Vaginitis

  • What Is Vaginitis?

    Vaginitis is a disorder of the vagina caused by infection or inflammation. It is often a result of infection by one of various microorganisms, but vaginitis may also be caused by irritation from soaps or medications, an allergic reaction, or hormonal changes. The three most common types of vaginitis are candidiasis (yeast infection), trichomoniasis (infection by a tiny, one-celled organism called a protozoan), and bacterial vaginosis. These three types account for more than 90% of all vaginitis seen in non-menopausal women. Menopausal women may get atrophic vaginitis associated with thinning of the walls of the vagina. This is due to estrogen deprivation.

    Although irritating, vaginitis is not a serious health risk, and it typically subsides quickly with treatment. Recurrent or persistent cases may be associated with an underlying medical condition.

     

    Who Gets Vaginitis?

    At some point in their lives, about one third of women must deal with vaginitis. Repeated bouts are common.

     

    Symptoms

    • Vaginal discharge. Discharge may be heavy, white, thick, and odorless (candidiasis); greenish yellow, frothy, with an intense unpleasant odor

    (trichomoniasis); white or gray, with a strong fishy odor (bacterial vaginosis).

    • Vaginal and vulvar pain or itching. Pain may be worse upon urination and during sexual intercourse.
    • Vulvar burning.
    • Bright reddish color to the vulva.
    • Vulvar spotting.

     

    Causes/Risk Factors

    • Bacterial, fungal, or protozoal infections.
    • An allergic reaction to or irritation by substances in spermicides, douches, soaps, or bath oils may produce vaginitis.
    • Trichomoniasis is usually spread through sexual intercourse.
    • Oral corticosteroids, antibiotics, and oral contraceptives may make vaginitis more likely.
    • Certain conditions, including pregnancy, malnutrition, poor health, and diabetes, mellitus carry a greater risk of vaginitis.
    • A decrease in estrogen levels in postmenopausal women may lead to thinning of the vaginal lining, resulting in atrophic vaginitis.

     

    What If You Do Nothing?

    Many cases of vaginitis will clear up without treatment. But some types are especially persistent, and the symptoms are often uncomfortable. Yeast infections can worsen and cause increase pain and irritation, difficulty with urination and raw sensitive areas in the vagina. Trichomoniasis can be associated with other sexually transmitted diseases and patients should be tested appropriately. Bacterial vaginosis is usually self-limiting but at times can progress and give bothersome symptoms.

     

    Diagnosis

    • Patient history
    • Pelvic examination.
    • Microscopic examination of discharge.
    • Vaginal pH
    • Vaginal culture
    • Cervical culture.

     

    Treatment

    • Antimycotic medication such as miconazole, clotrimazole, or terconazole is prescribed in the form of vaginal suppositories or cream to treat candidiasis (yeast infection). Some of these medications are now available over the counter. Oral antimycotic medication such as fluconazole (Diflucan) may be prescribed in cases that do not respond to topical therapy or if patient prefers oral agents.
    • Metronidazole, an antimicrobial drug, is administered to both sexual partners for trichomoniasis. A single dose of metronidazole orally is the treatment of choice. Only one partner may exhibit symptoms, but both should be treated to prevent a perpetual cycle of reinfection.
    • Metronidazole vaginally or orally is prescribed to treat bacterial vaginosis.
    • Topical or oral estrogens may be prescribed for atrophic vaginitis. Vaginal moisturizers and lubricants are recommended. A newer oral medication called ospemifene (Osphena) may be helpful.
    • If a medication is suspected as the cause of vaginitis, a change in prescription may be warranted.
    • Abstinence from sexual intercourse may be advised until treatment is completed.

     

    Prevention

    • Use a mild, unscented soap in the vaginal area or water alone.
    • Use condoms during sexual intercourse to help decrease the risk of infection.
    • Wear cotton undergarments. Avoid nylon undergarments, which do not breathe. Do not share underwear, towels, or swimsuits.
    • Do not use vaginal douches unless advised to do so by your doctor.
    • If you are prescribed antibiotics for another infection, check with your doctor about reducing your risk of yeast infection.

     

    When To Call Your Doctor

    • Call your gynecologist if you experience vaginal itching, burning, or pain, or if you notice any abnormal vaginal discharge. Also call your doctor if you are taking medication for vaginitis and see no improvement after three days; another medications may be more effective—or you may have some other type of condition.

     

    Reviewed by Thomas Moran, M.D., obstetrician-gynecologist in private practice, Springfield, MA.