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This chapter presents etiology, symptoms, diagnostic difficulties, and the treatment of vaginitis. Inflammation of the vagina is the most common gynecological problem encountered by primary care physicians. The symptoms of vaginitis may include itching, irritation, purulent or other discharge, and foul odor. Bacterial vaginosis (BV) is the most common cause of vaginitis in the USA. During pregnancy, trichomoniasis is sometimes associated with preterm labor and premature rupture of membranes. Over-the-telephone diagnosis of vaginal infection is difficult and often wrong. Men physicians are more likely to treat vaginal infections over the phone than women physicians who usually require an office visit. Treatment for BV includes a variety of oral and topical treatments. Complementary treatment for single episodes and recurrent vaginitis are common. Treatment of recurrent BV may be achieved by twice-weekly treatment with metronidazole topical gel, although secondary infection with Candida can occur.
Case A 55-year-old woman came to see her family physician for a routine follow-up of her hypertension. After a brief conversation about symptoms, medications, and side effects, the physician stood to retest her blood pressure. As he placed the cuff around her arm, she sighed and said, “I know it's going to be high today. I didn't get much sleep last night.” She paused. “We had a misunderstanding.” The physician asked, “What do you mean by ‘a misunderstanding’?” and she described her husband's rampage of the night before: after a night of heavy drinking, he stormed into the house at 2:00 a.m., yelling, demanding dinner, and smashing dishes against the wall when his wife did not move fast enough to suit him. The physician learned that the woman's husband had a pattern of terrorizing her, usually after drinking. Last Christmas, he had threatened her with a shotgun. Recently, her adult son had joined his father in drinking and abusing her.
Violence against women is widely prevalent, causes serious psychological and physical damage, and brings women to the attention of the health care system on a daily basis.
Women account for 70 percent of all murdered spouses in the USA, and are 10 times more likely than men to be assaulted by an intimate other. Present or former partners kill 40 to 45 percent of female homicide victims in the UK as compared with only 6 percent of male homicide victims.
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