reversed by progesterone. The same hormones can alter the proportions of the organic aliphatic acids produced by the vaginal wall which are responsible for the characteristic smells of normal vaginal secretions; in many animals, and maybe even in humans, the odours (pheromones) produced by vaginal secretions can increase the sexual attractiveness of the female around the time of ovulation.

Saffron Whitehead

Yeast Infection, Vaginal

What Is Candidiasis?

What Are the Symptoms of Candidiasis?

How Is Candidiasis Diagnosed and Treated?

How Can Candidiasis Be Prevented?

Resource

The vaginal yeast infection candidiasis (kan-di-DY-a-sis) is caused by an overabundance of a certain kind of fungus* in the genital area. Its symptoms include an itching or burning sensation in the genital area and, very typically, a white discharge from the vagina. Almost all cases of candidiasis affect women, although men also can show related signs of the infection.

* fungus

(FUN-gus) is any organism belonging to the kingdom Fungi (FUN-ji), which includes mushrooms, yeasts, and molds.

KEYWORDS

for searching the Internet and other reference sources

Candida albicans

Candidiasis

Fungal infections

Vulvovaginal Candidiasis

What Is Candidiasis?

The fungus that causes vaginal yeast* infection is usually Candida albicans (KAN-di-da AL-bi-kanz). It is naturally present in many parts of the body and grows in the vagina (va-JY-na), the gastrointestinal* tract, and the mouth. It is usually kept under control by a balance with various bacteria* that also are normally found in these naturally moist areas. Candidiasis will occur when this balance is disrupted and too many of the fungus cells are present in the vaginal area. (When Candida infection involves the mouth, it is called thrush. When it involves babies’ diaper area, it is called candidal diaper rash.)

* yeast

is a general term describing single-celled fungi that reproduce by budding.

* gastrointestinal

(GAS-troin-TES final) means having to do with the stomach and intestines.

* bacteria

(bak-TEER-ee-a) are single-celled microorganisms, which typically reproduce by cell division. Some, but not all, types of bacteria can cause disease in humans. Many types can live in the body without causing harm.

Candida fungus cells can multiply too much when the use of antibiotics* destroy too many of the bacteria that usually keep them in check. Other situations that may cause the fungus to grow out of control are the use of birth control pills, pregnancy, and the use of drugs that suppress the immune system*. When a woman has a disease like AIDS or diabetes that can cause weakening of the immune system, she will also be more likely to develop a vaginal yeast infection.

* antibiotics

(AN-ty-by-OT-iks) are drugs that kill bacteria.

* immune system

is the body system that fights disease.

It is estimated that 75 percent of women have a yeast infection at least once in their life. Half of them will have the infection more than once.

What Are the Symptoms of Candidiasis?

The most notable symptom of vaginal yeast infection is a white discharge from the vagina. The discharge has the appearance of cottage cheese. The area around the vagina also may itch or feel irritated. In yeast infections in men, the head of the penis becomes inflamed or shows a rash.

How Is Candidiasis Diagnosed and Treated?

Vaginal yeast infection is easily diagnosed by examining a sample of the white vaginal discharge. Treatment is with antifungal drugs* that are applied to the affected area or taken by mouth in the form of a pill.

* antifungal drugs

(an-ty-FUNG-al drugs) are medications that kill fungi.

While some creams for vaginal yeast infections are available without a prescription, it is advisable to see a doctor the first time a vaginal yeast infection is noticed. It is important to have any infection diagnosed properly before treatment is started. Health professionals recommend that anyone with a vaginal yeast infection should also have her partner examined for infection.

Antibiotics and Yogurt

Antibiotics prescribed to treat bacterial infections also kill beneficial bacteria. When the beneficial bacteria found normally in the vagina and other mucous membranes are killed, yeast cells can grow unchecked.

Eating active-culture yogurt daily while taking an antibiotic may help replenish the supply of beneficial bacteria.

How Can Candidiasis Be Prevented?

These steps can help prevent a vaginal yeast infection:

• Wearing cotton underwear
• Avoiding tight-fitting underwear made of synthetic fiber, like nylon
• Avoiding the daily use of panty hose
• Using white, nonperfumed toilet paper
• Keeping the genital area clean
• Using a towel (not a blow dryer) to dry the genital area
• Removing a wet bathing suit as soon as possible after swimming
• Avoiding douches and feminine hygiene sprays
• Using sanitary pads or tampons that are free of perfume

See also

Fungal Infections

Infection

Sexually Transmitted Diseases

Thrush

Resource

Organization

The U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road N.E., Atlanta, GA 30333. The U.S. government authority for information about infectious and other diseases, the CDC posts information about vaginal yeast infections at its website and sponsors a National Sexually Transmitted Diseases Hotline. Telephone 800-227-8922 http://www.cdc.gov/ncidod/dbmd/diseaseinfo/candidiasis_gen_g.htm

va·gi·na / vəˈjīnə/ • n. (pl. -nas or -nae / -nē; -nī/ ) the muscular tube leading from the external genitals to the cervix of the uterus in women and most female mammals. ∎  Bot. & Zool. any sheathlike structure, esp. a sheath formed around a stem by the base of a leaf. DERIVATIVES: vag·i·nal / ˈvajənl/ adj.

vagina The tube leading from the uterus to the outside. Sperm are deposited in the vagina during copulation and the fully developed fetus is born through it. In a number of mammals the vagina may be sealed when the animal is not sexually receptive and only open during oestrus. Its lining produces mucus, which prevents friction and the entry of infective organisms.

vagina (vă-jy-nă) n. the lower part of the female reproductive tract: a muscular tube, lined with mucous membrane, connecting the cervix of the uterus to the exterior. It receives the erect penis during coitus.
—vaginal adj.

vagina Portion of the female reproductive tract, running from the cervix of the uterus to the exterior of the body. Tube-like in shape, it receives the penis during sexual intercourse. Its muscular walls enable it to dilate during labour.

vagina canal connecting vulva with uterus XVII; sheath, theca XVIII. — L. vāgīna sheath, scabbard.

vagina. Lower part of a term pedestal with which the bust merges.

vagina see reproductive system .

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