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Inflammatory Vaginitis

By David E. Soper, MD, J. Marion Sims Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina

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Inflammatory vaginitis is vaginal inflammation without evidence of the usual infectious causes of vaginitis.

Etiology may be autoimmune. Vaginal epithelial cells slough superficially, and streptococci overgrow.

The major risk factor is

  • Estrogen loss, which can result from menopause or premature ovarian failure (eg, due to oophorectomy, pelvic radiation, or chemotherapy)

Genital atrophy predisposes to inflammatory vaginitis and increases risk of recurrence.

Symptoms and Signs

Purulent vaginal discharge, dyspareunia, dysuria, and vaginal irritation are common. Vaginal pruritus and erythema may occur. Burning, pain, or mild bleeding occurs less often. Vaginal tissue may appear thin and dry. Vaginitis may recur.


  • Vaginal pH and wet mount

Because symptoms overlap with other forms of vaginitis, testing (eg, vaginal fluid pH measurement, microscopy, whiff test) is necessary. The diagnosis is made if vaginal fluid pH is > 6, whiff test is negative, and microscopy shows predominantly WBCs and parabasal cells.


  • Clindamycin vaginal cream

Treatment is with clindamycin vaginal cream 5 g every evening for 1 wk. After treatment with clindamycin, women are evaluated for genital atrophy. Genital atrophy, if present, can be treated with topical estrogens (eg, 0.01% estradiol vaginal cream 2 to 4 g once/day for 1 to 2 wk, followed by 1 to 2 g once/day for 1 to 2 wk, then 1 g 1 to 3 times weekly; estradiol hemihydrate vaginal tablets 10 mcg twice/wk; estradiol rings q 3 mo). Topical therapy is usually preferred because of concerns about the safety of oral hormonal therapy; topical therapy may have fewer systemic effects.