Vaginitis

Overview

Vaginitis is a general term for inflammation of the vagina. Vaginitis is a common condition often caused by infections, which may be sexually transmitted but not always. There are various noninfectious types of vaginitis as well.

Different types of vaginitis are difficult to distinguish based on symptoms alone. Physicians diagnose vaginitis by performing laboratory tests of vaginal fluid and prescribe treatments based on the patient’s type of vaginitis.

Vaginitis most commonly results from one of the following conditions:

  • Bacterial vaginosis
  • Trichomoniasis
  • Yeast infection
  • Atrophic vaginitis (also called vaginal atrophy)

Most cases of vaginitis are curable, and complications are usually avoided when patients receive timely treatment.

Causes

Vagina and uterus (cross-section)Causes of Infectious Vaginitis

  • Bacterial vaginosis (BV), an overgrowth of vaginal bacteria, is the most common cause of vaginitis. Beneficial bacteria (primarily lactobacilli) normally live in the vagina in greater numbers than harmful bacteria. When harmful bacteria outnumber lactobacilli, the imbalance causes inflammation. The exact cause of bacterial vaginosis is unknown; however, sexual activity, intrauterine devices for birth control, and douching increase a woman’s chance of developing bacterial vaginosis.
  • Trichomoniasis (“trich”) is a highly contagious sexually transmitted infection caused by a parasite (Trichomonas vaginalis), which affects both women and men. Multiple sex partners and unprotected sexual intercourse increase the risk of infection.
  • Yeast infection is caused by an overgrowth of a fungus (usually Candida albicans). Yeast is normally present in the vagina in small numbers, but tends to overgrow in certain conditions, such as diabetes, weak immune system function, pregnancy, antibiotic usage, and steroid usage. Damp or tight clothing contributes to yeast infections by creating a dark, moist environment that promotes yeast growth.

Causes of Noninfectious Vaginitis

  • Atrophic vaginitis, caused by menopause or surgical removal of the ovaries, is the result of a reduced level of the hormone estrogen and thinning of the vaginal lining, which makes the vagina susceptible to inflammation, irritation, and burning.
  • Scented soaps, tampons, spermicides, and detergents may cause allergic reactions.
  • Vaginal douches can disrupt the balance of normal vaginal organisms and irritate vaginal tissues.

Symptoms

Normal vaginal fluid is white and odorless. Patients with vaginitis may develop abnormal vaginal discharge, irritation, itching, and odor. Although various types of vaginitis cannot be distinguished based on symptoms alone, there are classic characteristics associated with each form.

Patients with bacterial vaginosis may experience a thin, white or gray vaginal discharge with a foul fishy odor. Vaginal itching and irritation are rare and some women have no symptoms at all.

Most women and men with trichomoniasis (70%) experience no symptoms at all. Such individuals are unaware of their infection, but they still may infect others through sexual activity. Symptomatic women experience mild to severe inflammation, itching, burning, vaginal odor, and a profuse greenish yellow vaginal discharge. Men may notice irritation of the penis, burning with urination, or penile discharge.

Yeast infections often cause severe vaginal itching, burning, irritation, painful urination, and pain with sexual intercourse. Sometimes, there is a thick white vaginal discharge resembling cottage cheese.

Diagnosis and Treatment

Microscopic view of Trichomonas vaginalisThe types of vaginitis are difficult to distinguish on the basis of symptoms, so patient should undergo a pelvic examination by a health care provider. A pelvic examination consists of an inspection of the vagina and cervix and sampling of vaginal secretions for examination under a microscope.

  • Bacterial vaginosis is diagnosed when an examination of vaginal fluid detects the absence of lactobacilli bacteria and the presence of clumps of bacteria with abnormal cells called “clue cells.” This infection is treated with antibiotics: metronidazole, clindamycin, or tinidazole. Male sex partners do not need treatment.
  • Trichomoniasis results in redness and swelling of the vulva and vagina. The diagnosis is confirmed by examination of vaginal fluid for the presence of Trichomonas organisms. Treatment consists of a single dose of an antibiotic (metronidazole or tinidazole) and the infection is usually readily cured. Sex partners must also be treated or reinfection is likely.
  • A yeast infection is diagnosed by an examination of vaginal fluid for the presence of yeast cells. Yeast infections may be treated with over-the-counter antifungal creams such as miconazole, clotrimazole, or tioconazole. Yeast infections are difficult to diagnose based on symptoms alone, so patients should visit a heath care provider before using these treatments. Often a prescription antifungal medication such as fluconazole is required. Sex partners do not require treatment.
  • Atrophic vaginitis is treated with vaginal moisturizers, lubricants, or estrogen medication. There is a concern that estrogen therapy can increase the risk of breast cancer.
  • Other noninfectious types of vaginitis resolve with avoidance of irritating products.

Complications

  • Bacterial vaginosis and trichomoniasis increase the risk of developing HIV and other sexually transmitted infections, so timely treatment is essential.
  • During pregnancy, bacterial vaginosis and trichomoniasis increase the risk of premature deliveries.
  • Patients with HIV can develop severe, persistent yeast infections, which are unresponsive to treatment.

Prevention

The use of latex condoms reduces the risk of sexually transmitted infections; therefore, women can reduce their risk of vaginitis by using latex condoms for sexual intercourse and having only one sex partner at a time.

The risk of vaginitis is also decreased when women avoid douches, irritants, or tight clothing.

Sources

  • Eckert LO, Lentz GM. Chapter 23. Infections of the Lower and Upper Genital tracts: Vulva, Vagina, Cervix, Toxic Shock Syndrome, Endometritis, and Salpingitis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology, 6e. Philadelphia, PA: Elsevier Mosby; 2012.
  • Vaginitis. Mayo Clinic website. http://www.mayoclinic.org/diseases-conditions/vaginitis/basics/prevention/con-20022645. Accessed May 8, 2014.
  • Vaginitis. National Institutes of Health; National Institute of Allergy and Infectious Diseases website. http://www.niaid.nih.gov/topics/vaginitis/pages/default.aspx. Accessed May 8, 2014.
  • Trichomoniasis CDC Fact Sheet. Centers for Disease Control and Prevention website. http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm. Accessed May 8, 2014.
  • Vaginal atrophy. Mayo Clinic website. http://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/basics/treatment/con-20025768. Accessed May 8, 2014.