Vaginitis is also known as vulvovaginitis, is an inflammation of the vagina and vulva(the external part of female genitals). It is a medical term used to define an infected or inflammation condition of the vagina. These conditions can result in terms of infection from organisms like bacteria, yeast or viruses. It has symptoms of itching, burning, pain, vaginal discharge, and bad odor.
The main cause of this is an infection or the change in the bacterial volume in the vagina. Sometimes it has also been seen that reduction in estrogen level, some skin disorder and using a substance a person is allergic from can lead to vaginitis. A certain form of vaginitis may results in complications during pregnancy. More than one cause may be the reason for the disease.
Diagnosis generally includes examination, measuring the pH, and culturing the vaginal discharge for infection. Almost every woman faced it at least once in their lifetime. Women with reproductive age are most often affected.
A woman’s vagina normally produces a discharge. It is usually described as clear or slightly cloudy, non-irritating and with very little odor. During the normal menstrual cycle, at one time of the month, there may be a small amount of a very thin or watery discharge. But the latter part of the menstrual cycle, a more extensive thicker discharge may appear. These discharge conditions are normal.
A vaginal discharge that has an odor or irritating usually is considered an abnormal discharge. The irritation may be itching, burning, or both and the burning could feel like a bladder infection. The itching may be possible at any time of the day, but it often is most bothersome at night. These symptoms are often getting worse by sexual intercourse.
Types of Vaginitis
The most common types of vaginitis are:
- Yeast or Candida vaginitis
- Bacterial vaginosis
- Trichomoniasis vaginitis
- Non-infectious vaginitis
- Atrophic vaginitis
- Aerobic vaginitis
Each type of vaginitis can have different symptoms or it may be possible that there are no symptoms at all. In fact, to diagnose the symptoms can even be tricky for an experienced clinician. Sometimes more than one type of vaginitis may be present at the same time.
To better understand different types of vaginitis and the cause related to them, I have described briefly each of them. Let’s have a look.
1.Yeast or Candida vaginitis:
Candida vaginitis is commonly known as yeast or fungal infection. Yeast infections of the vagina are what most women think while hearing the term vaginitis. Many species of fungus are present but the yeast infections are caused by candida. Candida normally presents in the vagina, as well as in the mouth and digestive tract. An infection occurs when the normally occurring candida increase in number to cause annoying symptoms.
Yeast infections cause a watery, thick, and white vaginal discharge, it resembles with cottage cheese and it is generally odorless. This usually causes the vagina and the vulva to be very itchy and red, sometimes swollen even before the onset of discharge. The vulva may have small cuts due to friable skin of the area in yeast infection and may have burning during urination.
Usually, yeast is already present in the vagina, but the infection occurs when a change in the balance of a woman’s system takes place.
Bacterial vaginosis(BV) is the most common vaginal infection in women of reproductive age. Gardnerella is a bacteria that cause this disease. Bacterial vaginosis often causes an abnormal smelling vaginal discharge. The discharge usually is thin and milky and has a fish-like odor. This odor may become more obvious after sexual intercourse.
Itching, irritating or redness of the vagina are common symptoms of bacterial vaginosis and sometimes no symptoms are seen at all, this diagnosed only during a routine gynecologic check-up. Bacterial vaginosis is caused by a combination of several bacteria that live in the vagina. These bacteria seem to overgrow when the vaginal pH balance changed or disturbed. Bacterial vaginosis is not a sexually transmitted disease or infection, but it is seen more often in sexually active people.
Trichomoniasis is caused by protozoa, a single cell organism. When this organism infects the vagina, it can cause a profuse, greenish-yellow discharge and may have a foul smell. Symptoms seen in a woman with trichomoniasis may be itching and soreness of the vagina as well as burning during urination. In addition, there can be discomfort in the lower abdomen and painful intercourse. These symptoms may be worse after the menstrual cycle. Many women do not develop any of the symptoms. It is important to understand that Trichomoniasis vaginitis can be transmitted through sexual intercourse.
Sometimes, a woman can have itching, burning, and even a vaginal discharge, without having an infection. The most common cause is an allergic reaction or irritation. The use of vaginal sprays, douches or spermicidal products can lead to an allergic reaction. However, the skin around the vagina is so sensitive that using any harsh or perfumed soaps, lotions, sexual lubricants, detergents, and fabric softeners can cause allergy or irritation.
Atrophic vaginitis, also referred to as genitourinary symptoms of menopause(the time when periods stop). This occurs due to a decreasing hormone level during and after menopause. The vagina becomes dry or atrophic in this type of vaginitis. The woman may notice itching and burning, or symptoms of urinary urgency and pain after sexual intercourse.
Women with aerobic vaginitis show symptoms like burning, stinging and painful intercourse and yellowish discharge with the unpleasant smell are also seen. Symptoms can last for man years. sometimes no symptoms are found in the person having the infection.
What are the causes of Vaginitis?
The main cause of vaginitis is Infection, it may be a bacterial infection, yeast or fungal infection and protozoan infection. Although some other causes are also responsible for vaginitis which are discussed below:
Hormonal changes or imbalances: It is mainly seen in decreasing the level of estrogen during and after menopause. It is also associated with pregnancy or usage of birth control pills. The reason for reducing the estrogen level is breastfeeding, having ovaries removed or damage to your ovaries.
Sexual intercourse or Sexually transmitted infection: If you don’t take safety measures during intercourse, especially if you have multiple sex partners or a new sex partner it can lead to bacterial vaginosis. This mostly occurs in women who are sexually inactive.
Medications: Taking antibiotics and steroids can disturb the normal bacterial flora of the vagina.As antibiotics kill many friendly bacteria and cause the infection.
Spermicides: The use of spermicides for birth control can increase the risk of vaginitis. Using an intrauterine device (IUD) for birth control or certain types of lubricants, latex and condoms also cause the allergy in the vagina.
Uncontrolled diabetes: Women with diabetes are more prone to vaginitis.
Use of vaginal spray or vaginal deodorant: Some women are allergic to these products and using this product can cause irritation, lead to the disease. Using feminine hygiene products or scented toilet papers also affects.
Douching: Cleaning or washing out of the inside vagina with water or liquid.
Wearing damp: Wearing tight-fitting clothes or wet suits for a long time can cause irritation in the vagina. Even swimming can cause irritation. Using underwear without a cotton crotch.
Sexual intercourse is the most common means of transmission for vaginitis, although it is not a sexually transmitted disease. But it can occur due to the infection from a person having sexual intercourse. It is not the only means of infection. Some experts believe that having multiple sexual partners or new partners can increase the risk of bacterial vaginosis, which is particularly related to this. Yeast infections and bacterial infections are sexually associated infections according to healthcare professionals. Women who are sexually active contract them more frequently.
Signs and Symptoms of Vaginitis
The most common symptoms of vaginitis include:
- Inflammation, leading to swelling, redness or irritation caused by excess immune cells present in labia majora, labia minora or perineal area.
- Irritation of the genital area.
- Burning, itching, and pain in your vulva or vagina.
- Vaginal discharge that may be white, gray, watery, and foamy.
- Foul or bad vaginal odor.
- Pain during sexual intercourse.
- Painful urination or dysuria, discomfort during urination.
- Light vaginal spotting.
Some of the symptoms are super obvious in women having vaginitis, but sometimes there are no symptoms at all. So, it is better to pay attention to your vaginal discharge, how it smells, looks, and feels.
Vaginal infections left untreated can lead to further complications, during pregnancy or in the pregnant woman. For bacterial vaginosis, these include premature delivery, postpartum infections, pelvic inflammatory disease. And postsurgical complications like abortion, hysterectomy, and cesarean section increased vulnerability to HIV(human immunodeficiency virus) infection and possibly infertility. According to research, it is stated that vaginitis increases the number of immune cells at the site of infection and HIV then infects those immune cells.
There are complications which lead to daily discomfort are:
- Persistent pain
- Superficial skin infection
- Complications of the causative condition like gonorrhea and candida infection.
Diagnosis is based on women’s symptoms. The doctor will perform some test to diagnose the vaginitis:
Vaginal wet mount: It is a gynecologic test wherein a sample of vaginal discharge is observed by wet mount microscopy by placing the sample on a glass slide.
Medical History: Review your medical history of the vagina to know about any vaginal infection or sexually transmitted infection.
Pelvic Exam: The doctor will perform a pelvic exam using an instrument called speculum. During the test, the doctor will look inside the vagina for inflammation and abnormal discharge.
Sample for lab testing: The doctor might take your vaginal discharge to analyze the color, consistency, acidity, and other characteristics of the discharge, to confirm what kind of vaginitis you have and about the causative agent.
Perform a pH test: Your doctor might test your vaginal pH by applying a pH test stick or pH paper in your vagina. An elevated pH can indicate either bacterial vaginosis or trichomoniasis. However, performing only pH testing is not a reliable diagnostic test.
Another type of vaginitis, named as desquamative inflammatory vaginitis (DIV) also exists. DIV leads to the severe forms of aerobic vaginitis. Very few women are affected by this. The cause of this type is still poorly understood.
Determining the causative agent is important because women may have more than one infection. Sometimes symptoms that overlap with another infection, which requires different treatment processes to cure the infection.
Treatment and Management of the Vaginitis
Proper diagnosis and cause of infection determine the appropriate treatment. There are different types of vaginitis present and it is not easy since the same symptoms exist in a different form of vaginitis. The important thing is to understand the medication of particular vaginitis will cure that only. If you take the medication for yeast vaginitis, it cures that only not others. So, taking medication is also depends on which type of vaginitis you have according to symptoms and when they occur.
Bacterial vaginosis or vaginitis:
For this type of vaginitis, your doctor may prescribe metronidazole, available in the form of pills or tablets and in the form of a gel to directly apply on the vagina. Clindamycin is a cream that you apply to your vagina.
Yeast infections usually are treated with an antifungal cream or suppository, such as Local Azole. The advantages of suppository treatment are convenience, cost-effective and not waiting to see your doctor. If you take proper medication, it will cure in 3 to 7 days.
Your doctor may prescribe metronidazole or tinidazole tablets. The patient should be advised to avoid sexual intercourse for at least one week. The sexual partner should be treated simultaneously.
Estrogen is available in the form of vaginal creams, tablets or rings that can effectively treat this condition. This treatment only prescribed after analysis of other risk factors and possible complications by your doctor.
The vaginal skin is sensitive, using the harsh chemical product can cause irritation. To treat this type of vaginitis, you need to know the source of the irritation and avoid it. Possible sources include new soap, laundry detergent, sanitary napkins or tampons, fabric softener, vaginal spray, and douche.
For treatment, the patient can use topical steroids to reduce the inflammation or can take antibiotics to kill the proportion of aerobic bacteria. Vaginal rinsing with a povidone-iodine solution can provide relief in symptoms but does not provide long-term reduction of bacteria.
Home remedies or Natural treatment
Apart from the medications prescribed by a doctor you can also opt for various home remedies for vaginitis. It is not much effective as medication prescribed by the doctor but may not have any side effects as medicine have. Some of the best home remedies to treat vaginitis are given below:
Probiotic means containing a high amount of bacteria in it. Yogurt is a well known natural probiotic. Taking probiotic supplements daily helps in treating and preventing bacterial vaginosis. This helps in establishing a balanced bacterial environment.
It has a high antibacterial property helps in killing the unwanted bacterial microflora. Taking garlic supplement in a form of pills or tablet helps in treating bacterial vaginosis. People with sensitive skin may experience burning and even skin damage. As such, people should not use garlic if they have sensitive skin.
Tea Tree Oil:
It has very powerful antibacterial and antifungal properties, that help to treat bacterial and fungal infections. Before using tea tree oil mix it with coconut oil and apply. Do not use tea tree oil without mixing it with any other carrier oil as it can cause burn on the skin. Some people are allergic to the oil, before applying it on the vagina check it on another part of skin whether it causes an allergic reaction or not. If it does not cause any reaction it is safe to use.
It has many antifungal properties and it is useful in treating a yeast infection or yeast vaginitis. Coconut oil can be applied externally or internally. It can be used as a carrier oil with essential oil. It is also used for cooking so before buying it take a look at the product.
Oil of oregano:
Oil of oregano made from the wild oregano plant, Origanum vulgare, contains two potent antifungals: thymol and carvacrol.it helps in inhibiting the growth of fungi or candida. Capsules containing oil may be inserted in the vagina at night. Tampon filled with oil can be used or insert into the vagina.
Oil should be mixed with carrier oils like coconut oil, olive oil before use and never applied directly to the skin. People can mix 3 to 5 drops of oil of oregano essential oil in 1 ounce of sweet almond oil, warmed coconut oil, or olive oil. Before using a tampon it should be soaked in this mixture for a few minutes, then insert and change every 2 to 4 hours during the day. People should not leave a medicated tampon in for a long period of time. It is a good idea to test for allergies to the oil of oregano applying it on the forearm before use.
The boric acid capsule is used to treat both bacterial and fungal vaginitis. It can be inserted into the vagina every night for two weeks to treat the infection.
Apply a Cold compress:
Using washcloth helps in lowering the temperature, as a result reducing the pain and swelling.
When to avoid home remedies:
Many home remedies are safe for the infection. However, the following people should not try to treat themselves:
- Pregnant women.
- A person exposed to sexually transmitted infection.
- People with recurrent bacterial or fungal infection.
- People who are unsure of their symptoms.
What questions you should ask the doctor about treatment for vaginitis?
It is important to follow your doctor’s instructions, as well as the instructions that come with the medication. Do not stop taking the medicine when your symptoms are gone. Do not be embarrassed to ask questions to your doctor or health care professional. All types of vaginitis are very common.
Questions to ask include:
- Should I avoid sexual intercourse during treatment?
- Should my sexual partner be treated at the same time?
- Will the medication for this vaginitis interact with my other medication?
- Should I continue the vaginal cream or suppositories during my period?
- Do I need to be reexamined and if so, when?
Prevention from vaginitis
Doing certain things can decrease the chance of getting any type of vaginitis. The following practices can help in preventing you from vaginitis:
- Having good overall hygiene
- Using mild soaps without irritants or scents
- Wearing cotton underwear
- Avoid irritating agents, such as those present in hygiene sprays, soaps, and other feminine products
- Wiping from front to back to avoid spreading bacteria from the anus to the vagina
- Wearing loose-fitting clothing
- Safe sex or practicing sex with a condom
- Using antibiotics only when necessary
- Using loose cotton underwear
- The vaginal area should be washed with water.
- Don’t douche
- Taking healthy diets
- By minimizing stress
- Consume probiotics such as yogurt, sauerkraut, and kimchi, or in probiotic supplements.
If you are approaching menopause or have low levels of estrogen, you have had ovaries removed for any reason discuss with your doctor the use of hormone tablets or suppository to keep the vagina lubricated and healthy.
Normally chances of recurrence of vaginitis are very low. With better treatment, the prognosis is good for all types of vaginitis. If symptoms resolve than follow up is not recommended.
Bacterial vaginosis is not unusual, it is advised by healthcare professional that if symptoms recur than go for additional therapy. A treatment process after recurrence will be different from the earlier used to treat the disease.
Retesting is recommended for all sexually active women within 3 months of initial treatment. This is because of the high rate of reinfection.
Patients should be instructed to follow up if symptoms recur within 2 months of the onset of initial symptoms.
It is common for most women to have vaginitis at least once in their life, and it is rarely dangerous. Taking proper medicine and completing a course of doctor-prescribed antibiotics will remove any vaginal infections and cure the related inflammation. Not having sexual intercourse and avoiding vaginal products containing potential irritants for a few days after diagnosis may also help in fast recovery.