Vaginitis and Vulvovaginitis

Vaginal Inflammation

What is Vaginitis?

Vaginitis is an inflammation of the vagina resulting from infectious organisms or irritants. Vaginitis is the most common reason an adult female seeks medical attention. The three most common causes of vaginitis are

  • yeast (candidiasis),
  • bacterial infection (bacterial vaginosis),
  • parasite (trichomoniasis).

Yeast is normally found in the vagina. However, if something happens to change the normal environment of the vagina, the yeast organisms flourish and cause a yeast infection. This can be caused by antibiotics, pregnancy, diabetes, birth control pills, or the normal changes during a menstrual period. Other factors associated with increased incidence of yeast infection are sexually transmitted diseases, low estrogen levels accompanying menopause, wearing tight, non-breathing clothing or underwear, and the use of douches or perfumed feminine hygiene sprays.

Bacterial vaginosis, previously called non-specific vaginitis, is caused by an overgrowth of one or more types of bacteria. Symptoms may include strong unpleasant odor and an abnormal white or gray milky discharge. The exact cause of this bacterial imbalance is unknown, although it appears more frequently in women suffering from stress, poor diet, inadequate rest, or emotional upset. This kind of infection is seen in both sexually active and inactive women.

A third cause of vaginitis, trichomoniasis ("trich"), is a sexually transmitted disease caused by a one-cell parasite, which infects two to three million Americans yearly.

There are other less common causes of vaginitis, including allergic reactions, irritants, hormone deficiency associated with aging, a foreign body such as a forgotten tampon, or other sexually transmitted diseases. Noninfectious allergic symptoms can be caused by a reaction to the spermicidal creams used for contraception, chemicals used in vaginal douches (also in soaps, bath oils or salts), and laundry detergents or fabric softeners.

The vaginal lining becomes thin and dry after menopause, making it prone to inflammation. This inflammation (atrophic vaginitis) is due to the reduction of the hormone estrogen.

How is it diagnosed?

Symptoms of Vaginitis

  • With a yeast infection, reported symptoms may include thick white cottage cheese-like discharge, vaginal itching, painful urination, swelling and redness in the vaginal area, and painful intercourse.
  • With bacterial vaginosis, nearly half the women have no symptoms. If symptoms are present, they may include a strong unpleasant or fishy odor, and an abnormal white or gray milky discharge. Itching or vaginal irritation may or may not be present.
  • Trichomoniasis may or may not cause symptoms. If symptoms are present, they usually occur within four to twenty days after exposure, and include excessive yellow or green frothy vaginal discharge with a strong unpleasant fishy odor, itching in vaginal and external genital (vulva) area, painful urination or intercourse, and occasionally lower abdominal pain.
  • With allergic vaginitis, symptoms may include itching, burning, and a non-foul discharge. The history will include use of spermicides, douches, bath oils, deodorants, scented tampons or pads, or new detergents.
  • In a hormone deficiency, there may be complaints about vaginal dryness, discomfort during intercourse, and other menopausal symptoms.

Physical exam: A pelvic exam is performed to collect vaginal secretions for testing, to detect other involvement (such as cervicitis), and other co-existing disease. If a hormone deficiency exists, the vagina may have a characteristic appearance with loss of folds (rugae).

Tests: A microscopic examination of vaginal secretions is necessary for a correct diagnosis. It may show yeast cells, vaginal cells coated with bacteria (clue cells), or the Trichomonas parasite. If the microscopic examination is negative, a culture may be done.

The acidity of the vaginal secretions may also be tested. Compared to the normal acidic pH found in the vagina, women with bacterial vaginosis have an alkaline pH. After adding a chemical (potassium hydroxide), vaginal secretions may have a distinctive foul odor (the sniff test).

A blood test can demonstrate a reduction in estrogen level. A Pap test with maturation index may show changes in cells that indicate a reduction in estrogen level.

How is Vaginitis treated?

  • Yeast vaginitis is usually treated with antifungal vaginal creams; oral antifungals agents are sometimes included to treat chronic or recurring episodes.
  • Bacterial vaginosis and trichomoniasis require specific antibiotic treatment available by prescription.
  • Since trichomoniasis is a sexually transmitted disease, it is preferable that both partners are treated at the same time in order to fully eliminate the parasite. Over-the-counter products only mask the symptoms of vaginitis and should not be used as they do not treat the underlying problem.
  • Irritating agents should be avoided in cases of allergic reactions.
  • Appropriate medication may be needed to treat a secondary infection following the removal of a foreign body.
  • Hormone deficiency vaginitis can be treated by estrogen replacement therapy or vaginal estrogen in a cream or a continuous dispensing ring.

Medications

Information Brand Generic Label Rating
Metronidazole Flagyl Metronidazole On-Label
Gardnerella vaginitis treatment
Principen Principen Ampicillin
Postmenopausal atrophic vaginitis
Premarin Conjugated Estrogens

What might complicate it?

The medication used to treat bacterial vaginosis and trichomoniasis can cause side effects, especially nausea and vomiting. Pelvic inflammatory disease can result in infertility and tubal (ectopic) pregnancy. Data now suggests that women with bacterial vaginosis or trichomoniasis may also have increased risk of premature and low birth-weight infants.

Predicted outcome

Full recovery is expected in treated cases of yeast infections, bacterial vaginosis, and trichomoniasis. Avoiding irritating agents should resolve allergic reaction. Hormone replacement therapy is usually effective in reducing the inflammation related to decreased estrogen.

Alternatives

Cervical infections are also associated with abnormal vaginal discharge. Some women normally have a vaginal discharge during ovulation, but it may occasionally become so heavy that it causes concern. Other sexually transmitted diseases can cause vaginal discharge (gonorrhea) or vaginal pain (herpes).

Appropriate specialists

Gynecologist and infectious disease specialist.

Last updated 16 November 2011


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