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Vaginitis

Definition:
Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection. Vaginitis can also result from reduced estrogen levels after menopause.

The most common types of vaginitis are:
  • Bacterial vaginosis. This type of vaginitis results from overgrowth of one of several organisms normally present in your vagina, upsetting the natural balance of vaginal bacteria. More than one in six pregnant women in the United States has bacterial vaginosis, though many aren't aware of it.
  • Yeast infections. A naturally occurring fungus called Candida albicans usually causes this type of vaginitis. An estimated three out of four women will have a yeast infection in their lifetime.
  • Trichomoniasis. This type is caused by a parasite and is commonly transmitted by sexual intercourse.
  • Atrophic vaginitis. This type results from reduced estrogen levels after menopause. The vaginal tissues become thinner and drier, which may lead to itching, burning or pain.

Treatment depends on the type of vaginitis you have.

Causes:
The cause depends on the type of vaginitis you have.

Bacterial vaginosis
Bacterial vaginosis results from an overgrowth of one of several organisms normally present in your vagina. Usually, "good" bacteria outnumber "bad" bacteria in your vagina. But if bad bacteria become too numerous, they

upset the balance and bacterial vaginosis results. This type of vaginitis can spread during sexual intercourse, but it also occurs in people who aren't sexually active. Women with new or multiple sex partners, as well as women who douche or use an intrauterine device (IUD) for birth control, have a higher risk of bacterial vaginosis.

Yeast infections
Yeast infections occur when certain internal or external factors change the normal environment of your vagina and trigger an overgrowth of a microscopic fungus — the most common being C. albicans. A yeast infection isn't considered a sexually transmitted disease. Besides causing most vaginal yeast infections, C. albicans also causes infections in other moist areas of your body, such as in your mouth (thrush), skin folds and fingernail beds. The fungi can also cause diaper rash.

Factors that increase your risk of yeast infections include:
  • Medications, such as antibiotics and steroids
  • Uncontrolled diabetes
  • Hormonal changes, such as those associated with pregnancy, birth control pills and menopause

Bubble baths, vaginal contraceptives, damp or tightfitting clothing and feminine hygiene products, such as sprays and deodorants, don't cause yeast infections, but they may increase your susceptibility to infection.

Trichomoniasis
Trichomoniasis is a common sexually transmitted disease caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection. The organism usually infects the urinary tract in men, but often causes no symptoms in men. Trichomoniasis typically infects the vagina in women.

Noninfectious vaginitis
Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products may cause an allergic reaction or irritate the delicate skin around your vagina. Vaginal itching and burning can also result from vaginal dryness caused by a drop in your hormone levels after menopause or surgical removal of your ovaries.

When to seek medical advice:
You probably need to see your doctor if you have new vaginal concerns and:
  • You've never had a vaginal infection. Seeing your doctor will establish the cause and help you learn to identify the signs and symptoms.
  • You've had vaginal infections before, but these concerns seem different.
  • You've had multiple sex partners or a recent new partner. You could have a sexually transmitted disease. The signs and symptoms of some sexually transmitted diseases are similar to those of a yeast infection.
  • You've completed a course of over-the-counter anti-yeast medication and your symptoms persist, you have a fever or you have a particularly unpleasant vaginal odor. These are signs the infection may be from something other than yeast or from a resistant strain of yeast.
You probably don't need to see your doctor if you have vaginal discharge or burning, irritation and:
  • You've previously had a diagnosis of vaginal yeast infections 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 you have a yeast infection
Symptoms:
Vaginitis symptoms may include:
  • Change in color, odor or amount of discharge from your vagina
  • Vaginal itching or irritation
  • Pain during intercourse
  • Painful urination
  • Light vaginal bleeding
Additionally, you may have these signs and symptoms depending on the type of vaginitis:
  • Bacterial vaginosis. You may develop a grayish-white, foul-smelling discharge. The odor, often described as fish-like, may be more obvious after sexual intercourse.
  • Yeast infections. The main symptom is itching, but you may have a white, thick discharge that resembles cottage cheese.
  • Trichomoniasis. This infection can cause a greenish yellow, sometimes frothy discharge.
Dignosis:
To diagnose your condition, your doctor may review your history of vaginal infections or sexually transmitted diseases and conduct a pelvic examination. Your doctor may take a sample of a cervical or vaginal discharge for laboratory analysis. This sample can confirm what kind of vaginitis you have.

Complications:
Generally, vaginal infections don't cause serious complications. In pregnant women, however, both bacterial vaginosis and trichomoniasis have been associated with premature deliveries and low birth weight babies. Women infected with trichomoniasis or bacterial vaginosis are also at a greater risk of acquiring HIV and other sexually transmitted diseases than are women who aren't infected with trichomoniasis or bacterial vaginosis.

Treatment:
The type of medication used for vaginitis treatment depends on which type you have:
  • Bacterial vaginosis. For this type of vaginitis, your doctor may prescribe metronidazole (Flagyl, MetroGel) or clindamycin (Cleocin) as tablets or vaginal gels or creams.
  • Yeast infections. Yeast infections usually are treated with an antifungal cream or suppository, such as miconazole (Monistat) and clotrimazole (Gyne-Lotrimin). Yeast infections may also be treated with an oral antifungal medication, such as fluconazole (Diflucan). The advantages of over-the-counter treatment for a yeast infection are convenience, cost and not having to wait to see your doctor. The catch is you may be treating something other than a yeast infection. It's possible to mistake a yeast infection for other types of vaginitis or other conditions that need different treatment. Using the wrong medicine may delay a proper diagnosis and the most appropriate treatment, and can lead to complications.
  • Trichomoniasis. Your doctor may prescribe metronidazole (Flagyl) tablets.
  • Atrophic vaginitis. Estrogen, in the form of vaginal creams, tablets or rings, can effectively treat atrophic vaginitis. This treatment is available by prescription from your doctor.
  • 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.
Prevention:
Good hygiene may prevent some types of vaginitis from recurring and may relieve some Symptoms:
  • Avoid baths, hot tubs and whirlpool spas. Rinse soap from your outer genital area after a shower, and dry the area well to prevent irritation. Don't use scented or harsh soaps, such as those with deodorant or antibacterial action.
  • Avoid irritants. These include scented tampons and pads.
  • Wipe from front to back after using the toilet. Doing so avoids spreading fecal bacteria to your vagina.
Other things that may help prevent vaginitis include:
  • Don't douche. Your vagina doesn't require cleansing other than normal bathing. Repetitive douching disrupts the normal organisms that live in the vagina and can actually increase your risk of vaginal infection. Douching won't clear up a vaginal infection.
  • Use a male latex condom. This helps avoid infections spread by sexual contact.
  • Wear cotton underwear and pantyhose with a cotton crotch. Don't wear underwear to bed. Yeast thrives in moist environments.
  • Eat yogurt that contains active lactobacillus cultures. This sometimes may help reduce recurrent vaginal yeast infections. Lactobacillus is a type of "good" bacteria that's common in your vagina.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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