Vaginitis

Estrogens stimulate cellular proliferation, induce RNA and protein synthesis of uterine endometrium and the fibrous connective tissue framework for ovaries, and increase the size of the cells. This effect leads to the growth and regeneration of the endometrial layer and spinal arterioles, and increase in the number and size of endometrial glands. Under the influence of estrogen, vaginal mucosa becomes thicker, as cervical mucus becomes thinner (85,86). 

I = injection T = tablet C = cream Tr = transdermal, continuous delivery, P = parenteral VC = vaginal cream VS = vaginal suppositories Ca = capsule. 

Aerosols. Pressurized containers to deHver aerosolized dmg products through appropriate systems of valves and actuators have been available since the 1950s (see Aerosols). Such dosage forms are used as external appHcations of lotions and creams, for oral inhalation, or for treatment of the vaginal cavity, eg, contraceptive foams. Aerosols contain two- or three-phase systems, wherein a volatile Hquid or admixture of Hquids is sealed in a... 

Salts of acetarsone are used in the treatment of intestinal amoebiasis, vaginal trichomoniasis, and necrotizing ulcerative gingivitis (Vincent s angina). The diethylamine salt (acetylarsan [534-33-8]) has antisyphilitic properties. Because of toxicity problems, safer dmgs have been developed. Oral LD q in rabbits is 150 mg /kg. 

Oral treatment offers the advantage of bringing all the lesions at all sites under control, in addition to the absence of unpleasant cosmetic effects. In certain cases, it may be preferable to use oral treatment for C. albicans vaginitis and for extensive and persistent pityriasis versicolor, a skin disorder caused by Pityrosporum orbiculare. In the case of onychomycosis, a combination treatment, topical plus systemic, is required. It is preferable to use oral treatment for deep and systemic mycoses, though intravenous or intrathecal treatment is sometimes required. 

Nystatin is mainly used to treat vaginal and oral infections and localized skin lesions, including Candida intertrigo and Candida nappy dermatitis. It may also be used as prophylaxis during treatment with antibiotics. 

Amphotericin B. Amphotericin B (3), an important polyene antibiotic, is administered almost exclusively via the intravenous route and is therefore discussed in more detail under the systemic antimycotics. The vaginal tablets contain 50 mg amphotericin B, and 100 mg tetracycline base per tablet (see also Antibiotics, tetracyclines). The tablets for oral use contain 50 mg amphotericin B, 250 mg tetracycline base, and 125 mg sodium hexametaphosphate. A combination ointment contains 1 mg fludrocortisone acetate, 2.5 mg neomycin, 0.25 mg gramicidin, and 1 g plastibase in addition to 30 mg amphotericin B (see also Antibiotics, peptides). 

At the tested daily dose of 50 mg, fluconazole appears to be slightly less active against dermatophytes. The substance is used mainly to treat vaginal candidosis (a single capsule of 150 mg) and oral and esophageal candidosis (50 mg od for 14 d). In a number of countries, ie, England, the maximal period of treatment is 14 d. 

Clinical studies with Norplant attest to its high contraceptive efficacy and safety. The main reason patients request the removal of Norplant is unpredictable vaginal bleeding episodes followed by amenorrhea. The bleeding problem is an unavoidable sequela of progestogen-only contraception. 

Vaginal Rings. Vaginal epithelium is readily permeable to contraceptive steroids. Since the vascular drainage of the vagina bypasses the Hver, this route of adrninistration potentially permits utilisation of dmgs that have low oral activity. 

In the last several decades, physical properties of vaginal contraceptive formulations have been improved to deUver spermicide more effectively and enhance consumer compliance. The formulation that deUvers the spermicide can affect the efficacy of vaginal contraceptives (86,87). Formulations currentiy available include jeUies, creams, suppositories, aerosol foams, and foaming tablets. Each consists of a relative inert base material that serves as a carrier for the chemically active spermicide and blocks to some extent the passage of sperm. 

Two new female condoms, ie, vaginal pouches, are in early stages of development. These devices still require thorough preclinical and clinical studies to demonstrate safety and effectiveness before they reach the market (102). 

Rodent 20-day pubertal female with thyroid age of rats at time of vaginal opening. 

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