Vaginitis
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.
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.
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.
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
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.
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
Women with trichomoniasis or bacterial vaginosis are at a greater risk of getting sexually transmitted infections because of the inflammation caused by these disorders.
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.
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.
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.
References
- Sobel J. Approach to women with symptoms of vaginitis. https://www.uptodate.com/contents/search. Accessed Sept. 4, 2021.
- FAQs: Vaginitis. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/vaginitis. Accessed Sept. 4, 2021.
- AskMayoExpert. Vulvovaginitis. Mayo Clinic; 2020.
- Overview of vaginitis. Merck Manual Professional Version. http://www.merckmanuals.com/professional/gynecology-and-obstetrics/vaginitis,-cervicitis,-and-pelvic-inflammatory-disease-pid/overview-of-vaginitis. Accessed Sept. 4, 2021.
- Coudray MS, et al. Bacterial vaginosis — A brief synopsis of the literature. European Journal of Obstretrics & Gynecology and Reproductive Biology. 2020; doi:10.1016/j.ejogrb.2019.12.035.
- American College of Obstetricians and Gynecologists. Practice Bulletin 215: Vaginitis in nonpregnant patients. Obstetrics & Gynecology. 2020; doi:10.1097/AOG.0000000000003604.
- Vaginal candidiasis. Centers for Disease Control and Prevention. https://www.cdc.gov/fungal/diseases/candidiasis/genital/. Accessed Sept. 19, 2021.
- Can vaginitis be prevented? Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/vaginitis/conditioninfo/prevention. Accessed Sept. 19, 2021.
Related Topics
Good Habits You Should Know
Bad Habits You Should Know
About the Speciality
