Vaginitis

August, 10th, 2023

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Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the balance of vaginal bacteria or an infection. Reduced estrogen levels after menopause and some skin disorders also can cause vaginitis.

The most common types of vaginitis are:

• Bacterial vaginosis. This results from an overgrowth of the bacteria naturally found in your vagina, which upsets the natural balance.
• Yeast infections. These are usually caused by a naturally occurring fungus called Candida albicans.
• Trichomoniasis. This is caused by a parasite and is often sexually transmitted.

Treatment depends on the type of vaginitis you have.

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Symptoms

Vaginitis signs and symptoms can include:

• Change in color, odor or amount of discharge from your vagina
• Vaginal itching or irritation
• Pain during sex
• Painful urination
• Light vaginal bleeding or spotting

If you have vaginal discharge, the characteristics of the discharge might indicate the type of vaginitis you have. Examples include:

• Bacterial vaginosis. You might develop a grayish-white, foul-smelling discharge. The odor, often described as a fishy odor, might be more obvious after sex.
• Yeast infection. The main symptom is itching, but you might have a thick white discharge that resembles cottage cheese.
• Trichomoniasis. An infection called trichomoniasis (trik-o-moe-NIE-uh-sis) can cause a greenish-yellow, sometimes frothy discharge.

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When to see a doctor

See your health care provider if you develop vaginal discomfort, especially if:

• You have a particularly unpleasant vaginal odor, discharge or itching.
• You’ve never had a vaginal infection. Seeing your health care provider can establish the cause and help you learn to identify the signs and symptoms.
• You’ve had vaginal infections before.
• You’ve had multiple sex partners or a recent new partner. You could have a sexually transmitted infection, some of which have signs and symptoms similar to those of a yeast infection or bacterial vaginosis.
• You’ve completed a course of over-the-counter anti-yeast medication and your symptoms persist.
• You have a fever, chills or pelvic pain.

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Wait-and-see approach

You probably don’t need to see your health care provider every time you have vaginal irritation and discharge, particularly if:

• You’ve previously had a diagnosis of vaginal yeast infection and your signs and symptoms are the same as before
• You know the signs and symptoms of a yeast infection, and you’re confident that’s what you have

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Causes

The cause depends on what type of vaginitis you have:

• Bacterial vaginosis. This most common type of vaginitis results from a change of the bacteria found in your vagina, upsetting the balance. What causes the imbalance is unknown. It’s possible to have bacterial vaginosis without symptoms.

  This type of vaginitis seems to be linked to but not caused by sex — especially if you have multiple sex partners or a new sex partner — but it also occurs in women who aren’t sexually active.

• Yeast infections. These occur when there’s an overgrowth of a fungal organism — usually Candida albicans — in your vagina. C. albicans also causes infections in other moist areas of your body, such as in your mouth (thrush), skin folds and nail beds. The fungus can also cause diaper rash.

• Trichomoniasis. This common sexually transmitted infection is caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sex with someone who has the infection.

  In men, the organism usually infects the urinary tract, but often it causes no symptoms. In women, trichomoniasis typically infects the vagina, and might cause symptoms. It also increases women’s risk of getting other sexually transmitted infections.

• Noninfectious vaginitis. Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products can cause an allergic reaction or irritate vulvar and vaginal tissues. Foreign objects, such as toilet paper or forgotten tampons, in the vagina also can irritate vaginal tissues.
• Genitourinary syndrome of menopause (vaginal atrophy). Reduced estrogen levels after menopause or surgical removal of your ovaries can cause the vaginal lining to thin, sometimes resulting in vaginal irritation, burning and dryness.

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Risk factors

Factors that increase the risk of developing vaginitis include:

• Hormonal changes, such as those associated with pregnancy, birth control pills or menopause
• Sexual activity
• Having a sexually transmitted infection
• Medications, such as antibiotics and steroids
• Use of spermicides for birth control
• Uncontrolled diabetes
• Use of hygiene products such as bubble bath, vaginal spray or vaginal deodorant
• Douching
• Wearing damp or tight-fitting clothing
• Using an intrauterine device (IUD) for birth control

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Complications

Women with trichomoniasis or bacterial vaginosis are at a greater risk of getting sexually transmitted infections because of the inflammation caused by these disorders.

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Prevention

Good hygiene might prevent some types of vaginitis from recurring and relieve some symptoms:

• Avoid baths, hot tubs and whirlpool spas.
• Avoid irritants. These include scented tampons, pads, douches and scented soaps. Rinse soap from your outer genital area after a shower and dry the area well to prevent irritation. Don’t use harsh soaps, such as those with deodorant or antibacterial action, or bubble bath.
• Wipe from front to back after using the toilet. Doing so avoids spreading fecal bacteria to your vagina.

Other things that might help prevent vaginitis include:

• Avoid douching. Your vagina doesn’t require cleansing other than regular showering. Repetitive douching disrupts the good organisms that live in the vagina and can increase your risk of vaginal infection. Douching won’t clear up a vaginal infection.
• Practice safer sex. Using a condom and limiting the number of sex partners can help.
• Wear cotton underwear. Also wear pantyhose with a cotton crotch. Consider not wearing underwear to bed. Yeast thrives in moist environments.

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Diagnosis

To diagnose vaginitis, your health care provider is likely to:

• Review your medical history. This includes your history of vaginal or sexually transmitted infections.
• Perform a pelvic exam. During the pelvic exam, your health care provider might use an instrument (speculum) to look inside your vagina for inflammation and discharge.
• Collect a sample for lab testing. Your health care provider might collect a sample of cervical or vaginal discharge for lab testing to confirm what kind of vaginitis you have.
• Perform pH testing. Your health care provider might test your vaginal pH by applying a pH test stick or pH paper to the wall of your vagina. An elevated pH can indicate either bacteria vaginosis or trichomoniasis. However, pH testing alone is not a reliable diagnostic test.

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Treatment

A variety of organisms and conditions can cause vaginitis, so treatment targets the specific cause:

• Bacterial vaginosis. For this type of vaginitis, your health care provider might prescribe metronidazole tablets (Flagyl) that you take by mouth or metronidazole gel (MetroGel) that you apply to the affected area. Other treatments include clindamycin (Cleocin) cream that you apply to your vagina, clindamycin tablets you take by mouth or capsules you put in your vagina. Tinidazole (Tindamax) or secnidazole (Solosec) are taken by mouth.

  Bacterial vaginosis can recur after treatment.

• Yeast infections. Yeast infections usually are treated with an over-the-counter antifungal cream or suppository, such as miconazole (Monistat 1), clotrimazole (Lotrimin AF, Mycelex, Trivagizole 3), butoconazole (Gynazole-1) or tioconazole (Vagistat-1). Yeast infections might also be treated with a prescription oral antifungal medication, such as fluconazole (Diflucan).

  The advantages of over-the-counter treatment are convenience, cost and not waiting to see your health care provider. However, you might have something other than a yeast infection. Using the wrong medicine might delay an accurate diagnosis and proper treatment.

• Trichomoniasis. Your health care provider may prescribe metronidazole (Flagyl) or tinidazole (Tindamax) tablets.
• Genitourinary syndrome of menopause (vaginal atrophy). Estrogen — in the form of vaginal creams, tablets or rings — can treat this condition. This treatment is available by prescription from your health care provider, after other risk factors and possible complications are reviewed.
• Noninfectious vaginitis. To treat this type of vaginitis, you need to pinpoint the source of the irritation and avoid it. Possible sources include new soap, laundry detergent, sanitary napkins or tampons.

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Self care

You’ll need prescription medication to treat trichomoniasis, bacterial vaginosis and vaginal atrophy. If you know you have a yeast infection, you can take these steps:

• Use a medication specifically for yeast infections that you can get without a prescription. Options include one-day, three-day or seven-day courses of cream or vaginal suppositories. The active ingredient varies, depending on the product: clotrimazole, miconazole (Monistat 1) or tioconazole (Vagistat).

  Some products also come with an external cream to apply to the labia and opening of the vagina. Follow package directions and complete the entire course of treatment, even if you’re feeling better right away.

• Apply a cold compress, such as a washcloth, to the labial area to ease discomfort until the antifungal medication takes full effect.

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Preparing for your appointment

Your family health care provider, gynecologist or another medical practitioner can diagnose and prescribe treatment for vaginitis.

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What you can do

To get ready for your appointment, make a list of:

• Your symptoms and how long you’ve had them
• Key personal information, including how many sex partners you have and whether you have a new sex partner
• All medications, vitamins and other supplements you take, including doses
• Questions to ask your health care provider

Avoid using tampons, having sex or douching before your appointment so that your health care provider can assess your vaginal discharge.

For vaginitis, some basic questions include:

• What can I do to prevent vaginitis?
• What signs and symptoms should I watch for?
• Do I need medication?
• Are there over-the-counter products that will treat my condition?
• What can I do if my symptoms return after treatment?
• Does my partner also need to be tested or treated?

Don’t hesitate to ask other questions.

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What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

• Do you notice a strong vaginal odor?
• Do your symptoms seem tied to your menstrual cycle? For instance, are symptoms more intense just before or just after your period?
• Have you tried over-the-counter products to treat your condition?
• Are you pregnant?
• Do you use scented soap or bubble bath?
• Do you douche or use feminine hygiene spray?

Don’t be embarrassed to discuss symptoms that might suggest vaginitis. Talk to your health care provider as soon as possible so as not to delay treatment.