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.
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.
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.
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.
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:
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.
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.
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:
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:
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).
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:
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.
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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 healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 11/06/2018