Low vitamin D levels and vaginitis?  You may think this an unlikely association, but in a recent article in the dermatology journal, Cutis, (volume 86) July 2010 by Peacocke and associates, this is exactly what the researchers found. 
 
This was a small study of four patients with Desquamative Inflammatory Vaginitis (DIV), and Crohns Disease who also had low vitamin D levels.  Surprisingly, these patients experienced significant improvement or resolution of their chronic recurrent symptoms when their vitamin D levels were restored to within high normal range. The authors postulate that high normal vitamin D levels are required to maintain healthy mucosal tissue especially in the context of inflammatory conditions such as DIV.
 
This is the second study to report an association between vitamin D and vaginitis.  The first study in 2009 reported increasing incidence and risk  of  BV correlating with lower vitamin D levels.
 
Based on this new research clinicians should consider testing vitamin D (25(OH) vitamin D levels in patients with chronic recurrent vaginitis and to treat low levels aggressively.  The recommended goal is to target the high normal range between 30 and 50 ng/ml or higher.  This new study found ranges of 50 ng/ml or higher are necessary for patients with challenging recurrent vulvaginitis.  
 
This may require weekly or biweekly oral supplementation with 50,000 iu of ergocalciferol (vit D3).  In the recently published study, several patients required doses as high as 150,000 iu weekly, however more typically vitamin D supplementation is given in doses of 50,000 iu weekly by prescription (when levels are below 20 ng/ml).  Once optimal normal levels are achieved (or symptoms are resolving/resolved) maintenance vitamin D supplementation may be given in daily doses ranging from 2000-4000 iu.  Vitamin D levels should to be rechecked no sooner than 3 months after initial testing.  Parathyroid hormone, serum calcium and phosphorus should also be checked initially and monitored during vitamin D treatment.
 




For more information on vaginitis visit www.mimisecor.com or www.cutis.com or to order Advanced Health Assessment of Women: Clinical Skills and Procedures by Carcio and Secor (containing several chapters related to vulvovaginitis) visit www.springerpub.com
 

Mimi Secor is a national speaker and consultant.  She has worked for 33 years as a Nurse Practitioner specializing in women's health and is currently working at Newton Wellesley ObGyn in Newton, Massachusetts. She is also a visiting scholar at Boston College Graduate School of Nursing and guest lecturer at the Massachusetts General Hospital Institute of Health Professions.  Not only has Mimi been published extensively, but she also has years of media experience including hosting a new radio show on ReachMD XM 160, Partners in Practice.  She has also been a guest on Good Morning America, and interviewed by the Wall Street Journal, Boston Globe and many others. Mimi is a member of the Editorial Advisory Board for the PA and NP online community Clinician 1 and has received several awards in patient care and education.  She is also the co-author of Advanced Health Assessment of Women: Clinical Skills and Procedures.
 

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