Vaginitis

(Vaginal Irritation, Vaginal Discharge, Female Yeast Infection, Yeast Infection)

The Facts

The vagina has its own chemical balance, which can be easily disturbed. If the lining of the vagina becomes inflamed, a condition known as vaginitis may develop. This can occur in people of all ages.

The Causes

There are many different causes of vaginitis.

Non-infectious vaginitis refers to vaginal inflammation that's due to chemical irritants or allergies. Spermicides, douches, detergents, fabric softeners, and latex condoms can all irritate the vaginal lining. Also, some sanitary napkins can cause irritation at the entrance to the vagina.

Atrophic vaginitis may occur after a person has reached menopause. It results from lower hormone (estrogen) levels and the thinning of the vaginal lining caused by them. This makes the vagina more prone to irritation.

Infectious vaginitis is caused by an infection with bacteria or yeast. Trichomoniasis is caused by a parasite called Trichomonas vaginalis and spreads through unprotected sex with an infected partner. Other types of vaginal infections can occur when a person has a fistula, an abnormal passage connecting the intestine to the vagina. This allows stool to enter the vaginal area, greatly increasing the risk of infections.

Bacterial vaginosis may be due to an imbalance between normally occurring bacteria that protect the vagina and potentially infectious ones. Cigarette smoking, using intrauterine devices, douching, and having multiple sexual partners have all been shown to increase the risk of infection. Bacterial vaginosis is not considered a sexually transmitted infection, however, since it can occur in people who have never had vaginal intercourse.

Yeast infection, also known as vaginal candidiasis, occurs when there is an overgrowth of the yeast called Candida that normally lives in the vagina. Yeast infections can occur if you're taking antibiotics, if you have high levels of estrogen (for instance, during pregnancy or if you are taking oral contraceptive pills), if you have uncontrolled diabetes, or if your immune system is suppressed. Anything that changes the type and amount of bacteria normally present in the vagina, such as douching or irritation from inadequate vaginal lubrication can increase risk. A yeast infection can be sexually transmitted, especially through oral-genital sexual contact. However, yeast infection isn't considered a sexually transmitted infection because it happens in people who aren't sexually active and the candida fungus is naturally present in the vagina.

Newborns can also have vaginal inflammation and discharge for the first couple weeks of life, caused by exposure to the birth parent's estrogen just prior to birth. A common cause of vaginitis in children aged 2 to 6 is poor hygiene.

Symptoms And Complications

General symptoms of vaginitis can include discharge, odour, irritation, and itching. In some cases, people have no symptoms even if they have a bacterial infection. Generally, bacterial vaginitis causes itching and burning during urination or after sexual intercourse. There may also be whitish discharge with an unpleasant ("fishy") odour. The discharge may be more noticeable after sex.

Symptoms of trichomoniasis can be quite severe for some people, whereas others may have no symptoms at all. Trichomoniasis causes vaginal soreness and, sometimes, abdominal discomfort. It can lead to heavy yellow-green or grey discharge accompanied by an unpleasant odour. Urination and sexual intercourse can be painful. If left untreated during pregnancy, trichomoniasis can lead to premature labour. It can also increase the risk of HIV acquisition and infection.

Symptoms of yeast infections include vaginal itching and painful urination. The labia (vaginal lips) often swell and can be quite sore. There may be a thick and whitish discharge that can look like cottage cheese. Yeast infections can also lead to pain or discomfort during sex.

Irritant or allergic vaginitis can cause mild-to-severe itching or burning of the vagina, which often becomes swollen and red. This type of vaginitis doesn't cause a vaginal discharge.

*Atrophic vaginitis *often causes no symptoms. However, some people have dry, sore vaginas, which may be red and irritated. Sexual intercourse is painful and is often followed by a burning feeling. Occasional spotting (light bleeding) and watery discharge are common with this type of vaginitis.

Making A Diagnosis

Your doctor will first consider your history of vaginal infections or sexually transmitted infections and perform a physical or pelvic examination. If you have a discharge from your vagina, a sample will be sent to a lab for analysis to determine whether there's an infection or not. The doctor will check your vaginal pH, as this may provide a clue to the cause of the vaginitis.

If an infection is ruled out, your doctor will ask questions about what chemicals or irritants (e.g., douches or latex condoms) your vagina has been exposed to.

In some cases, vaginitis can be diagnosed simply by considering a person's age, as postmenopausal people are prone to irritation of the vaginal lining.

Treatment And Prevention

Treatment of vaginitis depends on the cause:

Tablets, gels, or creams are used to treat bacterial vaginitis. Some treatments might not be safe to use with alcohol or during pregnancy, and certain vaginal creams can weaken latex condoms. Talk to your doctor or pharmacist about how to safely use the medication prescribed. Contact your doctor if symptoms return after treatment.

Trichomoniasis requires either a single dose or a 7-day course of prescription of metronidazole, an antibiotic, and sexual partners should be treated at the same time to prevent them from reinfecting each other. Intercourse should also be avoided until both the antibiotic therapy and the symptoms have resolved. Pregnant people should consult their doctors regarding the safety of the treatment. You can help prevent Trichomonas vaginalis infection by limiting the number of sexual partners and by ensuring your partner always uses a condom during sexual intercourse.

Antifungal oral pills, vaginal tablets and suppositories, or creams are available for vaginal yeast infections. It's a good idea to seek your doctor's opinion before purchasing over-the-counter products. It's especially important to see your doctor if:

it's your first yeast infection
you're pregnant or breast-feeding
the treatments you've tried haven't worked
the infection keeps coming back
you're not sure it's a yeast infection
if the infection has come back within 2 months
you have any health conditions that weaken your immune system (such as HIV)
you also have pelvic pain, fever, or a coloured or unpleasant-smelling vaginal discharge

Some people have frequent yeast infections. If you've had 4 or more infections in the last year, see your doctor. Prescription products are also available.

Your doctor can also recommend a steroid ointment or cream to reduce the redness, swelling, and itching that can be caused by irritative or allergic vaginitis. Sitting in a cool sitz bath with baking soda or Epsom salts can provide some relief. It's important to identify the cause of the vaginitis so that irritants can be avoided in the future.

Atrophic vaginitis might be minimized by using estrogen therapy or lubricants. Estrogen therapy is not for everyone – talk to your doctor about whether it's a good choice for you.

If you have diabetes, managing your blood sugar helps reduce your chances of getting vaginitis from a yeast infection.

Using condoms can prevent infectious vaginitis. Good toilet habits are also helpful; wiping from front to back lowers the chance of spreading bacteria from the anus to the vagina.

Tips to keep your vaginal skin healthy and prevent non-infectious vaginitis include the following:

Avoid prolonged moisture and friction, for instance rubbing vigorously with a towel.
Don't wear wet or damp bathing suits or exercise clothes for long periods of time.
Wear cotton underwear which provide some air-flow.
Wear loose-fitting slacks.
Avoid pantyhose.
Find alternative contraceptives if your skin is irritated by lubricated condoms, jellies, creams, or sponges.
Keep the area around the genitals clean and dry.
Avoid irritants such as douches, feminine hygiene sprays, deodorized sanitary pads or tampons, and coloured or perfumed toilet paper.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.