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vaginitis Images (Click to view larger image)
Alternative Names
vulvovaginitis, vaginal infection, vaginal inflammation
Definition
Vaginitis is an inflammation of a woman's vagina that may be due to bacteria, fungus, viruses, parasites, lack of oestrogen (female hormone) or chemicals.
What is going on in the body?
A healthy vagina has a balance of many bacteria and fungi. Normal vaginal discharge, or fluid that passes out of the vagina, is clear, cloudy or whitish. But the balance in the vaginal environment can be thrown off by many factors. As a result, one woman in three will have vaginitis at some point in life.
Normally, oestrogen keeps the top layer of cells in the vagina thick. When a female has very little oestrogen, because puberty has not yet started or menopause has begun, this layer of cells is thin and resists infection poorly.
Each cell in the vagina has large quantities of glycogen, a stored sugar molecule. Protective bacteria use glycogen as their energy source. The slightly acid environment of the vagina helps foster the growth of bacteria that can keep other organisms in the vagina, such as yeast, in check. Unhealthy organisms can take over, though, under certain conditions.
What are the signs and symptoms of the condition?
Not all women have symptoms of vaginitis. Often, though, a woman will notice some of these symptoms: - irritation and itching inside and outside the vagina.
- inflammation or swelling of the lips of the vagina or the genital area.
- vaginal discharge that may be lumpy like cottage cheese, frothy, yellowish-green or colourless.
- a foul or fishy vaginal odour, especially after intercourse.
- discomfort or burning during urination.
- dryness, discomfort or burning during sexual intercourse.
What are the causes and risks of the condition?
Yeast infection is a common disorder, marked by itchy, whitish vaginal discharge that may look like cottage cheese. It occurs when too much yeast, or Candida, grow in the vagina. This leads to swelling, irritation and itching within the vagina and on the vulva, or outer genitals. Yeast infections may occur in the mouth or on the breasts and other moist areas of the skin, too.
Bacterial vaginosis occurs when several types of "unfriendly" bacteria that live in the vagina grow too fast. When this happens, the unfriendly bacteria can replace protective bacteria. This makes the vagina less acidic and may cause irritation, swelling and a fishy odour. No one knows what causes the overgrowth of these bacteria. Sexual intercourse makes a woman more likely to have bacterial vaginosis. Treating both partners does not seem to decrease the rate of recurrence. Women who are not sexually active can also have bacterial vaginosis.
Trichomoniasis is caused by a parasite. It spreads during sexual intercourse. The discharge is usually frothy and yellow-grey or green and has an unpleasant odour. Women who have this condition are at risk of having contracted other sexually transmitted diseases (STDs).
Atrophic vaginitis may be the culprit when a woman has a sense of dryness or feels "pins and needles" or burning in her vagina. Usually this condition occurs after menopause. Sometimes it affects girls before puberty or nursing mothers. It is linked to low levels of oestrogen, which cause less lubrication in the vagina. The tissues get less blood and nutrients, too. Over time, the tissues thin out a great deal. The vagina becomes less acidic. This allows harmful bacteria to nudge out healthy bacteria. That makes the vagina more susceptible to injury and infection. Some women with this condition have no symptoms. Many postmenopausal women report vaginal dryness and painful intercourse.
Many other factors can affect the natural acidity of the vagina or cause irritation and swelling. These include: - an object left in the vagina, such as a forgotten tampon.
- STDs, such as gonorrhoea, chlamydia, genital warts or herpes.
- cervicitis, or inflammation of the cervix.
- pinworms.
- antibiotics, birth control pills or an underlying health problem such as human immunodeficiency virus (HIV) infection or diabetes, which raise the risk of yeast infections.
- changes in hormone levels brought on by pregnancy, nursing a baby, or menopause.
- douches.
- sexual intercourse.
- stress.
- irritants in birth control methods, such as spermicides, condoms and diaphragms.
- irritating chemicals in perfumes, deodorants, powders or soaps applied to the vaginal area.
- clothes that hold heat and moisture, such as nylon pantyhose or tight pants.
- sex toys.
What can be done to prevent the condition?
- Wear loose-fitting, absorbent underwear and clothing. This keeps heat and moisture from building up in the vaginal area and helps to avoid yeast infections.
- Practice good hygiene. Wipe front to back after using the toilet. Wash hands often. Bath and shower regularly.
- Practice safer sex and limit the number of sexual partners. This can help a woman avoid getting STDs.
- Consider hormone therapy after menopause. It can prevent atrophic vaginitis.
- Avoid use of douches and perfumed soaps and deodorants that can irritate the vaginal area.
- Consider changing birth control methods if vaginal irritation occurs during or after sex.
How is the condition diagnosed?
A doctor will do a pelvic examination and may also: - take a sample of discharge from the vagina or cervix. This may be examined under a microscope or sent to a laboratory for further tests.
- consider whether or not a woman might have an underlying health problem, such as diabetes.
Sometimes a Pap smear detects vaginitis when a woman has had no symptoms.
What are the long-term effects of the condition?
If an infection is treated, long-term problems usually do not arise. Sometimes the cause of vaginitis, such as herpes, genital warts or HIV, cannot be cured.
If a severe, long-standing STD has spread to the pelvic organs, chronic pelvic pain and infertility may occur.
What are the risks to others?
If the cause of vaginitis is an STD, a woman could transmit the infection to a sexual partner or partners.
What are the treatments for the condition?
Treatment options depend upon the cause of vaginitis. Therapy may include: - pills or vaginal creams that combat bacteria.
- pills, such as fluconazole or vaginal creams, such as miconazole or clotrimazole that combat fungi.
- medication for viruses, e.g. acyclovir
- medications to relieve itching.
- oestrogen therapy in a cream, patch or pill.
- sitz baths, which involves sitting in a few inches of warm salty water.
What are the side effects of the treatments?
Side effects vary with different treatments. Because the vagina may be inflamed from the infection, further irritation of the sensitive tissues may occur if a vaginal cream has alcohol in it.
What happens after treatment for the condition?
Vaginitis may take a few days or more to disappear, depending on how long an infection has been present and the cause of the inflammation. - Most antibiotic treatment is used for 3 to 7 days.
- Oestrogen treatment is usually continued indefinitely.
- If a STD has been diagnosed, the sexual partner(s) must be tested. If necessary, the sexual partner(s) should be treated to keep the STD from spreading to others and avoid a recurrence.
How is the condition monitored?
If symptoms return, a woman should be evaluated by her doctor. The problem may be: - recurrence of vaginitis due to inadequate treatment or a resistant organism.
- an underlying health condition.
A change in medication or other tests may be needed.
Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
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