Vaginitis: Symptoms, Causes, and Treatment

When people use the word vagina, they are often erroneously referring to the outer structures of the female genitalia. These external structures are collectively called the vulva and include the labia, clitoris, and vaginal and urethral openings. The vagina is the canal that extends between the uterus and outer genital structures. Vaginitis is inflammation of the vagina, and vulvovaginitis is inflammation of the vagina and vulva, but many people use these terms interchangeably.  


Vaginitis is one of the most frequent reasons people with vaginas seek medical care. Anything that irritates the vagina can bring about vaginitis. Sexually transmitted infections, imbalance of normal microbes found inside the vagina, exposure to an irritating substance, or even hormonal changes may result in a diagnosis. With so many possible causes, contacting a healthcare provider is critical if you have vaginal irritation and do not know why. Vaginitis is not a significant health problem but can lead to complications if you forgo treatment.  


Although there are various reasons you might end up with vaginitis, there are three main culprits responsible for 90% of cases. If you have vaginitis, you most likely have yeast, a non-sexually transmitted bacterial infection, or a one-celled protozoa called Trichomonas. While all three are common and treatable, trichomonas is the only one of the three infections transmitted through sexual contact. Each infection requires treatment to clear it from your body.  


Vaginal Microbiome  


The various microorganisms that innocuously coexist on or in your body are called normal flora. It is advantageous for you to retain a healthy community of these microbes. Normal flora can aid digestion, synthesize vitamins, and reduce pathogenic infections by competing for space and nutrients. They cover your body from head to toe and create a dynamic ecosystem called the human microbiome. Within the human microbiome, different areas on our body act as individual habitats accommodating various species unique to each location.  


Your vagina hosts an entire community of generally harmless and often beneficial microbes. This complex vaginal environment and all the organisms it houses is called the vaginal microbiome. In a healthy microbiome, each organism competes for space and nutrients, thus creating a delicate balance that ensures no individual organism takes over and converts from harmless to pathogenic. Lactobacilli bacteria of various species dominate most vaginal microbiomes.


If the microbial balance gets thrown off for any reason, a commensal or beneficial organism may become pathogenic and outcompete other organisms. Additionally, beneficial bacteria living within the microbiome can prevent unwelcome pathogens from taking hold because there is limited space for them to inhabit. If there is a reduction in normal vaginal bacteria, a pathogen may have access to the room and nutrients it needs to flourish, resulting in an infection.  


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Vaginal Yeast Infection

A vaginal yeast infection, also called vaginal candidiasis, is a type of vulvovaginitis caused by an overgrowth of yeast. With vaginal candidiasis, both the vagina and vulva become inflamed when the yeast naturally found inside the vagina grows unchecked. Candida albicans is the species most often implicated in yeast infections, but other Candida species are also culpable. Vaginal yeast infections affect 75% of women at least once in their lifetimeiii and account for up to 25% of vaginitis cases.iv 


Vaginal Yeast Infection Symptoms 


Symptoms of a vaginal yeast infection vary between individuals. If you are diagnosed with a yeast infection, your symptoms may be mild to severe, and you may all or just a few of the symptoms on the list. Symptoms include:  


  • Itching of the vagina and vulva 

  • Burning sensation that worsens during urination 

  • Painful intercourse 

  • Red, irritated, and swollen vulva 

  • Thick, white cottage cheese-like discharge without odor 

  • Watery, odor-free discharge 

  • Vaginal pain  


You can diagnose and treat your yeast infection if a healthcare provider has previously diagnosed you with one and you begin to experience those familiar symptoms again. 


Causes of Vaginal Yeast Infections 


Yeast is considered normal vaginal flora, which means it is part of a healthy vaginal microbiome and generally lives inside the vagina without causing disease. When something disrupts the balance of organisms inside the vagina, yeast that is typically kept under control by competing microbes begins to grow unrestricted. The excess yeast aggravates the vagina and causes vaginitis. Treatment is necessary for most yeast infections. Rarely do they resolve on their own.  


Diagnosing Vaginal Yeast Infections  


You should see a healthcare provider for a proper diagnosis if this is your first yeast infection. You may need to provide a sample of your vaginal discharge for analysis. Your doctor can have the lab look at it under a microscope or do it themselves if they have the right equipment. This test is called a vaginal wet mount and is valuable in detecting yeast and other causes of vaginitis like bacterial vaginosis or trichomonas.  


Some laboratories also offer DNA amplification tests that look for trichomonas, candida, and the bacteria that causes bacterial vaginosis. When your sample goes to the laboratory, it may take a day or two to get the results back. If symptoms are severe, your doctor may prefer to diagnose your yeast infection based on your history and symptoms to avoid a delay in treatment. 


Treating Yeast Infections 


Vaginal yeast infections require an antifungal to reduce the yeast inside your vagina and stop symptoms. After diagnosis, discuss your treatment options with your doctor to determine which one is right for you. The over-the-counter antifungals available at your local grocery store come as either a cream or capsule and requires insertion into the vagina. Whichever brand you choose will come with an applicator and instructions for use.  


Some vaginal suppositories are a single dose, while others are one dose per day for seven days. Consult a physician if you are unsure which product is best for you. If your doctor has previously diagnosed you with a yeast infection and you are confident your symptoms are from yeast, you can purchase over-the-counter medication and treat yourself. However, make an appointment with a provider if symptoms return or do not go away. You may have another type of vaginitis. 


If a suppository is not suitable for you, your doctor can prescribe an oral antifungal pill. In most cases, a single dose will clear your infection, but you may need a second dose. Regardless of your treatment plan, avoid sexual activity until you have completed your medication and are symptom-free.  


How to Prevent Vaginal Yeast Infections 


You can prevent vaginal yeast overgrowth by not disrupting the balance of your vaginal flora. It sounds simple, but it is not always easy. For example, antibiotic use is sometimes necessary but is also known for increasing the risk of vaginal yeast infections. Taking antibiotics to kill bacteria in one area of your body may also kill off healthy bacteria in another, like your vagina. The reduction of beneficial bacteria leaves room for yeast to thrive.  


Douching, a process in which the vagina is flushed out with either water or a cleansing agent, can also alter the normal vaginal microbiome and allow yeast to take over. Many people will douche if their vagina does not feel right. Ironically, douching offsets the delicate balance of normal vaginal flora and can worsen the irritation. The vagina is self-cleaning and does not require any help. Rinsing the vulva with water or gentle soap is all that’s needed.  


For those with recurring yeast infections, taking probiotics has been shown to improve the number of beneficial bacteria inside the vagina.v Increased healthy bacteria inside the vagina takes resources away from yeast and prevents it from proliferating. You can purchase probiotic supplements as a pill, liquid, or chewable tablet. Fermented foods like yogurt also contain high levels of healthy bacteria and may benefit your diet.  

Bacterial vaginosis

Bacterial vaginosis is a non-sexually transmitted bacterial infection, which means you do not get it from engaging in sexual activity. Like yeast, when there is a reduction in healthy bacteria, the intricate balance within the vagina is disturbed, and unhelpful bacteria begin to grow. Although women in their reproductive years are most affected by it, anyone with a vagina at any age can experience bacterial vaginosis.  


Symptoms of Bacterial vaginosis 


Bacterial vaginosis can be so mild it goes unnoticed or generate intense discomfort. You could have just one or two symptoms or every documented symptom. Each case of bacterial vaginosis will vary between individuals in both presentation and severity. Symptoms can also come and go during a single infection. The hallmark sign of bacterial vaginosis is excessive amounts of thin vaginal discharge with a fishy smell that worsens after sexual intercourse. Other symptoms include vaginal itching, burning, or general irritation that may intensify with urination.  


Causes of Bacterial Vaginosis 


The microbe most commonly responsible for bacterial vaginosis is Gardnerella vaginalis. This bacterium exists as a normal part of the vaginal microbiome but can overgrow if given the opportunity. Together all the microbes of the vagina keep each other in a stable equilibrium so that no single one can dominate their habitat. Just like with yeast, if excess resources become available due to lack of competition, Gardnerella can take hold and cause disease.   


Diagnosing Bacterial Vaginosis 


If you suspect you have bacterial vaginosis, contact a doctor. Treatment will require a prescription medication. You may need to provide a sample of your vaginal discharge as part of the diagnosis process. Your doctor can perform a vaginal wet mount in the office if they have the right supplies, or they may send it to the lab for evaluation.  


During a vaginal wet mount, a doctor or trained laboratory scientist will look at your sample under the microscope and evaluate it for signs of yeast, trichomonas, or bacterial vaginosis. If you have bacterial vaginosis, your sample could show bacteria-laden cells called clue cells. These cells, visible only under a microscope, are vaginal skin cells covered in bacteria and are a strong indicator of bacterial vaginosis.  


Along with looking for clue cells, your doctor may want to test the pH of your vaginal discharge. A normal vagina is mildly acidic. Vaginas with bacterial vaginosis are less acidic and will have a more alkaline pH. Your doctor can do a pH test in the clinic, and the results are available within minutes. Often a microscopic examination and pH test are enough for an accurate diagnosis.   


DNA amplification tests that look for trichomonas, candida, and the bacteria that cause bacterial vaginosis are another diagnostic option for patients with vaginitis. These tests are panel tests because they look for multiple pathogens at once. DNA amplification tests are reliable but require expensive equipment. As a result, your doctor cannot do it in the office and will need to send your sample to the lab.  


Treating Bacterial Vaginosis 


You will need an antibiotic prescription to treat bacterial vaginosis. The antibiotic is either an oral pill or a cream that you insert into your vagina. Continue taking your medication as prescribed, even if symptoms resolve before you have finished your antibiotic. If your symptoms persist after treatment or reoccur, contact your doctor to determine an appropriate treatment plan. Avoid sexual intercourse until you are no longer under the care of a physician for vaginitis.  


How to Prevent Bacterial Vaginosis 


Anything that throws off the balance of normal flora inside the vagina can lead to bacterial vaginosis. Washing the vagina through a process called douching has been shown to increase the risk of this You can rinse the vulva with water or mild, non-scented soap, but the vagina does not require cleaning. If you are experiencing frequent bacterial vaginosis, talk to your doctor about introducing a probiotic supplement into your diet. Evidence supports the use of probiotics to help prevent recurring bacterial vaginosis infections.

Trichomonas vaginalis

A one-celled protozoan called Trichomonas vaginalis is the pathogen responsible for trichomonas infections. This tiny parasite is of no relation to the bacteria Gardnerella vaginalis, which is responsible for bacterial vaginosis. Trichomonas is a sexually transmitted infection that spreads from person to person through intimate sexual contact. It is a common infection and one of the top three causes of vaginitis.  


Trichomonas Symptoms 


About 70% of individuals with trichomonas have no symptoms. However, even if you are asymptomatic, you can still spread the infection to your partner. Men are less likely to have symptoms than women; if they do, their symptoms tend to be mild. Men with trichomonas may have discharge from their penis and burning after peeing or ejaculating. Trichomonas symptoms in women are:  


  • Vaginal or vulva itching 

  • Vaginal or vulva burning 

  • Red or sore genitals 

  • Discomfort with urination 

  • Frothy white, yellow, or green vaginal discharge 

  • Fishy smell 


If you have any abnormal symptoms or have had sex with someone who has trichomonas, refrain from sex and get screened for sexually transmitted diseases.  


Causes of Trichomonas Vaginalis 


Trichomonas is a sexually transmitted parasite spread through intimate sexual activity that involves genital contact. Anyone who is sexually active can get trichomonas, even if you have only had one partner. In women, trichomonas usually infects the vagina and the urethra. In men, it infects the urethra. Trichomonas infection does not spread through casual contact like cuddling, sharing utensils, holding hands, or kissing.  


Diagnosing Trichomonas  


If you have symptoms of trichomonas or believe you have been exposed to it, schedule an appointment with a doctor. Your doctor may want to collect a sample of your vaginal discharge to look at under a microscope or send it out to the lab for testing. Like with yeast and bacterial vaginosis, a trained professional can see Trichomonas under a microscope. This type of diagnostic test is called a vaginal wet mount.  


DNA amplification testing can also tell your doctor if you have a trichomonas infection, but this test requires your sample to be sent to the lab. Samples sent out take longer to get results and potentially delay treatment. Both a microscopic evaluation and DNA amplification can rule out other common causes of vaginitis. Some doctors’ offices have the resources to perform a vaginal wet mounts in their office, but only a specialized lab can perform DNA amplification.  


Trichomonas Vaginalis Treatment 


If you have trichomonas, you will need an antibiotic prescribed to you by a doctor. Follow the instructions closely and continue taking your medication until you have completed the appropriate course, even if symptoms improve before you finish. Treatment is very effective when taken correctly. However, without treatment, or when treatment is incomplete, the infection can persist long-term. Avoid sexual activity during treatment and until you no longer have symptoms.  


Preventing Trichomonas Infection 


Get an annual health exam and inform your doctor if you are sexually active. Because trichomonas is a sexually transmitted infection, the best way to prevent it is to either not have intercourse or use a condom every time. If you choose not to use a condom, you can practice sexual monogamy after you and your partner have been screened for and cleared of sexually transmitted infections.  


If you are being treated for trichomonas or any other sexually transmitted infection, refrain from sexual activity to avoid spreading the disease. Sexually transmitted infections like trichomonas are common among sexually active demographics and should not be a cause of shame or embarrassment. See a doctor if you have abnormal symptoms or are concerned you may have contracted a sexually transmitted infection.  

Other Causes of Vaginitis

Although just three primary offenders are responsible for most vaginitis diagnoses, it can result from anything that causes inflammation or irritation of the vagina. Allergic reactions, hormonal changes, and sexually transmitted infections other than trichomonas also result in vaginal irritation.   


Vaginitis Caused by Sexually Transmitted Infections  


Non-trichomonas sexually transmitted infections come in both bacterial and viral varieties. The two most common bacterial causes are chlamydia and gonorrhea. Both are common bacterial infections that require prescription antibiotics to treat. Many people with either condition will have no symptoms but can still spread it to their partners. Even asymptomatic infections can have negative consequences on your health. Condoms, monogamy, and annual screenings prevent the spreading of these two infections.  


Human papillomavirus (HPV) and herpes simplex virus (HSV) are two sexually transmitted viruses frequent among sexually active people that can produce vaginitis. HSV comes in two types, one and two. HSV1 more often infects the skin or mucous membranes around the mouth, while HSV2 is more likely to infect the skin or mucous membranes around the genitalia, but both types can occur in either location. HSV is common among adults. About 60% of people in the United States have HSV1 or HSV2. 


HPV is another less common culprit of vaginitis. Most people fight off the virus without ever knowing they have contracted HPV. Those who don’t clear HPV may grow irritating lesions or warts that can grow anywhere around the genital area, including inside the vagina. HPV can also lead to cancer of the cervix, anus, vulva, vagina, penis, and throat. Fortunately, a vaccine is available that prevents 90% of cancers caused by HPV. 


Allergic Vaginitis 


Vaginal irritation not caused by an infection could result from an allergic reaction. Anything that comes into contact with your genitals has the potential to aggravate your skin. You should discontinue using latex condoms, vaginal sprays, douches, or cleaning products if you have vaginal inflammation and do not know why. Even certain detergents or fabric softeners can irritate sensitive skin. Additionally, if you are treating a yeast infection and notice an increase in irritation or swelling after beginning treatment, you could be allergic to the antifungal cream.  


Atrophic Vaginitis 


Vaginal atrophy is thinning and drying of the vaginal walls. The change in vaginal tissue can lead to irritation and vaginitis. This atrophy is often due to a reduction in estrogen during menopause. However, anything that reduces estrogen can result in vaginal atrophy. If you have this bothersome condition, you may notice dryness, itching, painful intercourse, or burning with urination. You can usually remedy vaginal atrophy with hormone replacement therapy when menopause is the trigger, but treatment will vary depending on the cause.  

Schedule a Telemedicine Visit for More Information on Vaginal Irritation

Vaginitis is an uncomfortable condition with an impressive resume of causes. From an overgrowth of different types of normal vaginal microbes to an allergic reaction, determining the reason behind your vaginitis is essential to your health. In most cases, a general practitioner can diagnose and manage your condition. You may not even need to submit a sample or undergo a pelvic exam. Depending on your situation, you could receive appropriate medication based on your medical history and symptoms alone. An in-person visit may not be necessary.  


Although it can be troubling to have vaginitis, it is treatable, but you need to contact a doctor. Without treatment, vaginitis can lead to complications and painful symptoms. Whether your irritation results from a sexually transmitted infection or a hormonal imbalance, telemedicine is a great place to start. You may want to contact us if you are unsure what type of doctor to see or are uncomfortable discussing your concerns in person. Whatever your reasons, licensed doctors are available to discuss any of your symptoms and answer all your questions so that you can get diagnosed, treated, and start feeling better.  


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