Vaginitis

An Overview

What is vaginitis (va-jin-EYE-tis)?
Vaginitis is short for vulvovaginitis — any irritation in the vagina. It often causes an abnormal discharge.

How common is vaginitis?
Vaginitis is one of the most common reasons women seek health care. It affects all women — lesbian, straight, and bisexual — regardless of sexual orientation. You will most likely have it some time in your life. You may have it more than once. It usually is not serious. But it can be annoying and uncomfortable.

How can I tell if I have vaginitis?
You will have a vaginal irritation or an abnormal vaginal discharge. The discharge may have an unpleasant odor. You also may have vaginal itching or burning. And you may feel as if you need to urinate more often than usual.

What causes vaginitis?
Vaginitis is caused by

• allergies
• infections
• irritants — including douches, "feminine hygiene" sprays, and perfumed soaps
• lack of the hormone estrogen
• sexual activity

And sometimes there is more than one cause.

Questions About Vaginal Fluids

What are normal vaginal fluids like?
Vaginal fluids keep the vagina lubricated and healthy. They are either thick and whitish or slippery and clear. It depends on where you are in your menstrual cycle. There is little odor and no itching or burning. Regular bathing keeps the fluids from getting stale or uncomfortable. It is normal for these fluids to discolor underwear.

The fluids come from the walls of your vagina. They also come from your cervix at certain times in your cycle. They leave the body through the vagina.

How much fluid you produce depends on the hormones that guide your menstrual cycle. Usually there is more fluid

• just before you ovulate
• when you are pregnant
• when you are sexually excited

You will have less fluid just before your period, while you breastfeed, and during menopause.

Questions About the Types of Vaginitis

What are the infections that cause vaginitis?
They are

• bacterial vaginosis (back-TEER-ee-al VA-ji-NO-sis)
• candidiasis (can-di-DYE-a-sis)
• trichomoniasis (trick-oh-mo-NEYE-ah-sis)

What is bacterial vaginosis (BV)?
BV is a condition caused by several bacteria, including gardnerella (gard-ner-EL-la) vaginalis. BV used to be called "nonspecific vaginitis."

Usually there is a heavy vaginal discharge. It is grayish and frothy and has an unpleasant, "fishy" odor.

BV is sometimes caused or made worse by unprotected sexual contact that can disrupt the balance of normal bacteria that protect the vagina. Certain body fluids, especially semen, may be more disruptive for some women.

Diagnosis is made by examination of the vagina and vaginal discharge. Various creams and gels, as well as oral medication, can be used to treat BV.

What is candidiasis?
Candidiasis is an infection caused by a yeast called candida (CAN-di-duh). It is also called a yeast infection or monilial (mon-EEL-ee-al) vaginitis. Most people have small amounts of yeast in their mouths and intestines. Many healthy women have yeast in their vaginas. But sometimes this yeast grows too much. "Overgrowth" may happen when the normal condition of the vagina is changed by

• certain antibiotics
• diabetes
• drugs that slow the immune system (like cortisone)
• immune deficiency
• normal hormonal changes (some women)
• pregnancy

Symptoms include

• itching, irritation, and redness of the vulva and opening of the vagina
• painful intercourse
• a thick, white, odorless, vaginal discharge
• a white coating of the vagina

Men with yeast infections may notice redness and irritation of the penis or scrotum. Although yeast infections are not contagious, contact with a partner may stimulate an overgrowth.

When excess yeast appears in the mouth, throat, or on the tongue, it is called "thrush."

Diagnosis is made by examination of the vagina and vaginal discharge. Various creams, suppositories, vaginal tablets, as well as oral medication can be used to treat candidiasis. Treatment is successful more than 90 percent of the time.

What is trichomoniasis?
Trichomoniasis is a sexually transmitted infection caused by the protozoan trichomonas. "Trich" is one of the most common vaginal infections. It is spread by exchanging fluids through

• mutual masturbation, if fluids from one partner are passed to the genitals of the other
• sharing sex toys
• vaginal intercourse

Many women have no symptoms. Men rarely have symptoms. It may take years for them to appear. Symptoms include

• a frothy, often musty smelling discharge
• itching in and around the vagina
• spotty bleeding in the discharge
• an urge to urinate more often than usual

Diagnosis is made by examination of the vagina and vaginal discharge. Both partners can be successfully treated for "trich" with oral medication. You may become infected again if your partner isn't treated. If you have more than one sexual partner, each partner (and their partners) should be treated, too. Use condoms and avoid sharing certain fluids — semen, vaginal lubrication or discharge, and menstrual flow — with your partner(s) during treatment.

What is atrophic vaginitis?
Atrophic vaginitis is a vaginal irritation without a discharge. It is caused by lowered levels of estrogen due to

• breastfeeding
• induced menopause — when both ovaries are removed surgically or damaged by radiation or chemotherapy
• natural menopause

Lowered levels of estrogen make vaginal tissue dry and thin. They may also cause spotting. Estrogen creams and oral tablets can help

• decrease soreness and irritation
• restore lubrication

What irritants can cause vaginitis?
Objects and chemicals left in the vagina may cause irritations that lead to vaginitis. Do not leave tampons, contraceptives, or other objects in the vagina longer than necessary.

What can stimulate allergies that can cause vaginitis?
Some women are allergic to substances put in the vagina, including

• chemicals — including douches, "feminine hygiene" sprays, and perfumed soaps
• diaphragms, caps, and shields
• latex condoms
• medicines
• spermicides

Questions About Irritations of the Cervix and Vulva

What is cervicitis?
It is an irritation of the cervix. There may be an abnormal discharge from the cervix. It can look and feel just like a vaginal discharge. That's why cervicitis is often confused with vaginitis. Serious cases of cervicitis are caused by infections such as chlamydia, gonorrhea, or herpes. It's very important to diagnose and treat cervicitis.

What is vulvitis?
It is an irritation of the vulva — a woman's external sex organs that are outside the vagina, including the clitoris, the labia (lips), and the glands that lubricate the vagina. It may result from a yeast infection or the discharge associated with vaginitis.

The vulva and vagina may also be irritated by

• douches
• "feminine hygiene" sprays
• horseback riding
• hot tub and swimming pool water
• laundry detergents (especially enzyme-activated "cold-water" formulas)
• perfumed soaps or bubble baths
• rubbing against a bicycle seat
• scented or colored toilet paper
• scented panty liners, pads, or tampons
• shampoos and hair conditioners
• spermicides
• tampons or other objects left in the vagina too long
• wearing tight pants, underwear, or pantyhose without a cotton crotch
• wearing wet bathing suits for long periods of time

Questions About Reducing the Risk of Getting Vaginitis

Can I get vaginitis from a sex partner?
"Trich" is easily passed between sex partners — same sex as well as opposite sex partners. Men can carry trichomonas, the protozoan that cause trichomoniasis, on the penis, under the foreskin, and in the urethra, prostate gland, and other glands.

It is not yet clear if BV and candida infections are transmitted from one partner to another. All kinds of bacteria are exchanged during sex play. It may be that the bacteria exchanged between partners, especially new partners, may cause an overgrowth of BV or candida in the vagina.

How can I recognize and avoid vaginitis?
Each woman has her own pattern of vaginal fluids. Learn your own normal pattern. Then you will notice any changes that may mean you have vaginitis.

Avoid vaginal intercourse and sharing sexual fluids if

• you or your partner is being treated for BV, candidiasis, or a sexually transmitted infection
• you think either of you is infected
• condoms or female condoms are unavailable

Because yeast, BV, and "trich" develop more quickly in moisture

• Keep the area around the genitals as dry as possible.
• Wash your vulva regularly with mild soap and water.
• Rinse well and dry thoroughly after washing.
• Let towels dry between uses.
• Don't share towels.
• Avoid sitting around in a wet bathing suit.

And try to

• Avoid chemicals in perfumed or deodorant soap, detergents, fabric softeners, bubble baths, powders, tampons, panty liners, pads, and vaginal sprays. Don't douche unless your clinician advises.
• Inspect your partner's sex organs for sores or discharges. Use a latex condom every time you have vaginal intercourse, unless you and your partner
  • have no infections
  • have no other sex partners

Avoid wearing underwear and pantyhose without cotton crotches or any kind of tight pants, pantyhose, or underwear that irritate your vagina or vulva.

Questions About the Diagnosis and Treatment of Vaginitis

How can I help my clinician find the cause?

• Women should not douche, but if you do, don't douche for at least 24 hours before your appointment. Douching washes away the discharge and may make the tests less accurate.
• Don't use a deodorant on your vulva. It may mask odors that are important symptoms. And it may make an irritation worse.
• Don't put off going because you have abnormal bleeding. That might mean you have a serious problem.
• Don't have vaginal intercourse — or insert any object, such as a tampon, into your vagina — for 24 to 48 hours before your appointment.
• Try to schedule your visit for a time when you won't be having your period. Menstrual flow makes diagnosis more difficult.

How is vaginitis treated?
Treatment depends on

• the cause
• how severe your symptoms are
• whether you are pregnant

For vaginitis caused by infection, your clinician may prescribe creams, suppositories, vaginal tablets, or oral medications.

For vaginitis caused by low levels of estrogen, symptoms are usually relieved by replacing the estrogen with estrogen replacement creams and vaginal rings. They are available by prescription.

For vaginitis caused by an irritant left in the vagina, symptoms are usually relieved by removing the object. Using an antibiotic cream is necessary in some cases.

For vaginitis caused by allergies, common symptoms are usually relieved by avoiding contact with the substance stimulating the allergy. Severe reactions may require emergency medical attention.

For any type of vaginitis, allow your vagina to heal until the infection is gone. Avoid intercourse and inserting anything into your vagina except for medication or tampons used during the day for menstrual flow.

Remember — Vaginitis has little to do with how clean you are. Bathing or douching will not cure vaginitis. But good hygiene is an important part of being healthy. It includes washing your vulva daily with mild, perfume-free cleansers.

What about over-the-counter medicines for vaginitis?
You can buy medicine for yeast infections without a prescription. This will help if you are sure you have a yeast infection. Your symptoms should be the same as those your clinician diagnosed before. Also be sure you haven't been exposed to a sexually transmitted infection since your last treatment for yeast. What you think is yeast could be gonorrhea, herpes, or "trich." Consult your clinician if you

• have an unusual symptom
• are not better when you've finished the medicine

Should I use tampons or pads while I'm being treated?
In general, do what is most comfortable for you. Insert treatment suppositories before going to bed, and do not use tampons afterward during the night. Otherwise, the tampon may soak up the medicine. It's okay to use tampons during the day for your period — especially toward the end of treatment.

Some women use pads or panty liners to help keep the medicine from leaking onto clothing. Others find them irritating. Ask your clinician for advice.

Can I have vaginal intercourse while I'm being treated?
It is better not to. Intercourse — or other kinds of sex play — may be uncomfortable or painful. Having sex may also aggravate your symptoms and interfere with the effectiveness of treatment. If you and your partner are being treated for a sexually-transmitted infection, you may re-infect one another.

How can I help make the treatment work?

• Don't use anybody else's medicine. Your symptoms may be like somebody else's. However, the cause of your symptoms may be different and need different treatment.
• Don't use old medicine. It may not work anymore and it may cause problems.
• Use up your entire prescription — even if your symptoms have stopped. They may come back if you don't take all your medicine.
• Take your medicine even if you get your period. Some organisms that cause vaginitis grow quickly in menstrual flow.
• Be sure to return for all your checkups.

Your partner should also be treated if you are being treated for

• vaginitis caused by trichomoniasis
• cervicitis caused by chlamydia or gonorrhea

Do I need to see a clinician?
Yes. It is very important if you think you have vaginitis. Vaginitis isn't often a major health problem. But sometimes it can be serious. Pregnant women with BV run higher risks of miscarriage, especially in the first trimester. BV is associated with premature delivery, low birth weight, and pelvic inflammatory disease. It can also increase the risk for HIV infection. Other, more potentially dangerous infections like gonorrhea and clamydia have symptoms just like vaginitis. Your clinician can find the cause and offer the correct treatment.

You should see your clinician whenever

• you have abnormal vaginal discharge and/or odor, irritation, bleeding, or pain
  
• your symptoms have not been diagnosed
  
• your treatment isn't working

What is recurrent vaginitis?
Vaginitis is called "recurrent" if you have it four or more times a year. It can be caused by

• conditions like diabetes or HIV (human immunodeficiency virus) that weaken the immune system
  
• incomplete treatment of previous infections
  
• repeated new infections or irritations

It may be hard to find the cause and clear it up. Having recurrent vaginitis can be very frustrating. See your clinician regularly if you have it.