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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.

Is vaginal discharge normal?

A woman’s vagina normally produces a discharge that usually is described as clear or slightly cloudy, non-irritating and with very little odor. During the normal menstrual cycle, the amount and consistency of discharge changes. 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 that persists beyond a few days.

What are the most common types of vaginitis?

The most common types of vaginitis are:

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 the vagina, as well as in the mouth and digestive tract of both men and women. An infection occurs when the normally occurring candida increase in number to cause bothersome symptoms.

Yeast infections produce a thick, white vaginal discharge with the consistency of cottage cheese. Although the discharge can be somewhat watery, it is generally 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 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 that typically lives in the vagina. 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. If fact, treating for the wrong condition can make symptoms worse.

BV is not a sexually transmitted infection. 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: 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 aged 24 and younger, and also at any age 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 also 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 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. Outbreaks of HSV often are associated with stress or emotional distress.

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 test is abnormal. 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?

Not uncommonly, 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. However, the skin around the vagina also can be sensitive to perfumed soaps, lotions, sexual lubricants, detergents, and fabric softeners. In addition, the long-term use of over-the-counter topical products to help block odor and itch can cause vaginitis.

What is atrophic vaginitis?

Atrophic vaginitis, also referred to as genitourinary symptoms of menopause and 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). Breastfeeding and postpartum states can also contribute to atrophy. Medications such as aromatase inhibitors (used in breast cancer) or Lupron Depot® (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. Vaginal and oral treatments are available to successfully treat this condition.

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: