Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection. Vaginitis can also result from reduced estrogen levels after menopause.
The most common types of vaginitis are:
- Bacterial vaginosis, which results from overgrowth of one of several organisms normally present in your vagina
- Yeast infections, which are usually caused by a naturally occurring fungus called Candida albicans
- Trichomoniasis, which is caused by a parasite and is commonly transmitted by sexual intercourse
- Vaginal atrophy (atrophic vaginitis), which results from reduced estrogen levels after menopause
Treatment depends on the type of vaginitis you have.
Vaginitis signs and symptoms may include:
- Change in color, odor or amount of discharge from your vagina
- Vaginal itching or irritation
- Pain during intercourse
- Painful urination
- Light vaginal bleeding or spotting
The characteristics of vaginal discharge may indicate the type of vaginitis you have. Examples include:
- Bacterial vaginosis. You may develop a grayish-white, foul-smelling discharge. The odor, often described as fish-like, may be more obvious after sexual intercourse.
- Yeast infection. The main symptom is itching, but you may have a white, thick discharge that resembles cottage cheese.
- Trichomoniasis. An infection called trichomoniasis (trik-o-moe-NIE-uh-sis) can cause a greenish yellow, sometimes frothy discharge.
When to see a doctor
See your doctor if you develop any unusual vaginal discomfort, especially if:
- You've never had a vaginal infection. Seeing your doctor can establish the cause and help you learn to identify the signs and symptoms.
- You've had vaginal infections before, but in this case, it seems different.
- You've had multiple sex partners or a recent new partner. You could have a sexually transmitted infection. The signs and symptoms of some sexually transmitted infections are similar to those of a yeast infection or bacterial vaginosis.
- You've completed a course of over-the-counter anti-yeast medication and your symptoms persist, you have a fever, or you have a particularly unpleasant vaginal odor. These are signs the infection may be from something other than yeast or from a resistant strain of yeast.
You probably don't need to see your doctor every time you have vaginal irritation and discharge, particularly if:
- You've previously had a diagnosis of vaginal yeast infections and your signs and symptoms are the same as before
- You know the signs and symptoms of a yeast infection and you're confident that you have a yeast infection
The cause depends on the type of vaginitis you have.
Bacterial vaginosis results from an overgrowth of one of several organisms normally present in your vagina. Usually, "good" bacteria (lactobacilli) outnumber "bad" bacteria (anaerobes) in your vagina. But if anaerobic bacteria become too numerous, they upset the balance, causing bacterial vaginosis. This type of vaginitis seems to be linked to sexual intercourse — especially if you have multiple sex partners or a new sex partner — but it also occurs in women who aren't sexually active.
A yeast infection occurs when there's an overgrowth of a fungal organism — usually C. albicans — in your vagina. Besides causing most vaginal yeast infections, C. albicans also causes infections in other moist areas of your body, such as in your mouth (thrush), skin folds and nail beds. The fungus can also cause diaper rash.
Trichomoniasis is a common sexually transmitted infection caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection. In men, the organism usually infects the urinary tract, but often it causes no symptoms. In women, trichomoniasis typically infects the vagina, and usually it causes symptoms.
Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products may cause an allergic reaction or irritate vulvar and vaginal tissues. Thinning of the vaginal lining — a result of decreased hormone levels following menopause or surgical removal of your ovaries — can also cause vaginal itching and burning.
Factors that increase your risk of developing vaginitis include:
- Hormonal changes, such as those associated with pregnancy, birth control pills or menopause
- Sexual activity
- Having a sexually transmitted infection
- Medications, such as antibiotics and steroids
- Uncontrolled diabetes
- Use of hygiene products such as bubble bath, vaginal spray or vaginal deodorant
- Wearing damp or tight-fitting clothing
- Using an intrauterine device (IUD) for birth control
Generally, vaginal infections don't cause serious complications. In pregnant women, however, symptomatic bacterial vaginosis and trichomoniasis have been associated with premature deliveries and low birth weight babies. Women with trichomoniasis or bacterial vaginosis are also at a greater risk of acquiring HIV and other sexually transmitted infections.
Your family doctor, gynecologist or another medical practitioner can diagnose and prescribe treatment for vaginitis.
What you can do
To get ready for your appointment:
- Make a list of your symptoms and how long you've had them.
- Note key medical information, including any other conditions for which you're being treated and the names of medications, vitamins or other supplements you're taking.
- Avoid using tampons or douching before your appointment so that your doctor can assess any vaginal discharge you have.
- Make a list of questions to ask your doctor, putting the most important ones first in case time runs short.
For vaginitis, some basic questions include:
- Can I do anything to prevent vaginitis?
- What signs and symptoms should I watch for?
- Do I need to use medicine?
- Are there any special instructions for using the medicine?
- Are there any over-the-counter products that will treat my condition?
- What can I do if my symptoms return after treatment?
- Does my partner also need to be tested or treated?
During your appointment, don't hesitate to ask other questions as they occur to you.
Questions your doctor may ask
Be prepared to answer questions your doctor may have, such as:
- What symptoms are you experiencing?
- Do you notice a strong vaginal odor?
- How long have you had your symptoms?
- Do your symptoms seem tied to your menstrual cycle? For instance, are symptoms more intense just before or just after your period?
- Have you tried any over-the-counter products to treat your condition?
- Are you sexually active?
- Are you pregnant?
- Do you use scented soap or bubble bath?
- Do you douche or use feminine hygiene spray?
- What medications, vitamins or other supplements do you regularly take?
To diagnose vaginitis, your doctor may:
- Review your medical history, including your history of vaginal or sexually transmitted infections.
- Perform a pelvic exam. During the pelvic exam, your doctor may collect a sample of cervical or vaginal discharge for lab testing to confirm what kind of vaginitis you have.
A variety of organisms and conditions can cause vaginitis, so treatment targets the specific cause:
- Bacterial vaginosis. For this type of vaginitis, your doctor may prescribe metronidazole tablets (Flagyl) that you take by mouth, metronidazole gel (MetroGel) that you apply to your vagina or clindamycin cream (Cleocin) that you apply to your vagina. Medications are usually used once or twice a day for five to seven days.
- Yeast infections. Yeast infections usually are treated with an antifungal cream or suppository, such as miconazole (Monistat), clotrimazole (Gyne-Lotrimin) or tioconazole (Vagistat). Yeast infections may also be treated with a prescription oral antifungal medication, such as fluconazole (Diflucan). The advantages of over-the-counter treatment are convenience, cost and not waiting to see your doctor. The catch is you may be treating something other than a yeast infection. It's possible to mistake a yeast infection for other types of vaginitis or conditions that need different treatment. Using the wrong medicine may delay an accurate diagnosis and proper treatment.
- Trichomoniasis. Your doctor may prescribe metronidazole (Flagyl) or tinidazole (Tindamax) tablets.
- Thinning of vaginal lining (vaginal atrophy). Estrogen — in the form of vaginal creams, tablets or rings — can effectively treat atrophic vaginitis. This treatment is available by prescription from your doctor.
- Noninfectious vaginitis. To treat this type of vaginitis, you need to pinpoint the source of the irritation and avoid it. Possible sources include new soap, laundry detergent, sanitary napkins or tampons. Your doctor may prescribe topical estrogen, such as a cream, to relieve your symptoms.
You'll need prescription medication to treat trichomoniasis, bacterial vaginosis and vaginal atrophy. If you know you have a yeast infection, you may go ahead with treatment on your own, taking these steps:
- Use an over-the-counter medication specifically for yeast infections. Options include one-day, three-day or seven-day courses of cream or vaginal suppositories. The active ingredient varies, depending on the product: clotrimazole (Gyne-Lotrimin), miconazole (Monistat) or tioconazole (Vagistat). Some products also come with an external cream to apply to the labia and opening of the vagina. Follow package directions and complete the entire course of treatment, even if you're feeling better right away.
- Apply a cold compress, such as a washcloth, to the labial area to ease discomfort until the antifungal medication takes full effect.
Good hygiene may prevent some types of vaginitis from recurring and may relieve some symptoms:
- Avoid baths, hot tubs and whirlpool spas. Rinse soap from your outer genital area after a shower, and dry the area well to prevent irritation. Don't use scented or harsh soaps, such as those with deodorant or antibacterial action.
- Avoid irritants. These include scented tampons and pads.
- Wipe from front to back after using the toilet. Doing so avoids spreading fecal bacteria to your vagina.
Other things that may help prevent vaginitis include:
- Don't douche. Your vagina doesn't require cleansing other than normal bathing. Repetitive douching disrupts the normal organisms that reside in the vagina and can actually increase your risk of vaginal infection. Douching won't clear up a vaginal infection.
- Use a latex condom. Both male and female latex condoms may help you avoid infections spread by sexual contact.
- Wear cotton underwear. Also wear pantyhose with a cotton crotch. If you feel comfortable without it, skip wearing underwear to bed. Yeast thrives in moist environments.
March 06, 2014
- Sobel J. Approach to women with symptoms of vaginitis. http://www.uptodate.com/home. Accessed Oct. 3, 2013.
- Centers for Disease Control and Prevention, et al. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recommendations and Reports. 2010;59:1. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm. Accessed Oct. 3, 2013.
- Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.clinicalkey.com. Accessed Oct. 3, 2013.
- Hainer BL, et al. Vaginitis: Diagnosis and treatment. American Family Physician. 2011;83:807.
- American College of Obstetricians and Gynecologists. Vaginitis. Obstetrics & Gynecology. 2006;107:1195.
- Vaginal yeast infections fact sheet. Office on Women's Health. http://www.womenshealth.gov/publications/our-publications/fact-sheet/vaginal-yeast-infections.cfm. Accessed Oct. 8, 2013.
- Condom fact sheet in brief. Centers for Disease Control and Prevention. http://www.cdc.gov/condomeffectiveness/brief.html. Accessed Oct. 8, 2013.
- Sobel J. Trichomoniasis. http://www.uptodate.com/home. Accessed Oct. 9, 2013.
- Marnach ML (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 1, 2013.