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Vaginitis

(Also Called 'Vaginal Infections', 'Vulvovaginitis')

What is vaginitis?

"Vaginitis" is a medical term used to describe various disorders that cause infection or inflammation of the vagina. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from an infection caused by organisms such as bacteria, yeast or viruses. In addition, irritations from chemicals in creams, sprays, or even clothing that are in contact with this area can result in vaginitis. In some cases, vaginitis results from organisms that are passed between sexual partners and from vaginal dryness and lack of estrogen.

What are the symptoms of vaginitis?

The symptoms of vaginitis can vary depending on what is causing the infection or inflammation. Some women have no symptoms at all. Some of the more common symptoms of vaginitis include:

  • Abnormal vaginal discharge with an unpleasant odor
  • Burning during urination
  • Itching around the outside of the vagina
  • Discomfort during intercourse

Is vaginal discharge normal?

A women's vagina normally produces a discharge that usually is described as clear or slightly cloudy, non-irritating and odor-free. During the normal menstrual cycle, the amount and consistency of discharge vary. At one time of the month there may be a small amount of a very thin or watery discharge. At another time, (usually the latter part of the menstrual cycle) a more extensive thicker discharge may appear. All of these descriptions could be considered normal.

A vaginal discharge that has an odor or that is irritating usually is considered an abnormal discharge. The irritation might be itching or burning, or both. The burning could feel like a bladder infection. The itching may be present at any time of the day, but it often is most bothersome at night. These symptoms often are made worse by sexual intercourse. It is important to see your health care professional if there has been a change in the amount, color or smell of the discharge.

What are the most common types of vaginitis?

The six most common types of vaginitis are:

  • Candida or "yeast" vaginitis
  • Bacterial vaginosis
  • Trichomoniasis vaginitis (a sexually transmitted infection)
  • Chlamydia vaginitis
  • Viral vaginitis
  • Non-infectious vaginitis
  • Atrophic vaginitis

Each of these vaginal infections can have different symptoms, or no symptoms at all. In fact, diagnosis can even be tricky for an experienced clinician. Sometimes more than one type of vaginitis can be present at the same time

To better understand these seven major causes of vaginitis, let's look briefly at each one of them and how they are treated.

What are candida or "yeast" infections?

Yeast infections of the vagina are what most women think of when they hear the term "vaginitis." Yeast infections are caused by one of the many species of fungus called candida. Candida normally live in small numbers in the vagina, as well as in the mouth and digestive tract of both men and women.

Yeast infections produce a thick, white vaginal discharge with the consistency of cottage cheese. Although the discharge can be somewhat watery, it is odorless. Yeast infections usually cause the vagina and the vulva to be very itchy and red, even before the onset of discharge.

If yeast is normal in a woman's vagina, what makes it cause an infection? Usually, infection occurs when a change in the delicate balance in a woman's system takes place. For example, a woman may take an antibiotic to treat a urinary tract infection, and the antibiotic kills "friendly" bacteria that normally keep the yeast in balance. As a result, the yeast overgrows and causes the infection. Other factors that can upset the delicate balance include pregnancy, which changes hormone levels, and diabetes, which allows too much sugar in the urine and vagina.

What are the risk factors for vaginal candida infections?

  • Recent treatment with antibiotics
  • Uncontrolled diabetes
  • Pregnancy
  • High-estrogen contraceptives
  • Disorders affecting the immune system (such as HIV and organ transplantation)
  • Thyroid or endocrine disorders
  • Corticosteroid therapy
  • Vaginal douching

What is bacterial vaginosis?

Although "yeast" is the name most women know, bacterial vaginosis (BV) actually is the most common vaginal infection in women of reproductive age. Bacterial vaginosis often will cause a vaginal discharge. The discharge usually is thin and milky, and is described as having a "fishy" odor. This odor may become more noticeable after intercourse.

Redness or itching of the vagina are not common symptoms of bacterial vaginosis. Some women with BV have no symptoms at all, and the vaginitis is only discovered during a routine gynecologic exam. Bacterial vaginosis is caused by a combination of several bacteria. These bacteria seem to overgrow in much the same way as do candida when the vaginal pH balance is upset.

Because bacterial vaginosis is caused by bacteria and not by yeast, medicine that is appropriate for yeast is not effective against the bacteria that cause bacterial vaginosis.

BV is treated in asymptomatic females of child bearing age to decrease their risk of preterm delivery.

Risk factors for BV include:

  • New or multiple sexual partners
  • Douching
  • Cigarette smoking

What are trichomoniasis, chlamydia and viral vaginitis?

Trichomoniasis — Trichomoniasis is caused by a tiny single-celled organism known as a "protozoa." When this organism infects the vagina, it can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms. It is important to understand that this type of vaginitis can be transmitted through sexual intercourse. For treatment to be effective, the sexual partner must be treated at the same time as the patient.

Chlamydia — Is the most common sexually transmitted infection (STI). Unfortunately, most women with chlamydia infection do not have symptoms, making diagnosis difficult. A vaginal discharge is sometimes present with this infection but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18 to 35 years) who have multiple sexual partners. Routine chlamydia screening is done annually for sexually active females age 15-26 years and older if you have multiple sexual partners.

While chlamydia infections are treatable with antibiotic medications, the best "treatment" for chlamydia is prevention. Use of a condom will decrease your risk of contracting not only chlamydia, but other sexually transmitted diseases as well. Gonorrhea, another STI can rarely cause vaginitis symptoms.

Viral vaginitis — Viruses are a common cause of vaginitis. One form caused by the herpes simplex virus (HSV) is often just called "herpes" infection. These infections also are spread by sexual contact. The primary symptom of herpes vaginitis is pain associated with lesions or "sores." These sores usually are visible on the vulva or the vagina but occasionally are inside the vagina and can only be seen during a gynecologic exam.

Another source of viral vaginal infection is the human papillomavirus (HPV). HPV, sometime referred to as genital warts, also can be transmitted by sexual intercourse. This virus can cause painful warts to grow in the vagina, rectum, vulva or groin. These warts usually are white to gray in color, but they may be pink or purple. However, visible warts are not always present, and the virus may only be detected when a Pap smear is abnormal. Outbreaks of HPV often are associated with stress or emotional distress.

Many of the infections that cause vaginitis can be spread between men and women during sexual intercourse. Use of a barrier contraceptive, such as a condom, can help reduce your risk (but does not offer 100% protection against) contracting these and more serious infections, such as the human immunodeficiency virus (HIV), which can lead to AIDS.

What is non-infectious vaginitis?

Occasionally, a woman can have itching, burning and even a vaginal discharge without having an infection. The most common cause is an allergic reaction or irritation from vaginal sprays, douches or spermicidal products. The skin around the vagina also can be sensitive to perfumed soaps, lotions, sexual lubricants detergents, and fabric softeners.

What is atrophic vaginitis?

Atrophic vaginitis, or vulvovaginal atrophy, is another non-infectious form of vaginitis that results from a decrease in hormones. The vagina becomes dry or "atrophic." This occurs primarily during perimenopause and postmenopause, either natural or surgical (removal of ovaries). Post lactation and postpartum states can also contribute to atrophy. Medications such as aromatase inhibitors (used in breast cancer) or depo lupron (used in endometriosis) can drastically lower estrogen levels and cause atrophy. The woman may notice pain (especially with sexual intercourse), vaginal itching and burning, or symptoms of urinary urgency and frequency.

How is vaginitis treated?

The key to proper treatment of vaginitis is proper diagnosis. This is not always easy since the same symptoms can exist in different forms of vaginitis. You can greatly assist your health care provider by paying close attention to exactly which symptoms you have and when they occur, along with a description of the color, consistency, amount and smell of any abnormal discharge. We never recommend douching. Some providers ask that you abstain from sex for 24 hours before your appointment.

Because different types of vaginitis have different causes, the treatment needs to be specific to the type of vaginitis present. When a woman has had a yeast infection diagnosed by her doctor, she usually is treated with a prescription for a vaginal cream, suppositories or oral medication. If the infection clears up for some period of time but then the exact same symptoms occur again, a woman can obtain, with her doctor or pharmacist's consent, a vaginal cream or suppository without a prescription that can completely treat the infection.

The important thing to understand is that this medication may only cure the most common types of candida associated with vaginal yeast infections and will not cure other yeast infections or any other type of vaginitis. If you are not absolutely sure, see your doctor. You may save the expense of buying the wrong medication and avoid delay in treating your type of vaginitis.

When buying an over-the-counter medicine, be sure to read all of the instructions completely before using the product. Be sure to use all of the medicine and don't stop just because your symptoms have gone away.

Be sure to see your health care practitioner if:

  • All of the symptoms do not go away completely.
  • The symptoms return immediately or shortly after you finish treatment.
  • You have any other serious medical problems such as diabetes.
  • You might be pregnant.
  • You have a new sexual partner and are concerned for STI’s.

It is important to follow your doctor's instructions, as well as the instructions that come with the medication. Do not stop taking the medicine when your symptoms go away. Do not be embarrassed to ask your doctor or health care practitioner questions. Good questions to ask include:

  • Should I abstain from sexual intercourse during treatment?
  • Should my sexual partner(s) be treated at the same time?
  • Will the medication for this vaginitis interact with my other medication(s)?
  • Should I continue the vaginal cream or suppositories during my period?
  • Do I need to be re-examined and if so, when?

"Non-infectious" vaginitis is treated by changing the probable cause. If you recently changed your soap or laundry detergent or have added a fabric softener, you might consider stopping the new product to see if the symptoms remain. The same instruction would apply to a new vaginal spray, douche, sanitary napkin or tampon. If the vaginitis is due to hormonal changes, estrogen (either used locally in the vagina or systemically) may be prescribed to help reduce symptoms.

How can I prevent vaginitis?

There are certain things that you can do to decrease the chance of getting vaginitis. If you suffer from yeast infections, it usually is helpful to avoid garments that hold in heat and moisture. The wearing of nylon panties, pantyhose without a cotton panel and tight spandex or jeans can lead to yeast infections. Good hygiene also is important.

There is little scientific evidence that yogurt and probiotics containing lactobacillus will reduce vaginitis infections.

Because they can cause vaginal irritation, most doctors do not recommend vaginal sprays or heavily perfumed soaps for cleansing this area. Likewise, repeated douching may cause irritation or, more importantly, may hide a vaginal infection.

Safe sexual practices can help prevent the passing of diseases between partners. The use of condoms is particularly important.

If you are approaching menopause, have had your ovaries removed or have low levels of estrogen for any reason, discuss with your doctor the use of hormone pills or creams to keep the vagina lubricated and healthy.

Good health habits are important. Have a complete gynecologic exam, including a Pap smear and or HPV testing at intervals discussed with your doctor. If you have multiple sexual partners, you should request screening for sexually transmitted diseases

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/25/12...#9131


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