Vaginitis

What is vaginitis?

“Vaginitis” is a general term to describe conditions that cause inflammation or irritation to your vagina. Depending on the cause, you could have symptoms like itchiness, a burning feeling when you pee or foul-smelling vaginal discharge.

You can get vaginitis from bacteria, fungi, parasites or other organisms, or chemicals in creams or personal hygiene products. In some cases, vaginitis occurs due to sexually transmitted infections (STIs) or vaginal dryness from low estrogen levels. Having vaginitis is very common and affects almost everyone with a vagina at least once in their lifetime.

Your vaginal health probably doesn’t cross your mind until something feels different. Then, your vagina is the only thing you can think about. Itching, burning, pain, swelling and irregular discharge are all signs that something may be going on. While getting regular check-ups are important to your vaginal health, it’s also important to contact a healthcare provider when something doesn’t feel right to you.

There are many possible causes of vaginitis, and each cause has its own symptoms and treatment.

What are the most common types of vaginitis?

The most common types of vaginitis are:

• Bacterial vaginosis.
• Yeast infections.
• Trichomoniasis.
• Non-infectious vaginitis.
• Genitourinary syndrome of menopause (atrophic vaginitis).

Bacterial vaginosis (BV)

Bacterial vaginosis (BV) is the most common type of vaginitis. BV occurs when bacteria that normally live in your vagina overgrow for some reason, causing a bacterial imbalance. The most common sign is discharge with a fishy smell.

Yeast infection

Yeast infections are the second most common cause of vaginitis. An overgrowth of a fungus called candida causes it. Candida normally lives in your vagina without issue, but with a yeast infection, candida is off balance with other “good” bacteria. It can cause burning, itching and changes to your vaginal discharge.

Trichomoniasis

Trichomoniasis (trich) is an STI caused by a tiny single-celled parasite called Trichomonas vaginalis. When this organism infects your vagina, it can cause unpleasant symptoms like vaginal itching and a smelly discharge. This type of vaginitis is typically spread through sexual intercourse.

Non-infectious vaginitis

This type of vaginitis occurs when you have an allergic reaction or develop irritation from vaginal sprays, scented soap, douches or spermicide products. The skin around your vagina can also be sensitive to feminine products and wipes, sexual lubricants, detergents and fabric softeners.

Atrophic vaginitis

Atrophic vaginitis (genitourinary syndrome of menopause) is a form of vaginitis that occurs due to a decrease in estrogen levels. It causes your vagina to become thin and dry. This occurs primarily during perimenopause and postmenopause, which happens naturally or surgically (removal of your ovaries).

You can also experience similar symptoms if you’re breastfeeding (chestfeeding) or have recently given birth (postpartum) due to changing hormone levels.

What are the symptoms of vaginitis?

Vaginitis has different symptoms depending on what kind you have. Some may not cause symptoms at all. It’s also possible to have multiple types of vaginitis at the same time.

But certain signs and symptoms can occur in several different kinds of vaginitis. These include:

• Changes in the color, texture or smell of your vaginal discharge.
• Vaginal itching, burning or irritation. Your vulva may even appear or feel swollen.
• Pain when you pee (dysuria).
• Pain during sex or when inserting tampons.
• Light bleeding or spotting when you’re not on your period.

Your vaginal discharge provides several clues that may explain what type of vaginitis you have. Pay attention to what you see in your underwear or what you see when you wipe. Discharge that has a strong odor or is clumpy or foamy are signs of infection. Your discharge should be clear, white or off-white. Discharge that appears green or yellow may also point to an infection.

Does vaginitis affect my vaginal discharge?

Yes, it usually changes the smell, color and texture of your discharge. Your vagina normally produces a discharge that’s usually clear or slightly cloudy with very little or no odor.

It’s important to see a healthcare provider if you’ve noticed a change in the amount, color or smell of a discharge that persists beyond a few days.

How do you get vaginitis?

Vaginitis has multiple causes, depending on what kind of vaginitis you have. Some of the causes are:

• Changes in the microorganisms in your vagina. Two of the most common types of vaginitis — yeast infections and bacterial vaginosis — occur when bacteria naturally occurring in your vagina become unbalanced in some way. Taking antibiotics can also disrupt the normal bacteria in your vagina, leading to a yeast infection.
• Sexually transmitted infections. Parasites, bacteria and viruses that cause infection can pass from person to person through sexual contact. Depending on the STI, infection can spread through vaginal intercourse, anal sex or oral sex, and lead to vaginitis.
• Products with chemical irritants. Certain personal hygiene items like lotions, detergents, sprays and other products may contain chemicals that cause vaginitis. Spermicides can also cause an allergic reaction and lead to symptoms of vaginitis.
• Changing hormone levels. Drops in the amount of estrogen your body makes can cause changes to your vagina that lead to vaginitis. Some examples of times when your body goes through hormonal changes are pregnancy, lactation and menopause.

Is vaginitis contagious?

Yes, it’s possible to spread certain types of vaginitis to your sexual partners. Even types that aren’t considered STIs — like yeast infections — can spread from your vagina to other vaginas or penises.

Is vaginitis an STD?

Healthcare providers don’t classify vaginitis as a sexually transmitted infection, but some STIs (like trichomoniasis and genital herpes) do cause vaginitis.

What are the risk factors for vaginitis?

The following factors may increase your risk for vaginitis:

• Recent treatment with antibiotics or prolonged corticosteroids.
• Hormonal changes.
• Having unprotected sex with multiple partners.
• Having an STI.
• Wearing damp, sweaty and tight-fitting clothing.
• Douching.
• Use of scented vaginal sprays or spermicides.
• Unmanaged diabetes or health conditions and medications that weaken your immune system.

What are complications of vaginitis?

If you have vaginitis, you may be more likely to get STIs. This is because inflamed or irritated vaginal lining is more prone to infection.

How is vaginitis diagnosed?

A healthcare provider will take a thorough medical history, complete a physical exam and perform a pelvic exam. Be sure to let them know about any history of STIs.

During the pelvic exam, your provider may swab the inside of your vagina to collect a sample of discharge. They’ll send the sample off to a lab where it will be checked for infection. Your healthcare provider may also check the pH levels (how acidic something is) of your vaginal fluid to get them closer to a diagnosis.

Some providers may ask that you avoid sex or placing anything inside your vagina for at least 24 hours before your appointment.

How is vaginitis treated?

Getting a proper diagnosis is key to successful treatment. This isn’t always easy, as the same symptoms can exist in different forms of vaginitis. You can assist your healthcare 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 your vaginal discharge.

Your healthcare provider will recommend treatment for the specific cause of vaginitis:

• Bacterial vaginosis (BV). Your provider will prescribe antibiotics, typically metronidazole or clindamycin. These medications come in a gel or cream you insert into your vagina. Some antibiotics are pills you can take orally (by swallowing them).
• Yeast infections. Over-the-counter (OTC) antifungal creams or suppositories can treat most yeast infections, but you should be sure you have a yeast infection before starting medication. You must follow the instructions on the label. Using the wrong medication could make your symptoms worse. Your provider can also prescribe an oral medication such as Diflucan®.
• Trichomoniasis. Your provider will prescribe oral antibiotics to kill the parasite causing the infection. Common medications are metronidazole or tinidazole. Sex partners in the past three months (or most recent sex partners) should receive treatment, too.
• Non-infectious vaginitis. You must identify the cause of the irritation and then take steps to stop using it. For example, if you recently changed your soap or laundry detergent, or have added a fabric softener, you should stop using the new product to see if the symptoms remain.
• Genitourinary syndrome of menopause (atrophic vaginitis). When a lack of estrogen is the cause of your symptoms, taking prescription estrogen can improve your symptoms. Estrogen can come in various forms like creams, tablets or rings you insert into your vagina.

You should avoid having sex during treatment for vaginitis until your symptoms go away and/or until your medication is complete.

Can vaginitis go away on its own?

It isn’t a good idea to wait for vaginitis to disappear unless you know what’s causing it. For instance, some mild yeast infections go away on their own, but not all cases do. Bacterial vaginosis can clear up on its own, but left untreated, it can put you more at risk for STIs. It can also cause complications if you’re pregnant.

How can I prevent vaginitis?

There are certain things you can do to decrease your chance of getting vaginitis. Practicing good hygiene and safe sex are key. Other things you can do include:

• Avoid wearing clothes that hold in heat and moisture. Wearing nylon underwear, pantyhose without a cotton panel or tight spandex, yoga pants or jeans may lead to yeast infections. Choose loose, “breathable” fabrics that don’t hold in moisture, like cotton.
• Avoid staying in a wet bathing suit or sweaty workout clothes for too long. A warm, moist environment is ideal for yeast and bacteria to grow.
• Avoid cleaning your vagina with heavily perfumed soaps or sprays. Vaginal sprays or heavily perfumed soaps can irritate your vagina and worsen your vaginal infection.
• Don’t douche. Douching can disrupt the healthy balance of bacteria in your vagina and lead to a vaginal infection. Douching can also hide an infection you already have.
• Wipe from front to back. Be careful to not spread poop from your anus into your vagina. Similarly, be sure to wash sex toys or other objects (including fingers) before placing them in your vagina.
• Ask your healthcare provider about the benefits of taking hormones. If you’re approaching menopause or have low levels of estrogen for any reason, talk to a healthcare provider about the potential benefits of using vaginal hormone pills or creams to keep your vagina lubricated and healthy.
• Get regular screenings. Good health habits are important. Have a complete gynecologic exam, including screening for cervical cancer, at regular intervals as recommended by your provider. If you have multiple sexual partners, you should request screening for STIs.

What can I expect if I have vaginitis?

Vaginitis is uncomfortable, but finding the cause and the right treatment can bring relief. If chemical irritants are causing vaginitis, you can improve your symptoms by avoiding the offending lotion, detergent or spray. Bacterial and antifungal medications may take up to two weeks to clear your infection. Getting the right diagnosis and treating all causes of your vaginitis is key when it comes to relieving your symptoms.

When should I contact my healthcare provider?

Contact your provider if you have any of the following symptoms:

• Foul-smelling vaginal discharge or discharge that’s a different color or consistency than usual.
• Vaginal itching, irritation or pain.
• Pain when you pee or during sex.

It’s especially important to contact a provider if you have these symptoms and recently had new or multiple sexual partners. You could have an STI, which requires prompt treatment.

You should also see a provider if you’ve completed treatment for a yeast infection but still have symptoms. Sometimes, a stronger medication is necessary.

What questions should I ask my healthcare provider?

Good questions to ask include:

• Should I not have sex during treatment?
• Should my sexual partner(s) be treated at the same time?
• How will the medication for this vaginitis interact with my other medications?
• Should I continue the vaginal cream or suppositories during my period?
• Do I need to be re-examined and if so, when?