Causes and Treatments

Vaginitis is one of the most common reasons women present to their gynecologists. Vaginitis is a broad term used to describe inflammation within the vagina.  There are many causes and subsequently many treatments. Making the correct diagnosis is the goal.  

The Vagina

The vagina has a normal discharge as well as a normal pH range.  The vagina produces discharge that is usually clear or white.  This can change with the timing of a woman’s cycle.  The vaginal pH keeps a balance of many organisms such as bacteria and yeast.

Many factors can affect the normal balance of the vagina:

• Antibiotics
• Vaginal dryness due to breastfeeding or menopause
• Perfumed soaps/antiseptic wipes on the vulva (the external region between the pubic bone and the anus)
• Douches (it is not advised to douche)
• Spermicides
• Sexual intercourse
• Sexually transmitted diseases (STDs)
• Retained tampon
• Parasites like trichomoas
• Allergy or immune problems
• Vulvar cancer

A change in the normal pH can result in an overgrowth of bacteria or yeast thereby causing symptoms of vaginitis. Such symptoms usually include change in discharge, vaginal odor, itching, burning, and /or painful sex. Worsening cramping in pregnant women is also a common symptom.

Diagnosis and Treatment

A clinical exam is needed to evaluate for vaginitis.  This includes a careful history as well as a pelvic exam and vaginal swab. Many women self diagnose and self treat- the concern is this can result in a delay in correct treatment and missing the underlying cause.

Types of Vaginitis

Yeast Infection

Yeast infection is caused by a fungus called Candida. Candida is normally found in small amounts in the vagina.  It is only when there is overgrowth that irritating symptoms of yeast vaginitis develop.

Many women who take antibiotics will get yeast infections because the antibiotics alter the vaginal pH and yeast can overgrown.  Women with immunocompromise such as those with diabetes, HIV, chronic steroid use, or receiving chemotherapy have a higher incidence of yeast infection.

Vulvar redness/burning, painful urination, change in vaginal discharge (usually white/cottage cheese/irritating) are just some common symptoms. .

Yeast infections are usually treated by placing medication into the vagina. There are also oral medications.  A portion of yeast infections are chronic and require further workup such as a yeast culture and sensitivities OR longer medication treatment.  Using gentian violet may also be needed.  Keeping the vulva dry, avoiding undue moisture are ways to decrease yeast vaginitis.

Bacterial Vaginosis

The vagina has bacteria but when there is an overgrowth (just like with yeast), bacterial vaginitis can result. The main symptom is increased discharge with a strong fishy odor. Some women notice this more with sex or at time of menses. 

Three antibiotics are used to treat bacterial vaginosis. One is a drug called metronidazole It can be taken by mouth or applied to the vagina as a gel. The other drug is called clindamycin. It works best vaginally.  Tinidazole is an oral treatment.  The newest treatment for NONPREGNANT women ages 15-44 in a one day oral treatment called Solosec (Secnidazole). Secnidazole should not be used in breastfeeding patients.

Avoiding alcohol while on metronidazole is very important as nausea and vomiting can result. Usually there is no need to treat a woman’s sex partner but if the woman has repeated infections, treatment of the partner may be helpful. Some doctors may suggest that the couple not have sex or that they use a condom during treatment.  Having a man wash his penis with soap and water before sex can be helpful.  Washing sex toys with soapy water is also recommended.  Wearing cotton underwear is helpful. 

Pregnant women are always screened for bacterial vaginitis at their first OB visit.  The reason for this is untreated bacterial vaginitis can cause preterm delivery or miscarriage .

Bacterial vaginosis often comes back. Repeat treatment, or longer treatment is sometimes needed. In these cases boric acid placed VAGINALLY only (oral intake can be LETHAL) is often helpful.  Great care should be taken to keep boric acid out of the reach of children.  

Trichomonas Vaginitis

Trichomonas is a parasite that is spread through sex. Women who have trichomonas vaginitis are at higher risk for infection with other STDs.

Signs of trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor. There may be burning, irritation, redness ad welling of the vulva and vagina.

Trichomoniasis is usually treated with a single dose of metronidazole by mouth. Sexual partners must be treated at the same time for treatment to work.

Atrophic Vaginitis

This type of vaginitis is due to low estrogen levels which results in thin vaginal tissue. It can occur during breastfeeding ad after menopause. Symptoms include vaginal dryness and burning. Many treatments exist for vaginal atrophy such as moisturizers, prasterone, vaginal estrogen, and ospemifene.

Finally . . .

Vaginitis is very uncomfortable but it can almost always be successfully treated once the cause has been found.