Pregnancy is a beautiful phase where the mother awaits her baby knowing that the pain which she has to tolerate is enormous. There are a lot of anatomical, physiological, and immunological changes that take place inside a woman when she gets pregnant, which leads to discomforts ranging from mild to severe. While everyone discusses the common ailments like Hyperemesis gravidarum and anemia in pregnancy there are also other conditions which the pregnant lady might be concerned more about. These ailments which are related to skin may not appear alarming, but often affects the confidence and the mental status of the women. There are certain diseases that affect the vulva and vagina about which pregnant women find shy to express.
During the time of pregnancy, there is an increased cervical secretions and vaginal transudate. This is because of the hyper estrogenic state and increased vascularity. The discharge is usually mucoid, thick and is non-irritating. But owing to the fact that it affects their quality of life, we need to look into it more seriously. Most of the time, this can be a condition called Vaginitis. Vaginitis otherwise known as ‘Inflammation of vagina’ can occur because of two organisms: Trichomonas vaginalis and Monilia Vaginalis. While the first one is pear-shaped unicellular flagellate anaerobic protozoa, the latter is a gram-positive yeast-like fungus.
Vaginal trichomoniasis is the most common and the important cause of vaginitis in the childbearing period. It is mainly transmitted through sexual contact when the male carries the infection or through examination gloves. Usually, these parasites lie in between the rugae asymptomatically. When the defense mechanism is impaired due to any reasons, they become active and produce inflammatory reactions. The symptoms include sudden profuse and offensive vaginal discharge, irritation and itching along with urinary symptoms like dysuria and frequency of micturition occasionally. On examination, we usually find grey, greenish yellow, frothy discharge with scratch marks on vulva due to severe pruritis. Speculum examination is often painful, which reveals an inflamed red vaginal wall with multiple punctate hemorrhagic spots. Sometimes ‘strawberry’ appearance can also be seen in the upper portion of vagina and cervix if the condition is severe.
Monilia vaginalis is characterized by the vaginal discharge and vulvovaginal pruritis, with pruritis being out of proportion to the discharge. Dyspareunia can also come as an associated complaint. The risk factors of this disease include pregnancy because of the increased vaginal acidity, glycosuria and glycogen in the cells lactobacillus. Sometimes being a diabetic person, obesity and usage of broad-spectrum antibiotics also can trigger this infection. On examination, we can find thick, curdy white discharge. Vulva may be red and swollen with evidence of pruritis. Cottage cheese type flakes are often seen adherent to the vaginal wall. Removal of these flakes reveal multiple oozing spots.
These conditions share similar features with that of Upapluta yonivyapat. While Acharya Vagbhata does not use the word garbhini, Acharya Charaka clearly mentions that this disease is highly prone to garbhini. When a pregnant woman consumes sleshmala aahara or suppresses natural urges like chardi or swasa, then her vitiated vayu with holding kapha reaches the yoni pradesha and produces sraava. Here there is an increase in the chala and seeta guna of vayu along with an increase in the picchilata and snigdhata of kapha guna. Rasavaha, Raktavaha, Artavavaha srotas is affected which also increases a kledata in the body. All these contribute to the atipravrithi from the yonipradesha.
Since disease is considered as a vitiation of kapha in vata sthana, we need to administer the teekshna guna and ushna veerya dravya to tackle the same. But taking into consideration that the subject here is garbhini, we need to plan treatment in the line of sukumara. Aragwadhadi kashaya or Kataka Khadiradi is a good choice for internal administration. If it is associated with urinary symptoms, Chandraprabha vati can also be added. If the pregnant woman is having gestational diabetes, the Shiva gutika is considered as the drug of choice. The patients usually find relief when the treatment plan includes yonikshalana with Aragwadhadi kashaya or Triphalakashaya. Above all, improving the general condition of the patient is important. Eating a healthy balanced diet, by restricting the intake of oily, fried and junk foods is expected from the patient throughout the pregnancy period.
There are different studies which show reinfection and drug resistances while treating the vaginitis. These challenges can easily be managed through Ayurveda. Since the pregnant lady is delicate in nature, Ayurveda samana chikitsa can be done effectively in all such vaginitis conditions, taking into consideration the health of both mother and baby. In cases where quality of life is affected, pranayama and yogasana are also beneficial since stress is also found as a culprit in increasing the pruritis of vaginitis. Proper counseling of pregnant ladies must be carried to manage the situation in order to give her assurance and support. Being pregnant with proper physical and mental health should be given more importance in this present era.
As famous author Hariette Hartigan said:
“Giving birth and being born brings us into the essence of creation, where the human spirit is courageous and bold and the body, a miracle of wisdom.”