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.
- 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 lifetimes.
- 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.
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.
When to see a doctor
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 or bacterial vaginosis.
- 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.
The cause depends on the type of vaginitis you have.
Bacterial vaginosis results from an overgrowth of one of several organisms normally present in your vagina. Usually, "good" bacteria (lactobacilli) outnumber "bad" bacteria (anaerobes) in your vagina. But if anaerobic 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 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 or 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 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.
Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products may cause an allergic reaction or irritate the delicate skin of your vulva and vagina. Vaginal itching and burning can also result from thinning of the vaginal lining caused by a drop in your hormone levels after natural menopause or surgical removal of your ovaries.
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.
Preparing for your appointment
What you can do
So that your doctor can observe and evaluate any vaginal discharge you have, avoid using tampons and don't douche before your appointment.
Also make a list of medications or supplements you're taking or any allergies you have. Write down questions to ask your doctor. Some basic questions include:
- Can I do anything to prevent vaginitis?
- What signs and symptoms should I watch out for?
- Do I need to take medicine?
- Does my partner also need to be tested or treated?
- Are there any special instructions for taking the medicine?
- Are there any over-the-counter products that will treat my condition?
- What can I do if my symptoms return after treatment?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
Questions your doctor may ask
Be prepared to answer questions your doctor may have, such as:
- What vaginal symptoms are you experiencing?
- Do you notice a strong vaginal odor?
- How long have you had your symptoms?
- Do your symptoms seem tied to your menstrual cycle? Are they, for instance, more intense just before or just after your period?
- Have you tried any over-the-counter products to treat your condition?
- Are you sexually active?
- Are you pregnant?
- Do you use scented soap or bubble bath?
- Do you douche or use feminine hygiene spray?
- What medications or vitamin supplements do you regularly take?
Tests and diagnosis
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.
Treatments and drugs
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), clotrimazole (Gyne-Lotrimin) and tioconazole (Vagistat). 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) or tinidazole (Tindamax) 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.
Lifestyle and home remedies
You'll need prescription medication to treat trichomoniasis, bacterial vaginosis and atrophic vaginitis. If you know you have a yeast infection, you may go ahead with treatment on your own, taking these steps:
- Use an over-the-counter medication specifically for yeast infections. Options include one-day, three-day or seven-day courses of cream or vaginal suppositories. The active ingredient varies depending on the product: clotrimazole (Gyne-Lotrimin), miconazole (Monistat) 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.
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 reside 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. If you feel comfortable without it, skip wearing underwear to bed. Yeast thrives in moist environments.