Inflammatory Vaginitis

What Is Inflammatory Vaginitis?

[dropcap]I[/dropcap]nflammatory vaginitis, also called desquamative inflammatory vaginitis, is a female genital disorder characterized by non-infectious tissue inflammation of the vagina (birth canal).

Inflammatory vaginitis presents in females of any age including girls with a history of discomfort, irritation, and in those who are sexually active, painful sexual intercourse. Patients may also report an increased vaginal discharge.

Q: How do the tissues appear?

A: Examination of the vulva is normal, but erythematous regions on the vaginal walls are evident with increased vaginal secretion. This secretion is high in polymorphonuclear leukocytes, with an increased number of immature squamous epithelial cells. Repeated cultures are negative for bacteria, viruses and yeast.¹

What Is Inflammatory Vaginitis In Celiac Disease and/or Gluten Sensitivity?

• Vaginitis is a classic symptom of celiac disease and may be a presenting feature of malabsorption of multiple nutrients.

How Prevalent Is Inflammatory Vaginitis In Celiac Disease and/or Gluten Sensitivity?

Inflammatory vaginitis in celiac disease is described in case reports. Until recently, this vaginitis has been poorly diagnosed and treated.

What Are The Symptoms Of Inflammatory Vaginitis?

Vaginitis is marked by these symptoms:

• Itching.
• Irritation.
• Painful intercourse (dyspareunia).
• Greenish or yellowish discharge is negative for infectious organisms.

How Does Inflammatory Vaginitis In Celiac Disease and/or Gluten Sensitivity Develop?

• Vaginitis results from nutritional deficiencies due to malabsorption in celiac disease causing lack of tissue integrity so that compromised tissues become inflamed. Deficiencies include folic acid, niacin, vitamin A, iron, and vitamin D.
• Folate deficiency affects all rapidly growing (DNA synthesising) tissues and, in addition to its effect on the bone marrow (leading to megaloblastic erythropoiesis), folate deficiency also affects the epithelial surface of the mouth, stomach, small intestine and female genital tract, the cells showing macrocytosis (abnormal large cells) with increased numbers of multinucleate and dying cells.
• Pruritus (itching) results from iron deficiency.
• Niacin and vitamin A are required for mucosal integrity.
• Vitamin D has recently been shown to be a cause of this vaginitis.

• Researchers propose that this vaginitis is a mucous membrane manifestation of vitamin D deficiency that results in desquamation of the vaginal epithelium and discharge. Moreover, Peacocke, et.al. suggest that the loss of this epithelium leads to altered vaginal pH levels, mucous membrane fragility, inflammation, and secondary infection. Because vitamin D is a known transcriptional activator, they suggest that vitamin D is necessary for the synthesis of specific vaginal structural proteins, such as cytokeratins.
• Vitamin D deficiency results in decreased amounts of these proteins, resulting in loss of epithelial structural integrity and desquamation. Correction of the vitamin D deficiency ultimately leads to regeneration of the vaginal epithelium and cessation of desquamation.²

Does Vaginitis Respond To Gluten-Free Diet?

Yes. Celiac disease related vaginitis responds to gluten free diet and is preventive of occurence.

6 Steps To Improve Inflammatory Vaginitis:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both vaginal health and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.³
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁴
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁴
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁴.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁴
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁴
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁴[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain prescription drugs cause folate, iron, niacin, vitamin A,  vitamin D deficiencies any of which can cause poor vaginal health. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of these drugs. Do not stop prescribed medications without supervision.

 This is not a complete listing.

FEMALE HORMONES disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Folic Acid, Niacin and others. Correlation analysis shows significant association between some trace elements and the duration of contraception and body mass index of the study participants.⁵
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Folic Acid, Niacin and others.

DIURETICS

• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Folic Acid and others.

DIABETIC DRUGS 

• Metformin® depletes Folic acid and others.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Folic Acid, Vitamin D and others.
• NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid and others.
• Aspirin and Salicylates deplete Folic acid, Iron and others.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Folic Acid, Vitamin D and others.

ANTIBIOTICS  disrupt intestinal permeability.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins and others.
• Tetracyclines deplete Iron.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Folic Acid, Iron, Vitamin A, Vitamin D and others.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Folic Acid, Iron, Vitamin A, Vitamin D and others.
• Alka Seltzer®, Baking Soda deplete Folic Acid  and others.

CHOLESTEROL DRUGS

• Colestid® and Questran® Folic acid, Vitamin A, Vitamin D, Iron and others.[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Niacin (vitamin B3) as niacinimide as prescribed.
• Folic acid as prescribed following a blood test for serum level.
• Ferrous fumarate as prescribed following a blood test for iron status.
• Vitamin D3  following a blood test for serum level.
• Vitamin A as prescribed following a blood test for serum level.
• Probiotics that include lactobacillus and acidophilus strains are necessary to restore vaginal health.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle but is not advised in this condition due to increased pressure in the brain that occurs.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Vaginitis in Celiac Disease?

“Vulvodynia associated with celiac disease.” This case report describes diagnosing celiac disease in a 44 year old woman who presented with a six-month history of recurrent vulvovaginitis. She complained of burning, itching and a greenish vaginal discharge. The symptoms were worse before and after periods and soreness precluded the use of tampons. There was superficial dyspareunia with pain on penetration and splitting of the fourchette even when using lubricating jelly. General and abdominal examination was unremarkable. Genital examination revealed some atrophy of the external genitalia, inflammation and tenderness in the perivestibular area with Q-tip swab pressure. In addition a small ulcer in the anterior fornix of the vagina, a normal-looking cervix and a retroverted uterus with normal adnexae were found. High vaginal and endocervical swabs were taken for culture and chlamydia detection and colonoscopy and vulvoscopy were performed. Vaginal pH was 5, and there was no evidence of bacterial, viral or chlamydia1 infection. Vaginal and cervical cytology were normal. Hormone assays did not suggest that the woman was menopausal. Colposcopy was normal, vulvoscopy revealed a small split at the posterior fourchette with no areas of aceto-white. Symptoms did not respond to standard treatment but worsened. Signs of malnutrition prompted investigation for celiac disease.

A celiac disease diagnosis was confirmed on duodenal biopsy which showed a marked degree of villous atrophy and increase in chronic mononuclear inflammatory cells within the lamina propria and surface epithelium. Crypt hyperplasia was present. The patient began eating a gluten-free diet and took oral iron and folate supplements. Within a few weeks her vulva symptoms had markedly improved and by two months had completely resolved. Her energy level returned to normal and her symptoms of abdominal bloating and excessive flatus disappeared.⁶

Sources:

1. Murphy R. Desquamative inflammatory vaginitis. Dermatol Ther. 2004;17(1):47-9. [↩]
2. Peacocke M, Djurkinak E, Thys-Jacobs S. Treatment of desquamative inflammatory vaginitis with vitamin D: a case report. Cutis. 2008 Jan;81(1):75-8. [↩]
3. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
4. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
5. Akinloye O1, Adebayo TO, Oguntibeju OO, Oparinde DP, Ogunyemi EO. Effects of contraceptives on serum trace elements, calcium and phosphorus levels. West Indian Med J. 2011 Jun;60(3):308-15. [↩]
6. Costello C and Smith JR. Vulvodynia associated with celiac disease. British Journal of Obstetrics and Gynaecology. November 1996, Vol. 103, pp. 1162-1163 [↩]