Vaginitis

Vaginitis: Types, Causes, Symptoms, Treatment and Prevention

Definition

“Vaginitis” is a medical term used to describe various disorders that cause infection or inflammation of the vagina. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from an infection caused by organisms such as bacteria, yeast, or viruses. In addition, irritations from chemicals in creams, sprays, or even clothing that are in contact with this area can result in vaginitis. In some cases, vaginitis results from organisms that are passed between sexual partners and from vaginal dryness and lack of oestrogen.

Epidemiology

Vaginitis is common in adult women and uncommon in prepubertal girls. Bacterial vaginosis accounts for 40-50% of vaginitis cases; vaginal candidiasis, 20-25%; and trichomoniasis, 15-20%.
In US women of childbearing age, bacterial vaginosis is the most common vaginal infection. An estimated 7.4 million new cases of bacterial vaginosis occur each year. National data show that the prevalence is 29%. However, the rate varies in different subpopulations: it is 5-25% in college students and 12-61% in patients with STDs. In the United States, as many as 16% of pregnant women have bacterial vaginosis. 50-60% prevalence is found in female prison inmates and commercial sex workers.
Eighty-five percent of those with bacterial vaginosis are asymptomatic. More than a billion dollars is estimated to be spent annually on both self-treatment and visits to a medical provider.
An estimated 3 million cases of trichomoniasis occur each year in the United States. The worldwide prevalence of trichomoniasis is 174 million; these cases account for 10-25% of all vaginal infections.
Age- and race-related demographics
All age groups are affected. The highest incidence is noted among young, sexually active women. Vaginitis affects all races. The highest incidence of bacterial vaginosis is in blacks (23%), and the lowest is in Asians (6%). Prevalence increases with age among non-Hispanic black women. The incidence is 9% in whites and 16% in Hispanics.

Types

There are several types of vaginitis, depending on the cause.
The most common are:
Atrophic vaginitis: The endothelium, or lining of the vagina, gets thinner when estrogen levels decrease during the menopause, making it more prone to irritation and inflammation.
Bacterial vaginosis: This results from an overgrowth of normal bacteria in the vagina. Patients usually have low levels of a normal vaginal bacteria called lactobacilli.
Trichomonas vaginalis: Sometimes referred to as trich, it is caused by a sexually transmitted, single-celled protozoan parasite, Trichomonas vaginalis. It may infect other parts of the urogenital tract, including the urethra, where urine leaves the body.
Candida albicans: A yeast that causes a fungal infection, known as vaginal thrush. Candida exists in small amounts in the gut and is normally kept in check by normal gut bacteria.

Risk factors

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
Use of spermicides for birth control
Uncontrolled diabetes
Use of hygiene products such as bubble bath, vaginal spray or vaginal deodorant
Douching
Wearing damp or tightfitting clothing
Using an intrauterine device (IUD) for birth control

Causes

The cause depends on what type of vaginitis you have:
Bacterial vaginosis: This most common cause of vaginitis results from a change of the normal bacteria found in your vagina, to overgrowth of one of several other organisms. Usually, bacteria normally found in the vagina (lactobacilli) are outnumbered by other bacteria (anaerobes) in your vagina. 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.
Yeast infections: These occur when there’s an overgrowth of a fungal organism usually C. albicans in your vagina. 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: This common sexually transmitted infection is caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who 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 might cause symptoms. It also increases a women’s risk of getting other sexually transmitted infections.
Noninfectious vaginitis: Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products may cause an allergic reaction or irritate vulvar and vaginal tissues. Foreign objects, such as tissue paper or forgotten tampons, in the vagina can also irritate vaginal tissues.
Genitourinary syndrome of menopause (vaginal atrophy): Reduced oestrogen levels after menopause or surgical removal of your ovaries can cause the vaginal lining to thin, sometimes resulting in vaginal irritation, burning and dryness.

Symptoms

Vaginitis signs and symptoms can 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

If you have vaginal discharge, which many women don’t, the characteristics of the discharge might indicate the type of vaginitis you have. Examples include:
Bacterial vaginosis: You might develop a grayish-white, foul-smelling discharge. The odor, often described as a fishy odor, might be more obvious after sexual intercourse.
Yeast infection: The main symptom is itching, but you might 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.

Diagnosis and test

To diagnose vaginitis, your doctor is likely to:
Review your medical history: This includes your history of vaginal or sexually transmitted infections.
Perform a pelvic exam: During the pelvic exam, your doctor may use an instrument (speculum) to look inside your vagina for inflammation and abnormal discharge.
Collect a sample for lab testing: Your doctor might collect a sample of cervical or vaginal discharge for lab testing to confirm what kind of vaginitis you have.
Perform pH testing: Your doctor might test your vaginal pH by applying a pH test stick or pH paper to the wall of your vagina. An elevated pH can indicate either bacterial vaginosis or trichomoniasis. However, pH testing alone is not a reliable diagnostic test.

Treatment and medications

Treatment depends on the cause. It may include low-potency topical steroids, applied to the skin, topical or oral antibiotics, antifungals, or antibacterial creams.
Medications used to treat a fungal infection include butoconazole and clotrimazole.
Other options include:

Cortisone cream to treat severe irritation.
Antihistamines, if the inflammation appears to stem from an allergic reaction.
Topical oestrogen cream, if the vaginitis is due to low oestrogen levels.

If a woman is pregnant, she should make sure her doctor knows, because vaginitis can affect the fetus, and because some treatment options may not be suitable.

Prevention

The following best practices will help prevent vaginitis:

Good hygiene, using a mild soap without irritants or scents
Wear cotton underwear
Avoiding douching and irritating agents, found in hygiene sprays, soaps, and other feminine products
Always wiping from front to back to avoid spreading bacteria from the anus to the vagina
Wearing loose clothing
Practicing safe sex
Use antibiotics only when necessary
You can learn more about vaginal yeast infections here.