“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.
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.
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.
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
- Wearing damp or tightfitting clothing
- Using an intrauterine device (IUD) for birth control
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.
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.
Yogurt – Dip a tampon in yogurt and put it in your vagina for a couple of hours. Repeat twice daily until the symptoms completely disappear. Also, include plain yogurt daily in your diet.
Apple Cider Vinegar
- Add 2 tablespoons of raw, unfiltered apple cider vinegar to a glass of warm water and use it to wash your vagina twice daily for a few days.
- Also, add 1 to 2 tablespoons of raw, unfiltered apple cider vinegar and a little raw honey to a glass of warm water and drink it twice daily.
Cold Compress – The cold temperature helps numb the area, providing relief from itching, pain and other discomforts.
- Wrap a few ice cubes in a clean cloth and tie it together.
- Put this compress on your vagina for 1 minute.
- Take a break for 1 minute and reapply it.
- Repeat for a few more minutes.
- Use this remedy as needed.
You can also rinse the vaginal area with cold water a few times a day.
Garlic – The antibacterial and mild antiseptic qualities of garlic help treat vaginitis.
- Mix 4 or 5 drops of garlic oil with ½ teaspoon each of vitamin E oil and coconut oil. Apply it on the affected area twice daily for a few days.
- Eat a few cloves of raw garlic daily and use it in your daily cooking.
- Alternatively, you can take 300 mg of garlic supplements daily for a few days. However, it is best to consult a doctor before taking any supplement.
Boric Acid – Boric acid is a great remedy to get rid of the discomforts of vaginitis. Its antiseptic and antifungal properties help reduce itching, pain and irritation. In addition, it helps cleanse the vagina and restore its pH level.
- Put some boric acid powder inside an empty gel capsule.
- Insert this capsule in your vagina before going to bed.
- The next morning, wash the area thoroughly with warm water.
- Repeat once or twice a week.
Note: Do not use this remedy if you are pregnant.
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.