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   Leukorrhea  ตกขาว
  ลักษณะของสารค้ดหลั่งจาก
  ช่องคลอด มีกลิ่น มีอาการคัน
  อักเสบร่วมด้วย เกิดจากเชื้อ
  แบคทีเรีย เชื้อพยาธิ์ เชื้อรา

  

   กลับไปที่ข้อมูลก่อนหน้านี้
   Back to Leukorrhea


 
การตรวจภายใน Pelvic
  Examination

 
Classification of 
  Squamous Cells on 
  the  Pap Test
 
การแปลผลการตรวจ PAP

 
ชุดทดสอบการตรวจแบบ 
  Rapid Immuno C.alb/T.V 
  Combo Test

 

Skin and Acne 
    ศึกษาเรื่องของผิวหนัง

Skin and Acne 
    ศึกษาเรื่องของสิว
   

1. AHA (Alpha hydroxy
    acid) 
    Glycolic acid


2.
BHA (Beta hydroxy 
    acid)
    Salicylic acid


3.
Derma&Skin Roller
   
ลูกกลิ้งเข็มเพื่อใช้ในการ
    กระตุ้นและปรับสภาพผิว


4. Copper peptide 
    คอปเปอร์ เปปไทด์

5. Skin needling & 
    Facial Mesotherapy
    การใช้เทคนิค ลดริ้วรอย
    หน้าหมองคล้ำ จุดด่างดำ
    ลดปัญหาแผลหลุมสิว
    ด้วยตนเองที่บ้าน

 

Vitamin
วิตามิน
สารอินทรีย์ที่จำเป้นต่อ
การเจริญเติบโต สุขภาพ
สมบูรณ์


L- Glutathione
แอล-กลุตาไธโอน

skin whitening
ผลิตภัณฑ์ช่วยเสริมผิวขาว
อย่างธรรมชาติ

L- Carnitine
แอล คาร์นิทีน
ผลิตภัณฑ์ช่วยลดน้ำหนัก
อย่างธรรมชาติ

  Coemzyme Q10
โคเอ็มไซม์ คิวเท็น

ช่วยระบบไหลเวียนโลหิต
หัวใจ ความดันโลหิต
ช่วยลดริ้วรอยคืนความ
อ่อนเยาวืให้กับผิวหนัง

Minerals
เกลือแร่

สารอาหารที่มีความจำเป็น
ต่อการเจริญเติบโต สุขภาพ
แข็งแรง เป็นปกติ
  

 

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Women's Health : Leukorrhea  ตกขาว
From Wikipedia, the free encyclopedia จากวิกิพีเดีย  

From About.com
About.com Health's Disease 
and Condition


From MedScape
Practical Guide to Diagnosing 
and Treating Vaginitis

นพ.ภูชิชย์ มีประเสริฐสกุล แพทย์ผู้เชี่ยวชาญด้านสูตินารีเวช โรงพยาบาลบำราศนราดูร กรมควบคุมโรค
ติดต่อ
กระทรวงสาธารณสุข  เปิด เผยว่า ขณะนี้อัตราการเกิดโรคตกขาว ซึ่งจะเป็นเฉพาะผู้หญิง 
เพิ่มมากขึ้น ทั้งนี้เนื่องจากผู้หญิงส่วนใหญ่มักจะซื้อน้ำยาล้างช่องคลอด ตามที่มีจำหน่ายอยู่
ทั่วไปในท้องตลาดมาล้างช่องคลอดด้วยตนเอง
ซึ่งการกระทำดังกล่าว จะเป็นการทำให้เชื้อโรค
ประจำถิ่นที่มีอยู่ในช่องคลอดขาดการสมดุล อาทิ เชื้อรา
, เชื้อแบคทีเรีย ฯลฯ ไม่สมดุลกัน ทำให้เกิดอาการ
ผิดปกติได้ คือมีอาการตกขาวเป็นสีเหลืองปนหนอง ปนเลือด
, มีกลิ่นเหม็น ไม่สัมพันธ์กับการมีประจำเดือน 
ดังนั้น เมื่อเกิดอาการดังกล่าว จะต้องไปพบแพทย์โดยด่วน ไม่ควรที่จะไปซื้อยามาใช้เอง เพราะยาที่รักษา
อาจจะไม่ตรงกับโรคที่กำลังเป็นอยู่ได้

สิ่งสำคัญที่สุดที่ทำให้ผู้หญิงเกิดโรคดังกล่าวได้ง่าย เนื่องจากมีการนำน้ำยาล้างช่องคลอดมาใช้บ่อยครั้ง 
หรือมีการฟอกสบู่วันละหลายครั้ง
ทำให้สภาพความสมดุลของเชื้อโรคในช่องคลอดเสียไป และผิวหนัง
ภายนอกระคายเคือง ดังนั้น วิธีที่ดีที่สุดของการป้องกันคือ
ควรล้างด้วยน้ำเปล่า และล้างเฉพาะภายนอก
เท่านั้น
ไม่จำเป็นที่จะต้องล้างภายใน และไม่ควรใส่เสื้อผ้าหรือชุดชั้นในที่อับชื้น ซึ่งเป็นอีกสาเหตุหนึ่ง
ที่ทำให้เกิดโรคขึ้นได้
นายแพทย์ภูชิตกล่าวต่อว่า โดยทั่วไป ผู้หญิงจะเป็นตกขาวโดยธรรมชาติกันทุกคน 
ซึ่งตกขาวแบบปกตินั้น
จะสัมพันธ์กับประจำเดือนของคนคนนั้น คือจะเป็นก่อนที่จะเป็นประจำเดือน และ
ตกขาวส่วนใหญ่จะมีสีขาวใสเหมือนแป้ง แต่ไม่มีกลิ่น
, ไม่เหม็น ซึ่งหากเกิดอาการอย่างนี้ก็ไม่จำเป็นที่
จะต้องรักษา
ซึ่งเมื่อเป็นประจำเดือนแล้วอาการดังกล่าวก็จะหายไป
      
ผู้หญิงทุกคนควรรู้จักสังเกตความผิดปกติในระบบสืบพันธุ์ของตน ถ้ามีการตกขาวมาก มีกลิ่น หรือสี
ผิดปกติ พร้อมกับมีอาการคันหรือเจ็บแสบ
ซึ่งบอกให้รู้ว่ามีการอักเสบเกิดขึ้นแล้ว 

ตามปกติช่องคลอดจะชื้นอยู่เสมอ
เนื่องจากมีมูกที่ผลิตจากปากมดลูก มูกนี้จะมีลักษณะขาว และไม่ทำให้คัน 
หรือเจ็บแสบ แต่อาจมีมากในระหว่างการตั้งครรภ์ ระยะไข่สุก หรือเมื่อมีอารมณ์เพศซึ่งไม่ใช่สิ่งผิดปกติ 
ถ้ามีอาการอักเสบ
หรือมีเนื้องอกบริเวณอวัยวะเพศ ปัสสาวะบ่อยและปวดแสบ ตกเลือดขณะหรือหลังการ
ร่วมเพศ
หรือมีอาการเจ็บปวดขณะร่วมเพศต้องรีบไปปรึกษาแพทย์

หากต้องการทราบข้อมูลเกี่ยวกับโรคต่าง ๆ และการดูแลสุขภาพด้วยตนเอง สามารถสอบถามได้ที่ สายด่วนสุขภาพ 590- 2000 บริการเพื่อสุขภาพของกระทรวงสาธารณสุข โดยกดหมายเลขโทรศัพท์ 
590-2000

David M. Plourd , MD, FACOG , US Naval Medical Center

Abstract and Introduction

Bacterial vaginosis (BV), candidiasis, and trichomoniasis account for more than 90% of vaginal infections. BV typically is associated with a decrease in commensal, protective lactobacilli and a proliferation of other flora. Mobiluncus is pathognomonic but found in only 20% of cases. Presence of 3 of 4 criteria indicates BV: a homogenous noninflammatory discharge (not many WBCs); pH >4.5; clue cells (bacteria attached to borders of epithelial cells, > 20 % of epithelial cells); and a positive whiff test. New intravaginal BV preparations cause less-adverse systemic effects than oral regimens. Trichomonas vaginalis, a protozoan, appears to be sexually transmitted and causes up to 25% of vaginitis cases. Diagnosis is made by observation of a foul, frothy discharge; pH >4.5 (present in 70% of cases); punctate cervical microhemorrhages (25% of cases); and motile trichomonads on wet mount (50%-75% of cases). Recommended treatment is a single 2g dose of oral metronidazole. Treatment failure is usually due to nontreatment of the male partner. Candidiasis typically presents as a thick, "curdled" white discharge or vulvar pruritus, with a hyperemic vagina and an erythematous and/or excoriated vulva. Vaginal pH is usually in the normal range of 3.8- 4.2 in uncomplicated candidiasis. Microscopic examination of the discharge reveals hyphae or budding yeast in 50%-70% of cases. While the most common offender is Candida albicans, Candida tropicalis and Candida glabrata have become increasingly prevalent. Approximately 15% of C albicans organisms are resistant to clotrimazole and miconazole. Recurrent infections may be treated with fluconazole 150mg weekly for up to 12 consecutive weeks.

Let's Talk about Vaginal Discharge

Do you know the difference between normal vaginal discharge and abnormal 
vaginal discharge? Did you know that having a vaginal discharge is normal?   
Lets take a look at various types of vaginal discharges so that youll know when 
you have an abnormal vaginal discharge.

The Natural Vagina

The basic function of you vagina is to provide a route from the outside of your vagina to your uterus and the rest of your internal reproductive system. The natural, acidic, pH of your vagina acts to prevent infections. The acidic nature of your vagina is caused by natural, good, bacteria produced by your body. When your vagina is healthy, the vagina keeps itself clean and in a healthy state by producing secretions of normal vaginal discharge. The natural balance of the vagina can be disrupted by anything that interferes with its normal environment.

What is Normal Vaginal Discharge?

First its important to understand that all women experience some amount of vaginal discharge. Glands in your vaginal and cervix produce small amounts of fluid that flows out of your vagina everyday taking with it old cells that line the vagina. Your normal vaginal discharge helps to clean the vagina, as well as keep it lubricated and free from infection and other germs. A normal vaginal discharge does not have a foul odor and usually has no odor at all. Normal vaginal discharge often appears clear or milky when it dries on your clothing; occasionally you may notice white spots or a normal vaginal discharge that is thin and stringy looking.

Other things that may cause changes in the appearance or consistency of your vaginal discharge include:

  • Your menstrual cycle
  • Emotional stress
  • Pregnancy
  • Any prescribed or OTC medications you take including hormones such as in the Pill
  • Sexual excitement
  • Breastfeeding
  • Ovulation
  • Your diet

Other things that can upset the natural pH balance of your vagina and lead to vaginal infections include vaginal douches, feminine hygiene products, perfumed or deodorant soaps, antibiotics, pregnancy, diabetes, or the presence of another infection.

Your menstrual cycle has a significant affect on the type of vaginal discharge you experience throughout the month. Did you know youre more likely to experience vaginal infections just before or during your period? This is because the pH balance of your vagina varies during your monthly cycle causing the acidic level of your vagina to be at its lowest point a few days before and during your period. About halfway between your periods an increase in vaginal discharge that appears clear is normal. This increased wetness and clear vaginal discharge is an indication of ovulation.

 Some signs that may indicate an abnormal vaginal discharge and infection include:

  Changes in color, consistency, or amount

  Constant, increased vaginal discharge

  Presence of itching, discomfort, or any rash

  Vaginal burning during urination

  The presence of blood when its not your period time

  Cottage cheese-like vaginal discharge

  A foul odor accompanied by yellowish, greenish, or grayish white vaginal 
    discharge

If you have a vaginal discharge along with any of these signs, consult your health care provider for diagnosis and treatment. Vaginal discharges are common and you its likely youll have at least one vaginal infection in your life. The most common vaginal infection is bacterial vaginosis. Vaginal yeast infections are also very common and over-the-counter treatments are available; however, its important to never self-diagnose a vaginal yeast infection unless you have previously been diagnosed by your health care provider. Another common vaginal infection is called trichomoniasis

Bacterial Vaginosis

BV is a polymicrobial, primarily anaerobic, infection associated with sometimes fishy-smelling increased vaginal discharge (Fig. 1), but not accompanied by leukorrhea, vulvar burning, or pruritis. Infection with BV can have significant sequelae, however. It has been associated with an increased risk of septic abortion, premature rupture of amniotic membranes, preterm labor, preterm delivery, post-Cesarean endomyometritis, and post-hysterectomy pelvic cellulitis.[4-11]

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Figure 1. (click image to zoom) The characteristic milky or creamy vaginal discharge of bacterial vaginosis is associated with a high vaginal pH and a fishy odor. Figure courtesy of James A. McGregor, MD, University of Colorado Health Sciences Center.

Bacterial vaginosis identified on wet mount (Fig. 2) represents the most common vaginal infection identified in women with inflammation or altered flora on Papanicolaou smear.[17]

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Figure 2. (click image to zoom) On wet preparation of vaginal fluid, absence of WBCs and stippling of epithelial cells support a diagnosis of bacterial vaginosis. From Infect Med 9(1):50, 1992. Copyright 1992, SCP Communications, Inc.

Diagnosis. The diagnosis of BV requires the presence of at least 3 of the following 4 criteria (Table I):[18]

  1. A homogenous noninflammatory discharge (not many WBCs).
  2. Vaginal pH >4.5.
  3. Clue cells (bacteria attached to the borders of epithelial cells, >20 % of epithelial cells; Fig. 3).
  4. Whiff test positive for fishy or musty odor when alkaline KOH solution added to smear.

Click to zoom

Figure 3. (click image to zoom) Pap smear showing clue cells consistent with bacterial vaginosis. Courtesy of Abner P. Korn, MD. Copyright 1996, SCP Communications, Inc.

Applying these diagnostic criteria will result in correctly diagnosing BV more than 90% of the time with a false-positive rate of less than 10%.[18,19] Note that neither Papanicolaou smear nor culture are diagnostic in and of themselves. The Papanicolaou smear may indicate a coccobacillary shift of flora, but this report should prompt patient evaluation for the formal diagnostic criteria rather than empiric treatment. Culture is not helpful since the flora of BV are largely derived from the normal commensal flora.

 

Trichomonas, Trichomoniasis, Trich

Trichomonas, trichomoniasis, trich--it doesn't matter what you call it--it's all the same thing. Approximately 3 million women in the United States are infected annually with the organism that causes this usually sexually transmitted disease. However, the prevalence in men is unknown. In fact, some estimate that 30 to 50 percent of all women may be infected with this often asymptomatic infection.

This infection is caused by protozoan called trichomonas vaginalis which can live in the vagina, cervix, and occasionally the bladder. In men, trich can thrive in the urinary tract and reproductive system.

The trichomonad parasite is a flagellated protozoan that causes up to 25% of vaginitis cases. While trichomonas infection is asymptomatic up to 50% of the time,[34] when clinical signs are present they include irritation and soreness of the vulva, perineum, and thighs, with dyspareunia and dysuria. Typically, the trichomonas infection is accompanied by a copious, greenish-yellow frothy discharge (Fig. 4a). Unlike bacterial vaginosis, it seems that trichomonas is primarily a sexually transmitted infection.

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Figure 4a. (click image to zoom) Bubbly discharge of vaginal fluid growing the parasite Trichomonas vaginalis. Figure courtesy of James A. McGregor, MD, University of Colorado Health Sciences Center.

Diagnosis. The diagnosis is made by observation of the following features (Table I):

  • A foul-smelling frothy discharge (present in 35% of cases
  • Vaginal pH >4.5 (70% of cases)
  • Punctate cervical microhemorrhages (25%)[34]
  • Motile trichomonads on wet mount (50%-75%)[35]

Papanicolaou smear is quoted to be 70% sensitive in identifying trichomonads[28] (Fig. 4b). But the resemblance of leukocytes to nonmotile parasites can lead to overdiagnosis of trichomonas when a Pap smear is used to confirm a suspected infection. Cultures are not generally indicated because wet mount and clinical diagnostic criteria are sufficiently accurate (except for recalcitrant infections or when rare instances of metronidazole resistance are suspected).

Click to zoom

Figure 4b. (click image to zoom) Pap smear is reported to be 70% sensitive in showing Trichomonas vaginalis infection. Courtesy of Abner P. Korn, MD. Copyright 1996, SCP Communications, Inc.

What are the symptoms of trichomoniasis?

Because this infection often has no symptoms people often do not realize that they are infected, for men this is particularly true. When symptoms do appear it is usually 4-20 days after infection.

Women may experience mild symptoms or symptoms such as:

  • vaginal irritation and/or itching
  • vaginal inflammation
  • painful sexual intercourse
  • thin, yellowish or greenish to white, odorous vaginal discharge.

How is trichomonas transmitted?

Trichomonas is a sexually transmitted disease which is transmitted through unprotected sexual intercourse, although transmission through other routes such as dirty towels and wash cloths has been documented. Pregnant women can also pass this infection to their babies during vaginal births.

Who is most at risk for developing trichomonas?

People whose immune systems are already weakened by diabetes, excess weight, recent childbirth, antibiotics, or oral contraceptives may be at increased risk of infection. Nylon panties or pantyhose can also contribute to the development of trich by creating a breeding ground where parasites can thrive in a moist environment created by the lack of airflow caused by these materials.

How is trichomonas diagnosed?

Trichomonas is diagnosed through laboratory evaluation of a sample of vaginal discharge from a women suspected of having this infection. Physicians can also diagnose trich during a woman's annual pelvic exam and Pap smear. In men diagnosis is difficult, however a physician may take a swab from the urethra and send it to the lab for evaluation.

Are there any long-term health consequences from trich infection?

Although there are no firmly known long-term health risks associated with this infection treatment is necessary to relieve symptoms and prevent a possible twenty year long infection. There is some discussion that trichomoniasis is associated with increased risk of transmission of HIV and may cause a woman to deliver a low-birth-weight or premature infant. However, more study is needed to fully understand these relationships.

How is trichomonas treated?

Metronidazole is the treatment of choice for trichomonas. A study reported in the Journal of Obstetrics and Gynecology concluded that 1.5 gram and 2 gm doses of metronidazole were equivalent for treatment of Trichomonaisis, curing approximately 85% of infections.

The physician may also choose to treat the partner of the patient to prevent reinfection.

It's important not to consume alcoholic beverages during treatment with Flagyl (metronidazole) because it could cause severe vomiting.

How can trichomoniasis be prevented?

Proper use of condoms could prevent most cases of trichomonas, as well as other sexually transmitted diseases. Washcloths and towels should not be left for children or others to use to reduce the chance of transmission of this infection--trich can live for several hours in wet towels.

Remember, whenever you experience any usual vaginal discharge or symptoms contact your healthcare provider for proper evaluation and treatment.

Candidiasis

Candida, a commensal organism, is found in small population densities in the vaginal ecosystems of nearly one third of healthy women. Symptomatic infection arises, however, when proliferation causes a shift from colonization to frank adherence and infection. The most common offender is Calbicans; however, other species of Candida, such as tropicalis and glabrata, have become increasingly prevalent, currently representing one third of isolates.[39] Vaginal candidiasis occurs more commonly after antibiotic treatment and among women taking oral contraceptives.[40-42] Yet unless a patient has a history of antibiotic-associated candidiasis, it is not recommended to routinely prescribe antifungal therapy for every woman with candidiasis preceded by a course of antibiotics.

Diagnosis. The patient typically presents with a thick, "curdled" white discharge or vulvar pruritus (Table I). The vagina has no "itch" receptors, hence, pruritus ensues only after the fungus has spread distally onto the vulva (Fig. 5). The discharge is usually neither malodorous nor off-white unless a mixed infection is present. The vagina often appears hyperemic; the vulva can be erythematous and/or excoriated. Vaginal pH is usually normal in cases of uncomplicated candidiasis. Microscopy of the discharge with 10% KOH will often reveal hyphae or budding yeast in 50%-70% of cases[43,44] (Fig. 6). C albicans organisms are easiest to identify, as they have long hyphae with blastospores along their length and a terminal cluster of chlamydiaspores (Fig. 7). The "atypical" species of yeast, however, may only have features of budding yeast (resembling small snowmen), which are easily obscured within surrounding cellular debris. Hence, if a patient presents with classic symptoms of candidiasis and her thorough evaluation is otherwise negative (normal pH, no motile trichomonads, no clue cells, no excessive leukocytes), it is not unreasonable to offer the patient an antifungal agent as a therapeutic trial. Fungal cultures are not recommended initially.[39] The presence of fungal elements on Papanicolaou smear is not necessarily indicative of infection; because it could simply represent colonization, treatment is not recommended on the basis of this finding alone.[45]

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Figure 5. (click image to zoom) Vaginal mucosa can be covered with numerous white, thrushlike patches in vulvovaginal candidiasis. From The AIDS Reader, 1(5):155, 1991, courtesy of Jeffrey Laurence, MD. Reproduced from Kaufman RH: Common causes of vaginitis. Hosp Med 22:23-44, 1986.

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Figure 6. (click image to zoom) Pseudohyphae and blastoconidia (yeast cells) on wet mount (KOH preparation) are consistent with Candida albicans. Copyright 1992, SCP Communications, Inc.

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Figure 7. (click image to zoom) Both pseudohyphae and blastoconidia (yeast cells) stain purple on Gram's stain preparation of clinical material from patient with candidiasis. Copyright 1992, SCP Communications, Inc.

Patients often experience recurrent yeast infections. This complaint demands thorough attention. It is important to assess for underlying hygiene issues, such as frequent douching and constrictive synthetic undergarments that retain moisture in vaginal secretions. Also rule out other conditions that have been closely associated with candidal infections (eg, diabetes and immunocompromise). Finally, rule out other pathogens and mixed infections. Culture, to confirm and speciate yeast, may play a role in this setting.

Many factors can play a role in the occurrence of vaginal infections and discharge. What can you do to reduce your risk of vaginal infections? Practicing these simple tips significantly reduces your risk of getting a vaginal infection:

  1. Always wear white cotton panties. Cotton allows your genital area to breath, helping the vaginal are to stay dry. It's also a good idea to wear panties only during the day and not at night when you are sleeping.
  2. Don't use vaginal douches.
  3. Never use petroleum jelly or oils for vaginal lubrication. This can create a breeding ground for bacteria to grow.
  4. If you are being treated for a vaginal infection, use all the medication as directed even if you think you are better.
  5. Dont have sexual intercourse during treatment for a vaginal infection and until you have no more symptoms.
  6. Avoid vaginal contact with products that can irritate the vagina such as feminine hygiene products, perfumed or deodorant soaps, powders, lotions, and bubble baths.
  7. Always avoid prolonged wearing of tight-fitting clothing such as bathing suits, exercise wear, pantyhose, or slacks.
  8. Many times, vaginal infections cause intense itching dont scratch! Itching infected, inflamed areas will only make things worse.
  9. If your period starts while you are using vaginal creams or suppositories, continue your regular medication schedule during your period and dont use tampons use pads instead.
  10. If you are self-treating a vaginal infection and your symptoms are not improved after treatment, see your health care provider for a vaginal exam. Dont use any vaginal products or treatments for 48 hours before your appointment.
  11. Always use condoms during sexual intercourse unless you are in a long-term monogamous relationship.
  12. Always wipe from front to back after urination or having a bowel movement. Improper wiping easily spreads bacteria to the vagina and may lead to vaginal discharge and infection.

Of course good basic hygiene, plenty of sleep, and well-rounded nutrition with an appropriate fluid intake are always good idea for vaginal health, as well as for your overall health and well-being.

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