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. Irritations from chemicals in creams, sprays, or even clothing that are in contact with this area can also result in vaginitis. In some cases, vaginitis results from organisms that are passed between sexual partners, 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 healthcare 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:
- Candida or “yeast” vaginitis
- Bacterial vaginosis
- Trichomoniasis vaginitis
- Chlamydia or gonorrhea 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 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, sometimes swollen even before the onset of discharge. Women with yeast infection of the vulva may have “small cuts” on the vulva due to friable skin of the area, and may have burning with urination.
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 an abnormal smelling 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 unless the woman has a co-infection of BV and yeast. Some women with bacterial vaginosis 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 live 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.
Bacterial vaginosis is not a sexually transmitted infection, but it is seen more often in sexually active people. Risk factors for bacterial vaginosis include:
- New or multiple sexual partners
- 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 may 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(s) must be treated at the same time as the patient. They should abstain from sexual intercourse for seven days after all sex partners have been treated .
- 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 due to a friable/very soft cervix, 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 recommended by the CDC annually for sexually active females aged 24 and younger, and also at any age if you have multiple sexual partners, or are at risk. While chlamydia infections are treatable with antibiotic medications, the best treatment for chlamydia is prevention. Correct and consistent use of a condom will decrease your risk of contracting not only chlamydia, but other sexually transmitted infections as well. Gonorrhea, another STI, can also cause vaginitis symptoms. Sex partners should be tracked and treated appropriately to avoid re-infection.
- 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. Herpes genitalis vaginitis could also affect the mouth-pharynx if oral sex is performed.
- Human papillomavirus (HPV): 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 (does not offer 100 percent protection) of 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. One example is inflammatory vaginitis which is characterized by thick, mucoid, yellow to green copious vaginal discharge commonly seen in menopausal women.
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.
Symptoms and Causes
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 feeling outside of the vagina during urination
- Itching around the outside of the vagina
- Discomfort during intercourse
Management and Treatment
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 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 any abnormal discharge. We never recommend douching. Some providers ask that you abstain from sex for 24 hours before your appointment.
The important thing to understand is that 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 (or possibly making it feel worse).
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 healthcare 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 about STIs.
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. In general, the fewer chemicals and products the sensitive skin of the vagina and vulva are exposed to, the better. If the vaginitis is due to hormonal changes, a variety of hormonal options are available to help reduce symptoms (either used locally in the vagina or systemically).
What questions should I ask my doctor about treatment for vaginitis?
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 healthcare practitioner questions. Vaginitis of all types is very common. 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?
What are the risk factors for vaginal candida infections?
- Recent treatment with antibiotics
- Uncontrolled diabetes
- High-estrogen contraceptives
- Disorders affecting the immune system (such as HIV and organ transplantation)
- Thyroid or endocrine disorders
- Corticosteroid therapy
- Vaginal douching
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 may lead to yeast infections. Good hygiene is also important.
There is little scientific evidence that yogurt and probiotics containing lactobacillus will reduce vaginitis infections. Some also recommend limiting sugary foods to prevent the growth of yeast. Discuss with your doctor if this is something that he or she would recommend for you.
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 screening for cervical cancer at regular intervals discussed with your doctor. If you have multiple sexual partners, you should request screening for sexually transmitted diseases.