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 see Chlamydial and Other Infections) or gonorrhea (see 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 see 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.
Vaginal infections may be caused by bacteria, yeast, and other microorganisms.
Certain conditions make infection more likely:
Some specific causes of infection are more common among certain age groups.
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.
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.
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.
|PrintOpen table in new window
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.
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:
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.
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.
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 hydrocortisone) 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