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Vaginitis refers to any inflammation or infection of the vagina. This is a common gynecological problem found in women of all ages, with one-third of women having at least one form of vaginitis at some time during their lives.
The vagina is the muscular passageway between the uterus and the external genital area. When the walls of the vagina become inflamed, because some irritant has disturbed the balance of the vaginal area, vaginitis can occur.
Bacteria, yeast, viruses, chemicals in creams or sprays, or even clothing can cause vaginitis. Sometimes, vaginitis occurs from organisms that are passed between sexual partners. In addition, the vaginal environment is influenced by a number of different factors including a woman’s health, her personal hygiene, medications, hormones (particularly estrogen), and the health of her sexual partner. A disturbance in any of these factors can trigger vaginitis.
The six most common types of vaginitis include the following:
Candida or "yeast" infection
Each of these types of infection has a different cause and can present different symptoms, making diagnosis often complicated. In addition, more than one type of vaginitis may be present at the same time, with or without symptoms being present.
Yeast infections, as they are commonly called, are caused by one of the many species of fungus known as candida, which normally live in the vagina in small numbers. Candida can also be present in the mouth and digestive tract in both men and women.
Since yeast is normally present and well-balanced in the vagina, infection occurs when something in a woman’s system upsets this normal balance. For example, an antibiotic to treat another infection may upset this balance. In this case, the antibiotic kills the bacteria that normally protects and balances the yeast in the vagina. In turn, the yeast overgrows, causing an infection. Other factors that can cause this imbalance to occur include pregnancy, which changes hormone levels, and diabetes, which allows too much sugar in the urine and vagina.
The following are the most common symptoms of a candida infection. However, each individual may experience symptoms differently. Symptoms may include:
A thick, white, cottage cheese-like vaginal discharge that is watery and usually odorless
Itching and redness of the vulva and vagina
The symptoms of a vaginal candida infection may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.
While any woman can develop a yeast infection, the following women may be at an increased risk for the condition:
Women who have had a recent course of antibiotics
Women who are pregnant
Women who have diabetes that is not well-controlled
Women who are using an immunosuppressant medication
Women who are using high-estrogen contraceptives
Women who have a thyroid or endocrine disorder
Women who are undergoing corticosteroid therapy, which slows the immune system
In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for vaginal candida infections often include a microscopic examination of the vaginal discharge.
Specific treatment for candida will be determined by your health care provider based on:
Your age, overall health, and medical history
Extent of the disease
Type and severity of the symptoms
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment for candida may include:
Antifungal vaginal creams and suppositories
Oral antifungal medications
While yeast infections are the most commonly discussed vaginal infections, bacterial vaginosis is actually the most common type of vaginitis in women of reproductive age. This infection is caused by bacteria, not yeast. With a bacterial vaginosis infection, certain species of normal vaginal bacteria grow out of control and trigger inflammation. The cause of bacterial vaginosis is not known.
The following are the most common symptoms for bacterial vaginosis. However, each individual may experience symptoms differently. Symptoms may include:
A milky, thin discharge at times, or a heavy, gray discharge
"Fishy" odor (may become more noticeable during intercourse)
The symptoms of bacterial vaginosis may resemble other conditions. Always consult your health care provider for a diagnosis.
It is important that pregnant women receive prompt treatment for this condition, as bacterial vaginosis can cause complications during pregnancy and, in some cases, has been linked to preterm delivery.
Specific treatment for bacterial vaginosis will be determined by your health care provider based on:
Type and severity of symptoms
Bacterial vaginosis is caused by bacteria; therefore, it is generally treated with oral antibiotics.
Trichomoniasis, trichomonas, or "trich" as it is commonly called, is a sexually transmitted infection. It is caused by a one-celled parasite called Trichomonas vaginalis that passes between partners during sexual intercourse. Since most men do not present symptoms with trichomoniasis, the infection is often not diagnosed until the woman develops symptoms of vaginitis.
The following are the most common symptoms of trichomoniasis. However, each individual may experience symptoms differently. Symptoms may include:
A frothy, often musty-smelling, greenish-yellow discharge
Itching in and around the vagina and vulva
Burning during urination
Discomfort in the lower abdomen
Pain during intercourse
Some women with trichomoniasis have no symptoms. The symptoms of trichomoniasis may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.
Specific treatment for trichomoniasis will be determined by your health care provider based on:
Both partners must be treated for trichomoniasis to avoid reinfection. Treatment generally involves taking oral antibiotics. If a woman has more than one sexual partner, each partner (and any of their other partners) should also be treated.
It is especially important for pregnant women to receive prompt treatment for trichomoniasis, as this type of vaginitis can also cause complications during pregnancy and, in some cases, has been linked to preterm delivery.
Chlamydia is one of the most common sexually transmitted diseases in the United States, although it often goes undiagnosed. If left untreated, chlamydia infection often leads to pelvic inflammatory disease (PID), which increases a woman’s risk of infertility, pelvic adhesions, chronic pelvic pain, and ectopic pregnancy.
Chlamydia infection, caused by the bacterium Chlamydia trachomatis, exists in a number of different strains. This form of vaginitis is most commonly diagnosed in young women between the ages of 18 and 35 who have multiple sexual partners.
Unfortunately, many women have no symptoms, thus prolonging diagnosis and treatment and possibly spreading the disease. The following are the most common symptoms of chlamydia infection. However, each individual may experience symptoms differently. Symptoms may include:
Increased vaginal discharge
Light bleeding, especially after intercourse
Pain in the lower abdomen or pelvis
Pus in the urine
Redness and swelling of the urethra and labia
The symptoms of chlamydia may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.
Specific treatment for chlamydia will be determined by your health care provider based on:
Generally, treatment for chlamydia involves taking antibiotics. It is especially important for pregnant women infected with chlamydia to be treated, as the consequences for a newborn who has passed through the birth canal of an infected mother are quite serious.
Vaginitis can also be caused by the bacterium Neisseria gonorrhoeae (N. gonorrhoeae)--the same bacterium that causes the sexually transmitted disease known as gonorrhea.
In prepubertal children, the most common infection occurs in the genital tract, with vaginitis as the most common symptom. In adolescents who are sexually active, gonococcal infections may occur along with other types of vaginal infections, and are similar to gonococcal infections in adults. The following are the most common symptoms of a gonococcal infection. However, each individual may experience symptoms differently. Symptoms may include:
Yellowish or bloody vaginal discharge (females) or yellowish white discharge from the penis (males)
Painful or burning urination (males and females)
Swollen or painful testicles (males)
Vaginal bleeding during intercourse (females)
Lower abdominal (pelvic) pain during intercourse (females)
The symptoms of a gonococcal infection may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.
Specific treatment for a gonococcal infection will be determined by your health care provider based on:
Severity of the symptoms
Expectations for the course of the condition
If left untreated, gonococcal infections can lead to serious conditions, such as PID, which increases a female’s risk of infertility, pelvic adhesions, chronic pelvic pain, and ectopic (tubal) pregnancy. Because of these risks, early treatment of the infection with antibiotics is essential. Treatment of sexual partners is also necessary to prevent reinfection and further spread of the disease.
Viruses are a common cause of vaginitis, with most being spread through sexual contact. One type of virus that causes viral vaginitis is the herpes simplex virus (HSV, or simply herpes) whose primary symptom is pain in the genital area associated with lesions and sores. These sores are generally visible on the vulva, or vagina, but occasionally are inside the vagina and can only be found during a pelvic examination. Often stress or emotional situations can be a factor in triggering an outbreak of herpes.
Another source of viral vaginitis is the human papillomavirus (HPV), a virus that is also transmitted through sexual contact. HPV is the main cause of cervical cancer in women. This virus also causes painful warts to grow on the vagina, rectum, vulva, or groin. However, visible warts are not always present, in which case, the virus is generally detected by a test for HPV done with a Pap test.
Two HPV vaccines are effective in preventing infection by the particular strains of HPV that cause most cervical cancers, but they do not treat existing HPV infection or genital warts. One of the vaccines also is effective against genital warts as well as some cancers of the vulva, vagina, and anus. Both vaccines are approved for use in females between the ages of 9 and 26. One of the two vaccines is available for boys and men, ages 9 through 26, and protects against most genital warts. The vaccines are given as a three-dose series.
Noninfectious vaginitis usually refers to vaginal irritation without an infection being present. Most often, this is caused by an allergic reaction to, or irritation from, vaginal sprays, douches, or spermicidal products. It may be also be caused by sensitivity to perfumed soaps, detergents, or fabric softeners.
Another form of noninfectious vaginitis, called atrophic vaginitis, usually results from a decrease in hormones because of menopause, surgical removal of the ovaries, radiation therapy, or even after childbirth--particularly in breastfeeding women. Lack of estrogen dries and thins the vaginal tissue, and may also cause spotting.
The following are the most common symptoms of noninfectious vaginitis. However, each individual may experience symptoms differently. Symptoms may include:
Pelvic pain (particularly during intercourse)
The symptoms of noninfectious vaginitis may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.
Specific treatment for noninfectious vaginitis will be determined by your health care provider based on:
Treatment for noninfectious vaginitis generally includes estrogen creams or oral tablets, which can restore lubrication and decrease soreness and irritation.
Bayhealth is Southern Delaware’s healthcare leader with hospitals in Dover and in Milford. Bayhealth provides a wide range of medical services, including cardiovascular, cancer, orthopaedics and rehabilitation, pediatrics, respiratory care, sleep care, surgical weight loss and women’s services.