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Vaginitis

"Vaginitis" is a medical term used to describe various conditions 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, as well as by irritations from chemicals in creams, sprays, or even clothing that is in contact with this area. In some cases, vaginitis results from organisms that are passed between sexual partners.

The vagina creates its own environment and maintains a balance among the normal bacteria found there and the hormonal changes in a woman's body. Vaginitis occurs when the vaginal ecosystem has been changed by certain medications such as antibiotics, hormones, contraceptive preparations (oral and topical), douches, vaginal medication, sexual intercourse, sexually transmitted diseases, stress, and change in sexual partners.

Some vaginal infections are transmitted through sexual contact, but others such as yeast infections probably are not. Vaginitis often is caused by infections, which create distress and discomfort. Some infections are associated with more serious diseases.

Three vaginal infections are most common. Their causes are quite different, their symptoms similar, and treatment varies.

  • Bacterial vaginosis

  • Vaginal yeast infection

  • Trichomoniasis

Many women often mistakenly think they have a "yeast infection" and treat themselves when, in fact, they have a similar vaginal infection that will not respond to self-treatment with over-the-counter yeast medications. A recent study founded that 70% of women self-treated vaginal infections before calling a health care provider. Most often, they incorrectly thought they had a yeast infection when, in fact, it was bacterial vaginosis.

The important thing is not to guess, but to recognize the symptoms if you develop a vaginal infection. See your health care provider for precise testing and to get the most appropriate and effective treatment right away.


Causes of Vaginal Infections

Bacterial vaginosis (BV) is the most common cause of vaginitis, accounting for 50% of cases. BV is caused by a change in the bacteria normally found in the vagina and causes an overgrowth of organisms such as Gardnerella vaginalis.

  • Risk factors include pregnancy, intrauterine device (IUD) use, and frequent douching. It is associated with sexual activity, possibly a new sexual partner or multiple sexual partners. Women who have never had sexual intercourse are rarely affected.

  • You do not get BV from toilet seats, bedding, or swimming pools.

  • In the United States, as many as 16% of pregnant women have BV. This varies by race and ethnicity from 6% in Asians and 9% in whites to 16% in Hispanics and 23% in African Americans.

Vaginal yeast infections are caused by a fungus called Candida albicans. This is also called candidiasis, genital candidiasis, or vulvovaginal candidiasis (VVC). A yeast infection can spread to other parts of the body including skin, mucous membranes, heart valves, esophagus, and other areas. It can cause life-threatening systemic infections mostly in people with weakened immune defenses (such as women who are pregnant and people who are HIV positive, have diabetes, or are taking steroids).


What are the symptoms of vaginitis?

The symptoms of vaginitis can vary depending on what is causing the infection or inflammation. Some women have no symptoms at all. Some of the more common symptoms of vaginitis include:

  • Abnormal vaginal discharge with an unpleasant odor

  • Burning during urination

  • Itching around the outside of the vagina

  • Discomfort during intercourse


Is vaginal discharge normal?

A woman's vagina normally produces a discharge that usually is described as clear or slightly cloudy, non-irritating and odor-free. During the normal menstrual cycle, the amount and consistency of discharge vary. At one time of the month there may be a small amount of a very thin or watery discharge; and at another time, a more extensive thicker discharge may appear. All of these descriptions could be considered normal.

A vaginal discharge that has an odor or that is irritating usually is considered an abnormal discharge. The irritation might be itching or burning, or both. The burning could feel like a bladder infection. The itching may be present at any time of the day, but it often is most bothersome at night. These symptoms often are made worse by sexual intercourse. It is important to see your health care professional if there has been a change in the amount, color or smell of the discharge.


What are the most common types of vaginitis?

The six most common types of vaginitis are:

  • Candida or "yeast" vaginitis

  • Bacterial vaginosis

  • Trichomoniasis vaginitis

  • Chlamydia vaginitis

  • Viral vaginitis

  • Non-infectious vaginitis

Although each of these vaginal infections can have different symptoms, it is not always easy for a patient to figure out which type of vaginitis she has. In fact, diagnosis can even be tricky for an experienced clinician. Part of the problem is that sometimes more than one type of vaginitis can be present at the same time. Often vaginitis is present without any symptoms at all.

To help you better understand these six major causes of vaginitis, let's look briefly at each one of them and how they are treated.


What are candida or "yeast" infections?

Yeast infections of the vagina are what most women think of when they hear the term "vaginitis." Yeast infections are caused by one of the many species of fungus called candida . Candida normally lives in small numbers in the vagina, as well as in the mouth and digestive tract of both men and women.

Yeast infections produce a thick, white vaginal discharge with the consistency of cottage cheese. Although the discharge can be somewhat watery, it is odorless. Yeast infections usually cause the vagina and the vulva to be very itchy and red.

Since yeast is normal in a woman's vagina, what makes it cause an infection? Usually infection occurs when a change in the delicate balance in a woman's system takes place. For example, a woman may take an antibiotic to treat a urinary tract infection, and the antibiotic kills "friendly" bacteria that normally keep the yeast in balance. As a result, the yeast overgrows and causes the infection. Other factors that can upset the delicate balance include pregnancy, which changes hormone levels, and diabetes, which allows too much sugar in the urine and vagina.


What are the risk factors for vaginal candida infections?

  • Recent treatment with antibiotics

  • Uncontrolled diabetes

  • Pregnancy

  • High-estrogen contraceptives

  • Disorders affecting the immune system

  • Thyroid or endocrine disorders

  • Corticosteroid therapy


What is bacterial vaginosis?

Although "yeast" is the name most women know, bacterial vaginosis actually is the most common vaginal infection in women of reproductive age. Bacterial vaginosis often will cause a vaginal discharge. The discharge usually is thin and milky, and is described as having a "fishy" odor. This odor may become more noticeable after intercourse.

Redness or itching of the vagina are not common symptoms of bacterial vaginosis. It is important to note that many women with bacterial vaginosis have no symptoms at all, and the vaginitis is only discovered during a routine gynecologic exam. Bacterial vaginosis is caused by a combination of several bacteria. These bacteria seem to overgrow in much the same way as do candida when the vaginal balance is upset. The exact reason for this overgrowth is not known.

Because bacterial vaginosis is caused by bacteria and not by yeast, it is easy to see that different methods are needed to treat the different infections. A medicine that is appropriate for yeast is not effective against the bacteria that cause bacterial vaginosis.


What are trichomoniasis, chlamydia and viral vaginitis?

Trichomoniasis

Trichomoniasis is caused by a tiny single-celled organism known as a "protozoa." When this organism infects the vagina, it can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms. It is important to understand that this type of vaginitis can be transmitted through sexual intercourse. For treatment to be effective, the sexual partner must be treated at the same time as the patient.

Chlamydia

Another sexually transmitted form of vaginitis is caused by chlamydia. Unfortunately, most women with chlamydia infection do not have symptoms, which makes diagnosis difficult. A vaginal discharge is sometimes present with this infection but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18 to 35 years) who have multiple sexual partners. If you fit this description, you should request screening for chlamydia during your annual checkup. While chlamydia infections are treatable with antibiotic medications, the best "treatment" for chlamydia is prevention. Use of a condom will decrease your risk of contracting not only chlamydia, but other sexually transmitted diseases as well.

Viral vaginitis

Viruses are a common cause of vaginitis. One form caused by the herpes simplex virus (HSV) is often just called "herpes" infection. These infections also are spread by sexual contact. The primary symptom of herpes vaginitis is pain associated with lesions or "sores." These sores usually are visible on the vulva or the vagina but occasionally are inside the vagina and can only be seen during a gynecologic exam.

Another source of viral vaginal infection is the human papillomavirus (HPV). HPV, sometime referred to as genital warts, also can be transmitted by sexual intercourse. This virus can cause painful warts to grow in the vagina, rectum, vulva or groin. These warts usually are white to gray in color, but they may be pink or purple. However, visible warts are not always present, and the virus may only be detected when a Pap smear is abnormal. Outbreaks of HPV often are associated with stress or emotional distress.

Many of the germs that cause vaginitis can be spread between men and women during sexual intercourse. Use of a barrier contraceptive, such as a condom, can help reduce your risk of contracting these and more serious germs, such as the human immunodeficiency virus (HIV), which can lead to AIDS.


What is non-infectious vaginitis?

Occasionally, 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 from vaginal sprays, douches or spermicidal products. The skin around the vagina also can be sensitive to perfumed soaps, detergents and fabric softeners.

Another non-infectious form of vaginitis results from a decrease in hormones because of menopause or because of surgery that removes the ovaries. In this form, the vagina becomes dry or "atrophic." The woman may notice pain, especially with sexual intercourse, as well as vaginal itching and burning.


How is vaginitis treated?

The key to proper treatment of vaginitis is proper diagnosis. This is not always easy since the same symptoms can exist in different forms of vaginitis. You can greatly assist your health care provider by paying close attention to exactly which symptoms you have and when they occur, along with a description of the color, consistency, amount and smell of any abnormal discharge. Do not douche before your office or clinic visit; it will make accurate testing difficult or impossible. Some providers ask that you abstain from sex for 24 hours before your appointment.

Because different types of vaginitis have different causes, the treatment needs to be specific to the type of vaginitis present. When a woman has had a yeast infection diagnosed by her doctor, she usually is treated with a prescription for a vaginal cream or suppositories. If the infection clears up for some period of time but then the exact same symptoms occur again, a woman can obtain, with her doctor or pharmacist's advice, a vaginal cream or suppository without a prescription that can completely treat the infection.

The important thing to understand is that this medication may only cure the most common types of candida associated with vaginal yeast infections and will not cure other yeast infections or any other type of vaginitis. If you are not absolutely sure, see your doctor. You may save the expense of buying the wrong medication and avoid delay in treating your type of vaginitis.

When buying an over-the-counter medicine, be sure to read all of the instructions completely before using the product. Be sure to use all of the medicine and don't stop just because your symptoms have gone away.

Be sure to see your health care practitioner if:

  • All of the symptoms do not go away completely.

  • The symptoms return immediately or shortly after you finish treatment.

  • You have any other serious medical problems such as diabetes.

  • You might be pregnant.

Other forms of infectious vaginitis are caused by organisms that need to be treated with oral medication and/or a vaginal cream prescribed by your doctor. Products available without a prescription will probably not be effective. As with all medicine, 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 go away. Do not be embarrassed to ask your doctor or health care practitioner questions. Good questions to ask include:

  • It is okay to douche while using this vaginal cream?

  • Should I abstain from sexual intercourse during treatment?

  • Should my sexual partner(s) be treated at the same time?

  • Will the medication for this vaginitis interact with my other medication(s)?

  • Should I continue the vaginal cream or suppositories during my period?

  • Do I need to be re-examined and if so, when?

"Non-infectious" vaginitis is treated by changing the probable cause. If you recently changed your soap or laundry detergent or have added a fabric softener, you might consider stopping the new product to see if the symptoms remain. The same instruction would apply to a new vaginal spray, douche, sanitary napkin or tampon. If the vaginitis is due to hormonal changes, estrogen may be prescribed to help reduce symptoms.


How can I prevent vaginitis?

There are certain things that you can do to decrease the chance of getting vaginitis. If you suffer from yeast infections, it usually is helpful to avoid garments that hold in heat and moisture. The wearing of nylon panties, pantyhose without a cotton panel and tight jeans can lead to yeast infections. Good hygiene also is important. In addition, doctors have found that if a woman eats yogurt that contains active cultures (read the label) she will get fewer infections.

Because they can cause vaginal irritation, most doctors do not recommend vaginal sprays or heavily perfumed soaps for cleansing this area. Likewise, repeated douching may cause irritation or, more importantly, may hide a vaginal infection.

Safe sexual practices can help prevent the passing of diseases between partners. The use of condoms is particularly important.

If you are approaching menopause, have had your ovaries removed or have low levels of estrogen for any reason, discuss with your doctor the use of hormone pills or creams to keep the vagina lubricated and healthy.

Good health habits are important. Have a complete gynecologic exam, including a Pap smear at least every two years. If you have multiple sexual partners, you should request screening for sexually transmitted diseases.

 

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