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PHYSIOLOGY OF THE VAGINA THE VAGINA IS LINED BY NON-KERATINIZED STRATIFIED SQUAMOUS EPITHELIAL INFLUENCED BY ESTROGEN AND PROGESTERONE IN CHILDREN THE PH OF THE VAGINA IS 6-8 PREDOMINANT FLORA IS GRAM POSITIVE COCCI AND BACILLI .

5-4.5 . the vagina estrogenized and glycogen content increase Lactobacilli (Duoderline Bacilli) Convert glycogen to lactic acid pH of the vagina is 3.At puberty.

Hormones or lack of hormones 3. Vaginal Medication 6. Stress 8. Contraceptive preparations 4. Antibiotics 2. Diabetes Mellitus 9. Sexual trauma 7. Decrease host immunity – HIV + STEROIDS . Douches 5.VAGINAL ECOSYSTEM VAGINAL ECOSYSTEM  Dynamic equilibrium between microflora and metabollic by products of the microflora. host estrogen and vaginal pH  The predominant organism is aerobic Factors affecting the vaginal Ecosystem 1.

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VAGINAL DESQUAMATED TISSUE 1. Reproductive age – superfacial cells (est) Luteal phase.parabasal cells ( absence of hormone) .Intermediate cells (prog) Postmenopausal women. 3. 2.

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burning is not usual . grayish.BACTERIAL VAGINOSIS Causative organism: Past Haemophilus or Corynebacterium vaginale Now: Gardnella vaginalis Gram Negative Bacilli Symptoms: 30-40% asymptomatic Unpleasant vaginal odour (musty or fishy odor) Vaginal discharge: thin. or white Signs: Discharge is not adherent to the vagina. itching.

PATOFISIOLOGI .

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has no odor) Sign Erythema Oedema Excoriation Pustules Speculum: cottage cheese type of discharge Adherent thrush patches attached to the vaginal wall pH is < 4.5 . granular. highly viscous.WHAT KIND OF CLINICAL MANIFESTATION OF INFECTION IN FEMALE REPRODUCTIVE SYSTEM ? Candida Vaginitis: Moniliasis Causative organisms: Candida albicans Symptoms: 20% asymptomatic Pruritus Vulvar burning External dysuria Dyspareunia Vaginal discharge ( white.

Culture with Nickerson or Sabouraud media (Candida tropicalis) Standard Topically applied azole ( nystatin) . Fungal element either budding yeast form or mycelia under the microscope 4. 2.Clinical 1.5 3. Adjunctive treatment topical steroid .80% . pH of the vagina norma < 4. Whiff test is negative 5.1% hydrochortisone . Oral antifungal (Fluconazole) 4. 2.90% relief 3.Investigation Management 1.

edema of the vulva and vagina .Trichomonas vaginitis Symptoms: . profuse .25% : asymptomatic . frequency of urine. petcchiea or strawberry patches on the vaginal mucosa and the cervix .Vaginal discharge . dysparunea.5 The organism ferment carbohydrates – Produce gas with rancid odor Erythcum. malodorous. purulent. vulvar pruritis Sign Thin Frothy Pale Green or gray discharge pH 5-6.

hindari rokok dan alkohol 2. mengganti pembalut 4. tissu atau sabun dengan pewangi pada daerah vagina karena dapat menyebabkan iritasi 7. Tidak berlebihan menggunakan cairan pembersih vagina karena dapat mematikan flora normal vagina 6. istirahat cukup. Pola hidup sehat diet simbang .Edukasi patient 1. Membiasakan membasuh dengan cara yang benar tiap kali buang air kecil ( dari depan ke belakang ) 5. Hindari penggunakan alat mandi bersama . Menjaga hygiene daerah kelamin agar tetap kering dan tidak lembab misalnya menggunakan pakaian dalam yang menyerap keringat . hindari menggunakan celana dalam yang ketat . Hindari menggunakan bedak talkum . olahraga rutin . Setia kepada pasangan 3.

MANAGEMENT Oral Metronidazole (flagyl) Single dose 2 gm 500 mg P.O twice for 1 week : Cure Rate: 95% .

endometritis . Increase risk of pelvic inflammatory disease 2. Premature labour. Post operative cuff infection after hysterectomy 3. it increase the risk of premature rupture of membrane 4.BAKTERIAL VAGINOSIS MANAGEMENT Metronidazole 500 mg twice daily for 7 days Cure is 85% it fall to 50% if the partner is not treated Clindamycine 300 mg twice daily Vaginal COMPLICATION 1. chorioamnionitis. In pregnancy.