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2017 HCHB_digital

Vaginal Health The

Vaginal Health The vagina is a closed muscular canal that is naturally acidic and contains rich quantities of beneficial bacteria and yeasts. Changes to the natural environment or structure of the vagina, as a result of endometriosis, hormonal contraceptives, feminine hygiene products, infection, menopause, pregnancy and childbirth, psychological distress, or trauma can upset its proper functioning, leading to abnormal discharge, genital sores, infertility, sexual discomfort, urinary incontinence, or vaginitis. Good vaginal health is an important contributor to a woman's overall state of health. Symptoms of poor vaginal health A healthy vagina secretes a small amount of discharge to keep itself clean, and a change in this discharge (colour, smell, or consistency) is often the first sign that something is wrong. Other symptoms of concern include abdominal pain; a noticeable lump or bulge inside the vagina; bleeding between periods, after sex, or after menopause; and vaginal redness, itching or irritation. Discussions on vaginal health are best conducted in a private area and by a pharmacist since most vaginal conditions either require a pharmacist to sell the treatment (such as vaginal thrush) or refer the customer to a doctor. The exception is vaginal dryness, common in women going through menopause, for which a vaginal lubricant or gel can be sold. Pharmacists should also not assume any abnormal discharge is vaginal thrush as many other conditions (such as bacterial vaginosis, trichomoniasis) present in a similar way. Vaginal thrush Vaginal thrush (vaginal candidiasis) is a common fungal infection caused by overgrowth of the yeast, Candida albicans. Although not considered a sexually transmitted infection, occasionally the yeast can be transferred to a male partner causing redness, itching and soreness around the foreskin and head of the penis. Only symptomatic males need treatment with a topical antifungal cream; studies have shown treating non-symptomatic males does not reduce the number of episodes of candidiasis in their female partner. Symptoms of vaginal thrush in women include itching, irritation or a burning sensation in the genital area. Vulval soreness may occur and there may be a thick, white or creamy vaginal discharge. If itching is the main presenting complaint and there is no thick discharge, consider other causes such as cystitis or a rash due to sensitivity (eg, toiletries, synthetic underwear). If a "fishy" or malodorous smell is present, consider bacterial vaginosis (refer to a doctor). Occasional recurrent episodes of vaginal thrush may be treated with over-thecounter vaginal antifungal agents sold by a pharmacist, particularly if there is a readily identifiable cause, eg, a course of antibiotics. Customers with symptoms that show no improvement after four days must be reviewed by a doctor. There may be an underlying medical condition (eg, diabetes or an autoimmune condition), an atypical yeast infection (eg, Candida glabrata) or a non-fungal cause (bacteria, trichomoniasis, chlamydia, gonorrhoea, TREATMENT OPTIONS Category Examples Comments Imidazole antifungal vaginal products Triazole antifungal vaginal products Combination antifungal vaginal products Vaginal lubricants and gels Natural / herbal products / supplements [PHARMACIST ONLY MEDICINE] eg, clotrimazole (Canesten range), miconazole (Micreme Vaginal Cream, Resolve Thrush) eg, clotrimazole + hydrocortisone (Canesten Plus) [PHARMACIST ONLY MEDICINE] eg, fluconazole (Canesten Oral Capsule, Diflucan One, Flucazole 150) [PHARMACIST ONLY MEDICINE] eg, clotrimazole cream + oral fluconazole capsule (Canesten Duo) [GENERAL SALE] eg, Aci-jel, Kolorex Intimate Care cream, Lactigel*, Rephresh Vaginal gel, Replens Vaginal Moisturiser Horopito extract (eg, Kolorex Candida Care), Lactobacillus acidophilus, L. casei GG, Bifidobacteria, echinacea, Naturopharm Thrushmed Relief Gel Vaginal antifungal products are available as creams, pessaries or ovules for intravaginal use in single-dose, three and six-day treatments. Single-dose treatments are more convenient; however, longer therapy may be required in some circumstances (eg, if the woman is still on antibiotics). Disposable applicators are supplied in the packet and treatment is best used at night. The combination cream containing hydrocortisone can be used to treat the external symptoms of thrush only. Hydrocortisone is very effective at relieving the itch. Only one capsule needs to be taken, once. Similar in efficacy to imidazole vaginal antifungals. Avoid use if the patient has previously had liver disease with fluconazole (rare). Note possible drug interactions (see OTC Medicines Interactions). Pharmacist is not able to sell OTC in females aged under 18 or in pregnancy or breastfeeding. A combination pack, see above for selling notes related to individual products. Vaginal gels and creams maintain a healthy vaginal pH to reduce the risk of vaginal infections. Lactigel restores vaginal pH and may help suppress bacterial vaginosis-associated bacteria. Most are usually safe to use with condoms but check manufacturers’ recommendations. Horopito is an effective antifungal agent. Several probiotics are effective at returning gut yeast populations back to normal. Echinacea stimulates the immune system and the body’s ability to overcome Candida overgrowth. Products with an asterisk have a detailed listing in the Vaginal Health section of OTC Products, starting on page 266. READY, SET, LEARN! Page 160 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION herpes, vaginal dermatitis, malignancy and certain other conditions which may masquerade as vaginal thrush). Thrush triggers Many things can affect the delicate pH balance of the vagina, triggering an overgrowth of Candida albicans and an episode of thrush. The most common triggers include a course of broad-spectrum antibiotics (eg, tetracycline, amoxicillin with clavulanic acid), higher-dose combined oral contraceptive pills or oestrogen-based hormone replacement therapy, immunodeficiency (eg, HIV), iron-deficiency anaemia, hot and humid weather, emotional or physical stress, poorly controlled diabetes or pregnancy. Women with higher levels of oestrogen are more likely to get thrush because oestrogen causes the lining of the vagina to mature and produce glycogen, a substance on which Candida albicans thrives. Lack of oestrogen in young girls and older women makes vaginal thrush less common. Treatment Both oral and vaginal antifungal preparations which stop the growth of Candida yeast without affecting the “helpful” bacteria in the vagina are available for customers to purchase through a pharmacist. Guide to recommending topical versus oral thrush treatments Topical Oral Breastfeeding Cost Customer preference Interacting medicines Liver disease Pregnancy * Younger customers ( ⩾16 but

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