Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Vaginitis


Related Terms

  • Vaginal Inflammation
  • Vulvovaginitis

Differential Diagnosis

Specialists

  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

The underlying cause of the vaginitis may influence the length of disability. Pregnancy, uncontrolled diabetes, and the use of oral contraceptives or antibiotics are associated with recurring or chronic yeast infections.

Medical Codes

ICD-9-CM:
616.10 - Inflammatory Disease of Cervix, Vagina, and Vulva, Vaginitis and Vulvovaginitis, Nonspecific
616.11 - Inflammatory Disease of Cervix, Vagina, and Vulva, Vaginitis and vulvovaginitis in Diseases Classified Elsewhere
627.3 - Vaginitis, Postmenopausal Atrophic

Overview

Vaginitis is an inflammation of the lining (mucosa) of the vagina caused by infectious organisms or irritants. It is characterized by redness, swelling, itching, and irritation of the vaginal tissues. Almost every woman will experience at least one episode of vaginitis during her lifetime, and most will experience several. Vaginitis is the most common reason an adult female seeks medical attention. The three most common causes of vaginitis are yeast infections (candidiasis or moniliasis), bacterial infections (bacterial vaginosis, Gardnerella vaginitis, and nonspecific vaginitis), and parasites (trichomoniasis).

Yeast is normally found in the vagina. When the normal vaginal environment changes, yeast organisms can flourish. This overgrowth is commonly called a yeast infection (candidiasis or moniliasis). Symptoms of a yeast infection include intense itching, burning, redness, and an odorless, white, "cheesy" discharge. Sexually transmitted diseases may increase the likelihood of having a yeast infection, as may diabetes.

Bacterial vaginosis, previously called nonspecific vaginitis, is caused by an overgrowth of Gardnerella vaginalis. Symptoms may include a strong, unpleasant, fishy odor and an abnormal white or gray milky discharge. This kind of infection is associated with sexually transmitted diseases such as chlamydia and gonorrhea, but is seen in both sexually active and inactive women.

Trichomoniasis ("trich") may also cause vaginitis. This sexually transmitted disease is caused by trichomonas, a single-celled parasite, and is characterized by an irritating, frothy, yellow-green discharge with an unpleasant odor.

Women visiting undeveloped parts of the world occasionally acquire amoebic vaginal infections. Symptoms include a foul-smelling, often bloody discharge that may be accompanied by sores on the vagina.

As the estrogen level is reduced during and after menopause, a woman's vaginal lining becomes thin and dry. This puts her at a higher risk for a vaginal inflammation known as atrophic vaginitis.

Vaginitis can also be caused by an allergic reaction to spermicidal cream, the chemicals used in vaginal douches (also in soaps, bath oils, or salts), and laundry detergents or fabric softeners. A woman can also experience allergic vaginitis if her partner uses latex condoms. Other, less common causes of vaginitis include cuts or abrasions in the vagina or a foreign body such as a forgotten tampon.

Incidence and Prevalence: Among US women, vaginitis accounts for more than 10 million doctor visits each year (Hendrix 1374).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The low estrogen levels accompanying menopause are associated with increased incidence of yeast infection. Other risk factors include wearing tight, nonbreathing clothing or underwear, excessive douching, pregnancy, the use of antibiotics or birth control pills, and the use of perfumed feminine hygiene sprays.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms of a yeast infection may include thick, white, "cheesy" discharge, vaginal itching, painful urination, swelling and redness in the vaginal area, and painful intercourse. With bacterial vaginosis, nearly half of women have no symptoms. If present, symptoms may include an abnormal white or gray milky discharge with a strong, unpleasant, fishy odor. Itching or vaginal irritation may or may not be present. Trichomoniasis symptoms in women usually occur within 4 to 20 days after exposure and include excessive yellow or green frothy vaginal discharge with a strong, unpleasant odor, itching in the vagina and external genital (vulva) area, painful urination or intercourse, and, on occasion, lower abdominal pain. Although men with trichomoniasis usually experience no symptoms, they can still infect their sexual partners.

Symptoms of allergic vaginitis include itching, burning, and discharge. The individual's history includes use of spermicides, douches, bath oils, deodorants, scented tampons or pads, or new detergents. In atrophic or hormone deficiency vaginitis, women may report vaginal dryness, discomfort during intercourse, and other menopausal symptoms.

Physical exam: A pelvic exam is performed to collect vaginal secretions for testing; to detect possible involvement of the cervix, ovaries, or uterus; and to identify any coexisting diseases. If a hormone deficiency exists, the vagina may have a characteristic appearance with loss of folds (rugae).

Tests: A microscopic examination (wet smear) of vaginal secretions is necessary for a correct diagnosis. It may show yeast cells, vaginal cells coated with bacteria ("clue" cells), or the Trichomonas parasite. If the microscopic examination is negative, cultures may be done to identify infectious agents.

The acidity of vaginal secretions may also be tested. Compared with the normal acidic pH found in the vagina, women with bacterial vaginosis have an alkaline pH. After adding a chemical (potassium hydroxide), vaginal secretions may have a distinctive foul odor (the sniff test).

Because a vaginal discharge can also be associated with cervical or uterine cancer, a Papanicolaou (Pap) smear should be done to rule out cancer. Although a blood test can demonstrate a reduction in estrogen level, a Pap smear with maturation index shows more comprehensive changes in cells, indicating a pattern of estrogen reduction.

Source: Medical Disability Advisor



Treatment

Yeast vaginitis is usually treated with either antifungal vaginal creams or a single dose of an oral antifungal medication. Oral antifungal agents are commonly used to treat chronic or recurring episodes. Bacterial vaginosis and trichomoniasis require specific antibiotic treatment available by prescription. When vaginitis is caused by a sexually transmitted disease, both sex partners should be treated at the same time to prevent reinfection. Over-the-counter products only mask the symptoms of vaginitis without treating the underlying problem and should not be used.

Irritating agents should be avoided in cases of allergic reactions. Appropriate medication may be needed to treat a secondary infection following the removal of a foreign body. Atrophic or hormone deficiency vaginitis can be resolved with estrogen replacement therapy or vaginal estrogen cream.

Source: Medical Disability Advisor



Prognosis

With proper diagnosis and appropriate specific treatment, full recovery is expected in cases of yeast infections, bacterial vaginosis, and trichomoniasis. Avoidance of irritating agents should resolve any allergic reaction. Hormone replacement therapy is usually effective in reducing the inflammation related to decreased estrogen.

Source: Medical Disability Advisor



Complications

Pelvic inflammatory disease can result in infertility and tubal (ectopic) pregnancy. Women with bacterial vaginosis or trichomoniasis may be more likely to give birth to premature and low-birth-weight infants.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Genital itching and discomfort may make sitting for long periods of time uncomfortable. Allowances should be made for adequate break time in order to move around. Some physicians recommend that individuals avoid wearing pantyhose until the yeast infection resolves.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is individual pregnant? Taking antibiotics? Diabetic? Taking birth control pills?
  • Does individual have a sexually transmitted disease? Is she postmenopausal?
  • Does individual typically wear tight, non-breathing clothing? Does she douche excessively? Does she use perfumed feminine hygiene sprays?
  • Does individual report intense itching, burning, redness, and an odorless, white, "cheesy" discharge?
  • Does individual report a strong, unpleasant, fishy odor and an abnormal white or gray milky discharge?
  • Does individual report burning, itching, vulvar irritation, painful intercourse, and a clumpy, white discharge?
  • Has individual visited undeveloped parts of the world?
  • Does individual have an allergic reaction to spermicidal cream or the chemicals used in vaginal douches, soaps, bath oils, salts, laundry detergents, or fabric softeners? Does her partner use latex condoms? Does she have cuts or abrasions in the vagina? Is a forgotten tampon present?
  • Did individual have a pelvic exam? Was a microscopic examination (wet smear) of vaginal secretions done? Was a culture done? Was the pH tested? Was a Pap smear done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Does individual have yeast vaginitis? Is it being treated with antifungal agents?
  • Does individual have bacterial vaginitis? Is it being treated with antibiotics?
  • Has individual's sexual partner been treated, if necessary?
  • Does individual have atrophic vaginitis? Is it being treated with estrogen replacement therapy or vaginal estrogen cream?
  • Does individual avoid irritating agents?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect her ability to recover?
  • Does individual have any complications such as pelvic inflammatory disease or increased risk of premature and low birth weight infants?

Source: Medical Disability Advisor



References

Cited

Hendrix, Susan. "Vaginal Infections." The Merck Manual of Medical Information. Ed. Mark H. Beers. 2nd Home ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2003. 1374-1377.

Source: Medical Disability Advisor






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