Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection. Vaginitis can also result from reduced estrogen levels after menopause.
Many triggers can cause vulvovaginitis, including:
- environmental factors
- sexually transmitted infections
- chemical irritants
Certain bacteria can proliferate and can cause vulvovaginitis. These bacteria include Streptococcus, Gardnerella, and Staphylococcus. A bacterial infection can cause a grayish-white discharge that smells fishy. However, according to the Illinois Department of Public Health, about half of women with this type of infection have no symptoms.
One of the most common causes of vulvovaginitis is Candida albicans. This yeast infection can cause genital itching and a thick, white vaginal discharge that is similar to cottage cheese. A yeast infection often follows the use of antibiotics. Antibiotics can kill the antifungal bacteria that normally live in the vagina. This can lead to yeast infection.
Viruses that can cause vulvovaginitis include herpes simplex and human papillomavirus (HPV).
Pinworms, scabies, and lice can cause inflammation of the vulva and vagina.
A complex and intricate balance of microorganisms maintains the normal vaginal flora. Important organisms include lactobacilli, corynebacteria, and yeast. Aerobic and anaerobic bacteria can be cultured from the vagina of prepubertal girls, pubertal adolescents, and adult women. A number of factors can change the composition of the vaginal flora, including the following:
- Sexual activity (or abuse)
- Hormonal status
- Immunologic status
- Underlying skin diseases
The normal postmenarchal and premenopausal vaginal pH is 3.8-4.2. At this pH, growth of pathogenic organisms usually is inhibited. Disturbance of the normal vaginal pH can alter the vaginal flora, leading to overgrowth of pathogens. Factors that alter the vaginal environment include feminine hygiene products, contraceptives, vaginal medications, antibiotics, sexually transmitted diseases (STDs), sexual intercourse, and stress.
The overgrowth of normally present bacteria, infecting bacteria, or viruses can cause symptoms of vaginitis. Chemical irritation also can be a significant factor. Atrophic vaginitis is associated with hypoestrogenism, and symptoms include dyspareunia, dryness, pruritus, and abnormal bleeding. A state of decreased estrogen can result in an altered risk of infection.
Based on data from 11 countries, Kenyon and Colebunders found evidence that the risk of bacterial vaginosis is increased in women whose male sexual partner is concurrently having sexual relations with other partners.
The age of the patient affects the anatomy and physiology of the vagina. Prepubertal children have a more alkaline vaginal pH than do pubertal and postpubertal adolescents and women. The vaginal mucosa is columnar epithelium, vaginal mucous glands are absent, the normal vaginal flora is similar to that of postmenopausal women (eg, gram-positive cocci and anaerobic gram-negatives are more common), and the labia are thin with a thin hymen.
Pubertal and postpubertal adolescents and women have a more acidic vaginal pH, a stratified squamous vaginal mucosa, vaginal mucous glands, a normal vaginal flora dominated by lactobacilli, thick labia, and hypertrophied hymens and vaginal walls. Loss of vaginal lactobacilli appears to be the primary factor in the changes leading to bacterial vaginosis. Recurrences of vaginitis are associated with a failure to establish a healthy vaginal microflora dominated by lactobacilli.
The symptoms of vulvovaginitis vary and depend on their cause.
In general, symptoms can include:
- irritation of the genital area
- genital itching
- inflammation, specifically around the labia and perineal areas
- foul odor that’s typically quite strong
- increased vaginal discharge
- discomfort when urinating, including a burning sensation
To diagnose vaginitis, your doctor may:
- Review your medical history, including your history of vaginal or sexually transmitted infections.
- Perform a pelvic exam. During the pelvic exam, your doctor may collect a sample of cervical or vaginal discharge for lab testing to confirm what kind of vaginitis you have.
The correct treatment for vulvovaginitis depends on the type of infection and the organism causing the problems. It’s possible to treat some types of vulvovaginitis on your own. However, you should speak with a healthcare provider before initiating any treatment.
If you have had a yeast infection in the past, you may be able to treat vulvovaginitis using over-the-counter products. A pharmacist will be able to advise you on the best product for your symptoms and how to apply the product. Consult your doctor if the inflammation isn’t better after a week.
After your doctor identifies the type of organism causing your vulvovaginitis, they will prescribe medication to cure the condition.
This could include:
- oral antibiotics
- antibiotic creams applied directly to the skin
- antifungal creams applied directly to the skin
- antibacterial creams applied directly to the skin
- oral antihistamines, if an allergic reaction is a possibility
- estrogen creams
- oral antifungal pills
Your doctor may also recommend a personal hygiene routine to help heal the infection and prevent it from recurring. This could include taking sitz baths and wiping properly after using the toilet.
Other suggestions include wearing loose clothing and cotton underwear to allow the circulation of air and reduce moisture. Removing underwear at bedtime may also help.
Proper cleansing is important and may help prevent irritation. This is especially true if the infection is bacterial. Avoid using bubble bath, perfumed soaps, and washing powders as much as possible. Opt for sitz baths instead. You may also find sensitive-skin versions of these products less irritating.
A cold compress is useful to relieve pain on swollen or tender areas.