Three Out Of Every Four Women Will Experience Candidiasis…

A Review ofVULVOVAGINAL CANDIDIASIS (VVC) AMONG STUDENTS

Vulva and vaginal discomforts such as itching and discharge are among the most common reasons why women seek help from healthcare providers. It’s been found that more women complain of vaginal discharge than any other gynaecologic symptom. Normal vaginal discharge is clear to cloudy in appearance, turns yellow after drying, nonirritating, has mild inoffensive odour and slightly slimy. The amount usually differs with phases of the menstrual cycle; it is greater at ovulation, just before menses and during pregnancy.
 
Vulvovaginitis is the inflammation of the vulva and the vagina which is usually characterized by itching, irritation, burning sensation and abnormal vaginal discharge. This is usually caused by the introduction of chemical irritants, allergens and foreign bodies to the vaginal area which may produce inflammatory response. Infections by microorganisms remain one of the chief cause of vulvovaginitis. The most common vaginal infections are Bacterial vaginosis, Candidiasis and Trichomoniasis.
 
Candidiasis is the second most common vaginal infection – among others such as Bacterial vaginosis and Trichomoniasis. It is a fungal or yeast infection of the vulva and the vagina caused by Candida spp (most commonly the Candida albicans). It is estimated that, three out of every four women will experience at least one episode of VVC during lifetime.
 

How It Occurs

Basically, VVC is an overgrowth of yeast cells (Candida spp) in the vaginal area. Candida spp is a normal (harmless) microorganism that resides in the vagina and other areas of the body such as the gastrointestinal tract and the mouth. However, the growth of this organism is put in-check by the acidic environment of the vagina produced by the action of another normal microorganism called the lactobacillus.  VVC occurs when the normal acidic environment of the vagina is altered by the action of factors such as use of chemical irritants and antibiotics. This enhances the overgrowth of the Candida organism.

Signs and Symptoms

The signs and symptoms of the disease are often not specific and may also indicate other vaginal diseases. At times, people having the infection may show no signs and symptoms at all. Therefore diagnosis of the disease is not based on signs and symptoms alone but also, laboratory investigation. Some of the cardinal signs and symptoms include
v  Vaginal pruritis or itching
v  Painful urination –  usually due to excoriations from scratching
v  Vaginal discharge –
ü  Thick, white and lumpy
ü  May be formed in patches on the vaginal walls, cervix and labia
ü  Sometimes there is yeasty or musty smell
v  Commonly the vulva is red and swollen

Risk Factors

The incidence of VVC remains high within the age group of 20 to 25years. This may be due to
  1. High sexual activity found among this age group
The mechanism by which sexual activity may increase the risk for this condition is unknown but the possibilities include
v  Trauma of the vaginal mucosa during intercourse which may facilitate the invasion of the microorganism
v  Sexual transmission – Candida can be sexually transmitted though not considered an STI because it affect children and celibate women
  1. The use of oral contraceptives
Oral contraceptives may promote yeast adhesion and growth through increased nutrients availability or oestrogen stimulation
  1. Abuse of antibiotics
The use of antibiotics decreases the number of beneficial microorganisms such as lactobacillus that protect the vagina and the vulva against harmful microorganisms such as Candida spp.
  1. The use of chemicals at the vaginal area
The use of scented products such as pads, certain soaps, and detergents among other preparations meant to keep the vaginal area free from odour can irritate the vagina, causing an imbalance in the natural bacteria.
  1. Poor personal hygiene
Bad hygiene practices such as douching kill the beneficial microorganisms that protect the vagina against infections.
  1. The use of tight fitting clothing and underwear
Tight clothing and underwear made of nonabsorbent materials create an environment in which vaginal fungus can grow.
  1. Others include Obesity, Pregnancy and Uncontrolled Diabetes Mellitus

Prevention Of VVC

v  Wearing of cotton underwear or at least underwear with cotton lining in the crotch. Cotton allows more air to flow through the genital area.
v  Avoid using powders and fragrant sprays in the genital area. Use only unscented items and gentle cleansers.
v   Practices such as douching must be avoided. Clean only the outside areas of your vagina with gentle soap and water.
v  Indiscriminate use of antibiotics and oral contraceptives must be avoided. Only prescribed antibiotics must be used and students must seek for adequate information from healthcare providers on contraceptives before use.
v  Students must exercise some level of control over their sexual life. Unmarried individuals must abstain from sex as much as possible. In cases where this is not possible, faithfulness to sexual partners must be encouraged. Also, protective measures such as condom use can be ensured.
 

 

Written By Prince Assandoh-Mensah (RN, BSN- CHN, Clinical Nurse)Edited By Rhoda Domale (RN, BSN, Clinical Nurse)

REFERENCES

1.      Centre for Disease Control and Prevention. Genital Candidiasis. (2016). https://www.cdc.gov/fungal/diseases/candidiasis/genital/
2.      Day, R. A., Brunner, L. S., & Day, R. A. (2010). Brunner & Suddarth’s textbook of Canadian medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.
3.      Emeribe, AU., Nasir IA., Onyia, J., & Ifunanya AL. Prevalence of vulvovaginal candidiasis among nonpregnant women attending a tertiary health care facility in Abuja, Nigeria. Dove Press Journal: Research and Reports in Tropical Medicine 2015:6 37–42
4.      Geiger, A. M., Foxman, B., & Gillespie, B. W. The Epidemiology of Vulvovaginal Candidiasis among University Students. American Journal of Public Health. August 1995, Vol. 85, No. 8
5.      Lowdermilk, D. L., Perry, S. E., & Bobak I. M. (1999). Maternity Nursing (5th Edition). USA. Mosby Inc.

 

6.      Scanlon, V. C., & Sanders,T. (2007). Essentials of anatomy and physiology. Philadelphia. F. A. Davis Company
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