Vaginitis

Overview

What is vaginitis?

Vaginitis is a medical term that describes various disorders that cause your vagina to become infected or inflamed. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from an infection caused by organisms like bacteria, yeast or viruses. Irritations from chemicals in creams, sprays or even clothing that come 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.

What are the most common types of vaginitis?

The most common types of vaginitis are:

What are candida or “yeast” infections?

Most people think of yeast infections when they hear the term vaginitis. Yeast infections are the second most common cause of vaginitis and are caused by one of the many species of fungus called candida. Candida normally live in your vagina, as well as in the mouth and digestive tract of all people, regardless of gender. An infection occurs when the normally occurring candida increases and cause bothersome symptoms.

If yeast is normal in your vagina, what makes it cause an infection? Usually, infection occurs when a change in the delicate balance in your system takes place. For example, you 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 your urine and vagina. Another category of medications that may allow overgrowth of candida is immunosuppressives or biologics.

What is bacterial vaginosis?

Although “yeast” is the name most people know, bacterial vaginosis (BV) is actually the most common vaginal infection in women of reproductive age (who haven’t gone through menopause yet). Bacterial vaginosis is caused by a combination of several bacteria that typically live in your vagina. These bacteria seem to overgrow in much the same way candida does 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. In fact, getting treated for the wrong condition can make symptoms worse.

Bacterial vaginosis is not a sexually transmitted infection (STI), but it’s seen more often in sexually active people. Risk factors for bacterial vaginosis include:

  • New or multiple sexual partners.
  • Douching.
  • Cigarette smoking.

What are trichomoniasis, chlamydia and viral vaginitis?

Your vagina can become irritated because of infections caused by sexually transmitted parasites, bacteria or viruses. The most common STIs that cause vaginitis are trichomoniasis, chlamydia and viral vaginitis.

What is trichomoniasis?

Trichomoniasis is caused by a tiny single-celled organism known as a protozoa. When this organism infects your vagina, it can cause unpleasant symptoms like vaginal itching and a smelly discharge. This type of vaginitis is transmitted through sexual intercourse, but it can be spread through vulva-to-vulva contact, too. For treatment to be effective, your sexual partner(s) must be treated at the same time you’re treated. All partners should abstain from sex for seven days after all sex partners have been treated. All sex toys should be properly disinfected based on the manufacturer’s direction.

What is chlamydia?

Chlamydia is the most common sexually transmitted infection (STI). Chlamydial vaginitis is most common in young adults aged 15 to 24 who have multiple sexual partners. Routine chlamydia screening is recommended by the Centers for Disease Control and Prevention (CDC) annually for sexually active women 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 condoms and dental dams will decrease your risk of contracting not only chlamydia, but other sexually transmitted infections as well. Gonorrhea, another bacterial STI, can also cause vaginitis symptoms. It often occurs with chlamydia. Sex partners should be tracked and treated appropriately to avoid re-infection.

What is viral vaginitis?

Sexually transmitted viruses are a common cause of vaginitis that lead to inflammation of your genitals. The most common type of viral vaginitis is herpes simplex virus (HSV).

  • Herpes simplex virus (HSV). Herpes simplex virus is often just called a herpes infection. These infections are spread by sexual contact and often lead to painful sores. Herpes outbreaks are often associated with stress or emotional distress. You can also get herpes that affects your mouth-pharynx through oral sex.
  • Low risk human papillomavirus (HPV) can lead to the development of condyloma, referred to as genital warts, and can be transmitted through vaginal, anal or oral sex. This virus can cause painful warts to grow in your vagina, rectum, vulva or groin. Although it doesn’t offer 100% protection, using a barrier contraceptive, like a condom or dental dam, can help reduce your risk of contracting these and more serious infections, such as the human immunodeficiency virus (HIV), which can lead to AIDS.

What is non-infectious vaginitis?

You can have an allergic reaction that causes vaginal irritation 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 your vagina can also be sensitive to perfumed soaps, feminine products and wipes, lotions, sexual lubricants, detergents and fabric softeners. In addition, the long-term use of over-the-counter (OTC) topical products to help block odor and itch can cause vaginitis.

What is atrophic vaginitis?

Atrophic vaginitis, also referred to as genitourinary syndrome of menopause and vulvovaginal atrophy, is a non-infectious form of vaginitis that results from a decrease in your hormones. If you have it, your vagina becomes dry or atrophic. This occurs primarily during perimenopause and postmenopause — which occurs either naturally or surgically (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.

Symptoms and Causes

What are the symptoms of 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.

Candida or “yeast” infections

Symptoms include:

  • A thick, white vaginal discharge with the consistency of cottage cheese.
  • A discharge that is somewhat watery and generally odorless.
  • A vagina or vulva thats itchy, red and sometimes swollen even before the onset of discharge.
  • “Small cuts” on your vulva due to “friable” (very soft) skin of the area.
  • A burning sensation when you pee (dysuria).

Bacterial vaginosis

You may not notice any symptoms at all. You may find out that you have vaginitis after your provider discovers it during a routine gynecologic exam. Or, you may notice:

  • An abnormal smelling vaginal discharge that’s worse after sex or menstruation.
  • A discharge that’s thin and milky and can be described as having a “fishy” odor. This odor may become more noticeable after intercourse.

A red or itchy vagina isn’t common with bacterial vaginosis unless you have a co-infection of BV and yeast.

Trichomoniasis

Symptoms include:

  • A frothy, greenish-yellow discharge that often has a foul smell.
  • Itching and soreness of your vagina and vulva, as well as burning when you pee.
  • Discomfort in your lower abdomen and vaginal pain with intercourse. These symptoms may feel worse after your menstrual period.

Chlamydia

Unfortunately, many people with chlamydia infection don’t notice symptoms, making diagnosis difficult. A vaginal discharge is sometimes present with this infection, but not always. More often, you may experience:

  • Light bleeding, especially after intercourse due to a “friable” or very soft cervix.
  • Pain in your lower abdomen and pelvis.

Herpes vaginitis (HSV)

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 are occasionally inside the vagina and can only be seen during a gynecologic exam.

Human papillomavirus (HPV)

Symptoms include warts on your genitals that are usually white to gray in color but that 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.

Non-infectious vaginitis

Symptoms include:

  • Itching, burning and irritation in your vulva and vagina.
  • Vaginal discharge that is thick, mucus-like, yellow or green.

Atrophic vaginitis

Symptoms include:

  • Pain, especially with sexual intercourse.
  • Vaginal itching and burning.
  • Symptoms of urinary urgency and frequency.

Is vaginal discharge normal?

Your vagina normally produces a discharge that’s usually clear or slightly cloudy, non-irritating and with very little odor. During your 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 is usually considered an abnormal discharge. The irritation might feel itchy 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 is often most bothersome at night. These symptoms often are made worse by sexual intercourse. It’s important to see your 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.

  • Changes in the microorganisms in your vagina. Two of the most common types of vaginitis — yeast infections and bacterial vaginosis — occur when there are changes to your vagina’s natural internal environment, or vaginal flora. Yeast infections occur when there’s an overgrowth of candida fungus. Bacterial vaginosis occurs when there’s an overgrowth of Gardnerella vaginalis bacteria and other BV-associated bacteria. Both candida and Gardnerella vaginalis occur naturally in your vagina and keep it healthy, but too much can lead to a vaginal 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. Some of the chemicals in products commonly used for good hygiene cause harm instead. Lotions, detergents, sprays and other products may contain chemicals that cause vaginitis.
  • Changing hormone levels. Drops in the amount of estrogen your body makes can cause changes to your vagina that lead to vaginitis.

Is vaginitis contagious?

The sexually transmitted infections that cause vaginitis are contagious. Trichomoniasis, chlamydia, herpes and HPV all spread person-to-person through sex. Getting infected can lead to vaginal inflammation and irritation associated with vaginitis. Bacterial vaginosis isn’t contagious, but having unprotected sex with multiple partners may put you at greater risk of getting it.

Is vaginitis an STD?

Vaginitis isn’t an STD or STI, but some sexually transmitted diseases can cause vaginitis. Trichomoniasis, chlamydia, gonorrhea, herpes and HPV are all transmitted through sexual contact. And all of them can lead to vaginal inflammation and pain associated with vaginitis. But sex isn’t the only way you can get vaginitis. Bacterial vaginosis, yeast infections, non-infectious vaginitis and atrophic vaginitis are all types of vaginitis that aren’t considered STIs.

Diagnosis and Tests

How is vaginitis diagnosed?

Your healthcare provider will take a thorough medical history, complete a physical exam and swab the inside of your vagina to collect a fluid sample. They will send the sample off to a lab where the cells can be checked for signs of vaginitis. Your healthcare provider may check the PH levels of your vaginal fluid to get closer to a diagnosis.

Some providers may ask that you abstain from sex for 24 hours before your appointment.

Management and Treatment

How is vaginitis treated?

The key to proper treatment of vaginitis is proper diagnosis. This isn’t always easy since 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 any abnormal discharge.

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 aren’t sure, see your healthcare provider. 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.

See your healthcare provider if:

  • All of your symptoms don’t 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).

Can vaginitis go away untreated?

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 usually clears 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. The symptoms from viral vaginitis may resolve on their own, but in the meantime, your provider needs to know about any STIs you have so they can monitor any cell changes. Some kinds of high-risk HPV can lead to cervical cancer.

Speak with your healthcare provider to determine what’s causing your vaginitis, and follow their guidance about what treatments are best.

Care at Cleveland Clinic

Prevention

What are the risk factors for vaginal candida infections?

How can I prevent vaginitis?

There are certain things that you can do to decrease your chance of getting vaginitis.

  • Avoid wearing clothes that hold in heat and moisture. Wearing nylon panties, 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. The warm, moist environment is ideal for yeast and bacteria to grow.
  • Try yogurt and probiotics containing lactobacillus. There is little scientific evidence that yogurt and probiotics containing lactobacillus can reduce vaginitis infections. Some also recommend limiting sugary foods to prevent the growth of yeast. Ask your provider if this is something that they would recommend for you.
  • 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.
  • Use condoms and dental dams. Safer sexual practices can help prevent the passing of diseases between partners.
  • Ask your healthcare provider about the benefits of taking hormones. If you’re approaching menopause, have had your ovaries removed (oophorectomy) or have low levels of estrogen for any reason, talk to your 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 discussed with your healthcare provider. If you have multiple sexual partners, you should request screening for STIs.

Outlook / Prognosis

What can I expect if I have vaginitis?

Vaginitis is uncomfortable, but finding the cause and the right treatment can bring you relief. If chemical irritants are causing your vaginitis, you can improve your symptoms by avoiding the offending lotion, detergent, spray, etc. Bacterial and antifungal medications may take up to two weeks to clear your infection. Antiviral medications for viral vaginitis can’t cure the virus, but they can cause your symptoms to go away faster. Getting the right diagnosis and treating all causes of your vaginitis is key when it comes to relieving your symptoms.

Living With

How do I take care of myself?

Follow your healthcare provider’s instructions, as well as the instructions that come with any medication you’re taking for vaginitis. Don’t stop taking the medicine when your symptoms go away. Speak to your healthcare provider about any questions you have about your treatment or follow-up.

What questions should I ask my doctor?

Good questions to ask include:

  • Should I abstain from 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?

A note from Cleveland Clinic

Don’t be embarrassed to talk to your provider about symptoms you’re experiencing that might be vaginitis. It’s a common condition that’s treatable — once you find out what’s causing your symptoms. The sooner you and your healthcare provider diagnose what’s causing your discomfort, the sooner you can get the treatment needed to bring you relief.

Last reviewed by a Cleveland Clinic medical professional on 11/30/2021.

References

  • Neal CM, Kus LH, Eckert LO, Peipert JF. Noncandidal vaginitis: a comprehensive approach to diagnosis and management. (https://pubmed.ncbi.nlm.nih.gov/31513780/) Am J Obstet Gynecol. 2020;222(2):114-122. Accessed 11/30/2021.
  • Reiter S, Kellogg Spadt S. Bacterial vaginosis: a primer for clinicians. Postgrad Med. 2019;131(1):8-18. Accessed 11/30/2021.
  • Russo R, Superti F, Karadja E, De Seta F. Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment. (https://pubmed.ncbi.nlm.nih.gov/30565745/) Mycoses. 2019;62(4):328-335. Accessed 11/30/2021.
  • Willems HME, Ahmed SS, Liu J, et al. Vulvovaginal Candidiasis: a current understanding and burning questions. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151053/) J Fungi (Basel). 2020;6(1):27. Accessed 11/30/2021.

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