• Vaginal infections are caused by microorganisms, but women can take precautions, such as wearing loose, absorbent underwear, to reduce their risk of getting infections.
• Infections usually cause a discharge with itching, redness, and sometimes burning and soreness.
• Doctors examine a sample of fluids from the vagina or cervix to check for microorganisms that can cause infections.
• Treatment depends on the cause, but a sitz bath and antihistamines taken by mouth can help relieve itching.

In the United States, vaginal infections are one of the most common reasons women see their doctor, accounting for more than 10 million visits each year. Vaginal infections can cause discomfort, discharge, and vaginal odor. However, these symptoms do not necessarily indicate an infection. Instead, they may result from irritation of the vagina by chemicals or other materials such as hygiene products, bubble bath, laundry detergents, contraceptive foams and jellies, and synthetic underwear. The inflammation that results is called noninfectious vaginitis.

A vaginal discharge may be caused by a disorder that affects other reproductive organs, rather than the vagina. For example, a discharge can result from certain sexually transmitted diseases such as chlamydial infection (see Sexually Transmitted Diseases: Chlamydial and Other Infections) or gonorrhea (see Sexually Transmitted Diseases: Gonorrhea). These diseases can affect the uterus, including the cervix (the lower, narrow part of the uterus that opens into the vagina). Genital herpes (see Viral Infections: Herpes Simplex Virus Infections), which can cause blisters on the vulva (the area around the opening of the vagina), in the vagina, and on the cervix, can also cause a vaginal discharge.

Causes

Vaginal infections may be caused by bacteria, yeast, and other microorganisms.

Did You Know... Douching can often remove normal, protective bacteria from the vagina, increasing the risk of infection.

Certain conditions make infection more likely:

• Reduced acidity (increased pH) in the vagina: When acidity in the vagina is reduced, the number of protective bacteria that normally live in the vagina decreases, and the number of bacteria that can cause infection increases (see Vaginal Infections and Pelvic Inflammatory Disease: Bacterial Vaginosis).
• Poor hygiene: When the genital area is not kept clean, the number of bacteria increases, making bacterial infections more likely.
• Tight, nonabsorbent underwear: This type of underwear may trap moisture, which encourages the growth of bacteria and yeast.
• Tissue damage: If tissues in the pelvis are damaged, the body's natural defenses are weakened. Damage can result from tumors, surgery, radiation therapy, or structural abnormalities such as birth defects or fistulas. Fistulas are abnormal connections between organs, which may, for example, allow the intestine's contents to enter the vagina.
• Irritation: Irritation of vaginal tissues can lead to cracks or sores, which provide access to the bloodstream for bacteria and yeast.

Some specific causes of infection are more common among certain age groups.

Children: In children, vaginal infections are usually caused by bacteria from the anus. These bacteria may be moved to the vagina when girls, particularly those aged 2 to 6 years, wipe from back to front or do not adequately clean the genital area after bowel movements. Fingering the genital area, particularly if girls do not wash their hands after bowel movements, may also move these bacteria to the vagina. Fingering is often a response to itching.

Putting an object (such as a toy or toilet tissue) in the vagina is another common cause of vaginal infections. Pinworms may also cause vaginal infections.

Did You Know... Children may get a vaginal infection when they move bacteria from the anus to the vagina by wiping from back to front.

Women of childbearing age: Hormonal changes shortly before and during menstrual periods or during pregnancy can reduce acidity in the vagina, as can frequent douching, use of spermicides, and semen. Reduced acidity encourages the growth of bacteria that cause disease.

Leaving tampons in too long can lead to infection, possibly because tampons provide a warm, moist environment where bacteria can thrive and because they can irritate the vagina.

Postmenopausal women: After menopause, estrogen levels decrease. As a result, tissues in the vagina become thinner, drier, and more fragile. Cracks or sores may form, providing access for bacteria or yeast. Also, acidity in the vagina decreases.

Women who have urinary incontinence or are confined to bed may have difficulty keeping the genital area clean. Irritation from urine and stool can lead to infection.

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Some Vaginal Infections Infection Symptoms Complications Treatment Bacterial vaginosis A thin, white or gray cloudy discharge with a fishy odor, which may become stronger after sexual intercourse or during menstrual periods Itching and irritation Pelvic inflammatory disease Infection of the membranes around the fetus Infections of the uterus after delivery of a baby or after an abortion Preterm labor and delivery ClindamycinSome Trade Names CLEOCIN MetronidazoleSome Trade Names FLAGYL Trichomonas vaginitis A usually profuse, greenish yellow, frothy, fishy-smelling discharge Itching and soreness Pain during sexual intercourse and urination Pelvic inflammatory disease Preterm labor and delivery MetronidazoleSome Trade Names FLAGYL TinidazoleSome Trade Names TINDAMAX Yeast infection (candidiasis) Thick, white, clumpy discharge (like cottage cheese) Moderate to severe itching and burning (but not always) Redness and swelling of the genital area No serious complications ButoconazoleSome Trade Names GYNAZOLE-1 ClotrimazoleSome Trade Names LOTRIMIN AF MYCELEX FluconazoleSome Trade Names DIFULCAN MiconazoleSome Trade Names MONISTAT TerconazoleSome Trade Names TERAZOL TioconazoleSome Trade Names VAGISTAT-1

Nearby Infections: Vulvitis and Bartholinitis
The vulva is the area surrounding the opening of the vagina and containing the external female genital organs. Bartholin glands, which are external genital organs, are located on either side of the opening of the vagina. Vulvitis: Vulvitis is inflammation of the vulva. When both the vulva and vagina are inflamed, the disorder is called vulvovaginitis. Vulvitis may result from allergic reactions to substances that come in contact with the vulva (such as soaps, bubble bath, fabrics, and perfumes), from skin disorders (such as dermatitis), or from infections, including yeast infections and sexually transmitted diseases (such as herpes). The vulva may be infested by pubic lice—a disorder called pediculosis pubis. In children, infections of the vagina may also affect the vulva. These infections may be due to bacteria from the anus or other bacteria. Urine or stool, if it remains in contact with the vulva, can irritate it and cause ongoing (chronic) vulvitis. Women who have incontinence or are confined to bed may have this problem. Vulvitis causes itching, soreness, and redness. Rarely, the folds of skin around the vaginal and urethral openings (labia) become stuck together. Chronic vulvitis may result in sore, scaly, thickened, or whitish patches on the vulva. If chronic vulvitis does not respond to treatment, doctors usually do a biopsy to look for the cause, including skin disorders of the vulva (vulvar dystrophies, such as lichen sclerosus or squamous cell hyperplasia) or cancer. Bartholinitis: Bartholinitis—infection of one or both Bartholin glands or their ducts—may develop when bacteria from the vagina enter the glands. Rarely, bartholinitis is due to a sexually transmitted disease. Pus can accumulate in the gland, causing a painful, swollen abscess. If the ducts to the gland become blocked, the gland may swell without causing pain—a disorder called Bartholin cyst. A cyst may become infected. Doctors can diagnose Bartholin cyst and bartholinitis during a physical examination. In women 40 and older, a cyst is usually biopsied. Cysts that cause no symptoms do not require treatment. Infections are treated with an antibiotic, which usually clears the infection in a few days if there is no abscess. However, the infection may recur. Analgesics may be taken to relieve pain. Cysts that cause symptoms or recur and abscesses are usually drained.

Symptoms

Typically, vaginal infections cause a vaginal discharge. This discharge differs from a normal one because it is accompanied by itching, redness, and sometimes burning or soreness in the genital area. A discharge may have a fishy odor. The appearance and amount of the discharge tend to vary depending on the cause. However, different disorders sometimes cause similar discharges.

Itching may interfere with sleep. Some infections can make sexual intercourse painful and make urination painful and more frequent. Rarely, the folds of skin around the vaginal and urethral openings become stuck together. However, sometimes symptoms are mild or do not occur.

Diagnosis

Girls or women who have a vaginal discharge with itching or who have other vaginal symptoms, such as redness, burning, soreness, or pain during sexual intercourse, should see a doctor. To determine the cause, the doctor asks questions about the discharge (if present), about possible causes of the symptoms, and about hygiene. Questions may include the following:

• Have lotions or creams (including home remedies) been used to try to relieve the symptoms?
• When did the discharge begin?
• Was the discharge accompanied by itching, burning, pain, or a sore in the genital area?
• When do symptoms occur in relation to the menstrual period?
• Does the discharge come and go, or is it always present?
• Has an abnormal discharge occurred before, and if so, how did it respond to treatment?
• What kind of birth control has been and is being used?
• Is pain felt during sexual intercourse?
• Has the woman had previous vaginal infections?
• Does the sex partner have symptoms?

The doctor also asks about the possibility of sexually transmitted diseases. For example, a woman may be asked whether she is sexually active and, if so, whether she has more than one partner. This information helps the doctor determine whether other people require treatment.

A pelvic examination is done. While examining the vagina, the doctor takes a sample of the discharge (if present) with a cotton-tipped swab. The sample is examined under a microscope. With this information, the doctor can usually determine whether the cause is bacterial vaginosis, Trichomonas vaginitis, or a yeast infection. Usually, the doctor also uses a swab to take a sample of fluid from the cervix. The sample is tested for sexually transmitted diseases.

To determine whether there are other infections in the pelvis, the doctor checks the uterus and ovaries by inserting the index and middle fingers of one gloved hand into the vagina and pressing on the outside of the lower abdomen with the other hand. If this maneuver causes substantial pain or if a fever is present, other infections may be present.

Prevention

Keeping the genital area clean and dry can help prevent infections. Washing every day with a mild, nonscented soap (such as glycerin soap) and rinsing and drying thoroughly are recommended. Wiping from front to back after urinating or defecating prevents bacteria from the anus from being moved to the vagina. Young girls should be taught good hygiene.

Wearing loose, absorbent clothing, such as cotton or cotton-lined underpants, allows air to circulate and helps keep the genital area dry. Douching frequently and using medicated douches are discouraged. Douching can remove normal, protective bacteria from the vagina and reduce the acidity of the vagina, making infections, including pelvic inflammatory disease, more likely. Practicing safe sex and limiting the number of sex partners are important preventive measures.

Treatment

Measures used for prevention, such as keeping the genital area clean and dry, also help treat infections. Strong or scented soaps and unnecessary topical products (such as feminine hygiene sprays) should be avoided. Occasionally placing ice packs on the genital area, applying cool compresses, or sitting in a cool sitz bath (with or without baking soda or Epsom salts) may reduce soreness and itching. A sitz bath is taken in the sitting position with the water covering only the genital and rectal area. Flushing the genital area with lukewarm water squeezed from a water bottle may also provide relief.

If these measures do not relieve symptoms, drugs may be needed. For itching, a corticosteroid cream (such as hydrocortisoneSome Trade Names
See cortisol
) can sometimes be applied to the vulva but not inside the vagina. Antihistamines taken by mouth help relieve itching. They also cause drowsiness and may be useful if symptoms interfere with sleep.

Specific treatment depends on the cause.

Last full review/revision March 2013 by David E. Soper, MD