When chronic vaginal irritation is suggested by direct inspection of the vaginal barrel and confirmed by adequately stained vaginal smear or hanging-drop preparation of the vaginal discharge, which may be profuse and irritating, the husband also should be suspected of harboring the trichomonads, possibly beneath the foreskin if he is uncircumcised, but more frequently in the prostate gland, the seminal vesicles, or the urinary bladder.
If both husband and wife are not treated simultaneously for this particular distress, the infection may become a source of chronic dyspareunia, as it may be exchanged frequently between marital partners during repeated opportunities at coital connection.
It does little good to treat the wife for trichomonal vaginitis and then have her reinfected by her husband. And it obviously does little good to treat the husband individually and have him reinfected by his wife. With chronic trichomonal vaginitis, there may be recurrent bouts of dyspareunia, particularly with the coital connection of any significant duration.
Fungal vaginitis is seen clinically more and more frequently. Incidence of this particular infectious entity used to be primarily confined to the late spring, summer, and early fall months, but now such pathogens as Monilia and Candida albicans are encountered regularly throughout the year.
The chronic fungal infection creates a debilitating situation for the recipient woman. Burning and itching are intense and swelling and weeping of soft tissues are frequent complications. Coital connection is virtually impossible due to the pain involved when a fungal infection dominates in the vaginal environment.
Infections with antibiotics frequently will protect women from the complications of fungal vaginitis.
Symptoms of dyspareunia
Aside from direct infective agents, there are many other sources of burning, itching, or aching in the vaginal barrel that can produce chronic dyspareunia. Among those most frequently encountered are the sensitivity reactions associated with intravaginal chemical contraceptive materials.
Many women develop vaginal sensitivity to chemical factors included in contraceptive creams, jellies, suppositories, foams, or foam tablets.
When persistent itching or burning is intense enough to engender the symptoms of dyspareunia during or shortly after intercourse, and when any of these above-mentioned intravaginal chemical contraceptive agents are employed routinely during coital connection, the possibility of sensitivity to the chemical agents should always be kept in mind.
There also are occasional irritations created by the rubber used in manufacturing both diaphragms and condoms. In a few women, the response of the vaginal mucosa to latex products (condom sensitive) is quite irritative in character.
When these contraceptive techniques are employed with regularity and chronic noninfectious irritation in the vagina causes obviously increasing dyspareunia, sensitivity to rubber products should be suspected.
The sensitivity to rubber is quite infrequent but must be kept in mind in the differential diagnosis of non-infectious, irritative, vaginal dyspareunia.
Agents frequently most often responsible for making the vaginal mucosa sensitive to infective processes and emphasizing the potential irritation of maintained penile thrusting are the various douching preparations.
Many women feel they must douche after every coital exposure to maintain cleanliness. This is one of the most persistent and widespread misconceptions in the folklore of human sexual functioning.
From a cleanliness point of view, there is not the slightest need for douching after intercourse. The vagina returns to its natural protective pH value within 6 to 8 hours after seminal-fluid deposition.
Repeated douching usually accomplishes only the untoward result of washing protective levels of residual acidity from the vagina. Thereafter, secondary infection frequently develops from the elevated levels of pH usually found in the post-douching vaginal environment.
Additionally, proprietary products used in douching can create reactive, chemical-type vaginitis of the same pattern as that stimulated by intravaginal chemical contraceptives.
Esthetically concerned women should be reassured by the authority that the simple expedient of external washing with soap and water is all that is necessary to maintain security from post-ejaculatory drainage and to avoid any suggestion of postcoital odor.
There is another type of chronic vaginal irritation that should be highlighted. It frequently is seen associated with clinical complaints of dyspareunia and is described as senile vaginitis.
Older women not supported by steroid protection techniques develop thin, atrophic mucosal surfaces in the vagina.
These tissue-paper-thin areas crack and bleed easily under duress of forceful or maintained penile thrusting.
Many women in the 50 to 70 year age group complain of vaginal burning and irritation not only during but even for hours and occasionally days after coital exposure due to the atrophic condition of the mucosal lining of the vagina.
Aging women can be fully protected from these distressing symptoms by the initiation of adequate sex steroid support. Although seen infrequently, yet in the same physiological category as senile vaginitis, is a radiation reaction in the vagina.
After local radiation for carcinoma, the vaginal barrel shrinks, the mucosa becomes atrophic, and dyspareunia usually develops not only from the atrophic mucosa but also on the basis of loss of vaginal wall elasticity and marked reduction of lubrication production.