From the Research
A history of anorexia nervosa (AN) can be associated with conditions that cause vaginal discharge, primarily due to hormonal imbalances and compromised immune function. Anorexia nervosa often leads to low estrogen levels, which can affect vaginal health and increase susceptibility to infections like bacterial vaginosis and yeast infections, both of which produce vaginal discharge 1. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, with bacterial vaginosis being the most prevalent, accounting for 40% to 50% of cases when a cause is identified 2.
Some key points to consider in the diagnosis and management of vaginitis include:
- Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard 2
- Vulvovaginal candidiasis is diagnosed using a combination of clinical signs and symptoms with potassium hydroxide microscopy; DNA probe testing is also available 2
- Trichomoniasis may cause a foul-smelling, frothy discharge and, in most affected women, vaginal inflammatory changes, and is best detected by antigen testing using vaginal swabs collected and evaluated by immunoassay or nucleic acid amplification test 3
- Atrophic vaginitis results from estrogen deficiency and is treated with topical estrogen 4
Treatment typically involves addressing both the underlying eating disorder and any specific infections present, often requiring a multidisciplinary approach involving mental health professionals, nutritionists, and gynecologists. It's essential to note that these associations are indirect consequences of the physiological changes caused by anorexia rather than direct symptoms of the eating disorder itself. Given the potential complexity of these cases, a comprehensive approach to diagnosis and treatment is necessary, considering the latest evidence and guidelines, such as those provided by the American family physician 2 and the Journal of obstetrics and gynaecology Canada 3.