Vaginal infections are one of the most common reasons women see their doctor, accounting for millions of visits each year.
Vaginal infections are caused by infectious organisms (such as bacteria or yeast).
Infections usually cause a vaginal discharge with itching, redness, and sometimes burning and soreness of the vagina and vulva (labia).
Doctors examine a sample of fluids from the vagina or cervix to check for infectious organisms.
Treatment depends on the cause.
Vaginitis is a term that usually refers to vaginal infections but may also be used to describe inflammation of the vagina or vulva (labia), without infection. Vaginitis can cause vaginal discharge, discomfort, itching, or vaginal odor, and sometimes irritation, redness, itching, or swelling of the vulva. Inflammation of the vulva is called vulvitis. When both the vulva and vagina are inflamed, the disorder is called vulvovaginitis.
Vaginal infections include
Yeast infections (candidiasis)
Bacterial vaginosis is a change in the balance or overgrowth of the normal bacteria in the vagina. It is not considered a vaginal infection, but can cause similar symptoms.
Vaginal discharge may also be caused by an infection that affects other reproductive organs, rather than the vagina. For example, a discharge can result if the cervix (the lower, narrow part of the uterus that opens into the vagina) is infected with certain sexually transmitted infections such as chlamydia or gonorrhea. The bacteria that cause these infections can spread from the cervix to the uterus, and even through the fallopian tubes and into the abdominal cavity. Infection that involves the uterus or other upper reproductive tract organs is called pelvic inflammatory disease.
Genital herpes, 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.
However, vaginitis symptoms do not necessarily indicate an infection. Instead, they may result from other conditions that affect the vagina or vulva. For example, chemicals or other materials (such as hygiene products, bubble bath, laundry detergents, contraceptive foams and jellies, and synthetic underwear) can irritate the vagina and cause a discharge and discomfort. The inflammation that results is called noninfectious (inflammatory) vaginitis. Another form of noninfectious vaginitis is atrophic vaginitis, which can occur in women after menopause because the vaginal tissue becomes dry and prone to irritation due to a decreased level of estrogen.
Internal Female Reproductive Anatomy
Causes of Vaginitis
Vaginal infections may be caused by bacteria, yeast, and other infectious organisms.
Certain conditions may make infection more likely:
Reduced acidity (increased pH) in the vagina: The pH in the vagina is usually acidic. Menopause, semen, use of vaginal products, or infection can change the pH in the vagina. When acidity in the vagina is reduced, the number of protective bacteria (lactobacilli) that normally live in the vagina decreases, and the number of bacteria that can cause inflammation increases, sometimes resulting in bacterial vaginosis.
Irritation or allergy: Irritation of vaginal tissues (for example, due to a reaction to certain kinds of soap or other vaginal products) can lead to cracks or sores, which provide access to the bloodstream for bacteria and yeast.
Prolonged exposure to moisture: If the vulva or vagina is exposed to moisture for a long time (for example, due to sitting in a bath or not changing menstrual or incontinence pads frequently enough), this may encourage the growth of bacteria and yeast.
Exposure to bacteria from other sources: Bacteria from the digestive system may enter the vagina, shifting the balance of bacteria or causing an infection. For example, bacteria can enter if fecal matter from the anus comes into contact with the vagina. Ways to prevent this include keeping the area clean and wiping from front to back after urinating or having a bowel movement.
Tissue damage: If tissues in the pelvis are damaged, the body’s natural defenses are weakened. Damage can result from pregnancy or childbirth, injury, surgery, medications, cancer, or radiation therapy.
Some specific causes of vaginal infections are more common among certain age groups.
Children
In children, vaginal infections are usually caused by bacteria from fecal matter from the anal area. These bacteria may be moved to the vagina when girls, particularly those aged 2 to 6 years, wipe from back to front after urination or a bowel movement or do not adequately clean the anal and genital area after bowel movements. Frequent touching of the genital area may also move these bacteria to the vagina, particularly if girls do not wash their hands after bowel movements.
Occasionally, children place small objects (such as tissue paper) into body cavities, including the vagina. An object placed in the vagina may cause a vaginal infection.
Sexual abuse is another possible cause. Sexually transmitted infections, including those that cause vaginal infections, can be spread during sexual abuse.
Pinworms may also cause vaginal infection.
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Women of childbearing age
Hormonal changes shortly before and during menstrual periods or during pregnancy can reduce acidity in the vagina, as can douching, use of spermicides, and semen. Reduced acidity can shift the balance of bacteria and increase risk of inflammation or infection.
Leaving tampons in too long can lead to infection, possibly because tampons provide a warm, moist environment where bacteria can thrive and because prolonged use can irritate the vagina.
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Postmenopausal women
After menopause, estrogen levels in the blood 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, increasing the risk of infection.
Women who have urinary incontinence or fecal incontinence and/or are confined to bed may have difficulty keeping the genital area clean. Prolonged exposure to urine and stool can lead to infection.
Women of all ages
At any age, conditions that increase the risk of getting a vaginal infection include
Irritation of the vulvar or vaginal tissues or an allergic reaction
Damage to the tissues of the vulva, vagina, or pelvis
Vaginitis symptoms may be caused by exposures other than to infectious organisms. For example, vaginitis may result from an allergy (hypersensitivity) to or irritation from hygiene sprays or perfumes, menstrual pads, laundry soaps, bleaches, fabric softeners, fabric dyes, synthetic fibers, bathwater additives, toilet tissue, spermicides, vaginal lubricants or creams, or, in some people, latex condoms or contraceptive rings or diaphragms.
Damage to the tissues of the vulva, vagina, or pelvis may occur due to pregnancy and childbirth, injury, surgery, medications, cancer, or radiation therapy. Damaged tissue is more vulnerable to infection. Rarely, childbirth, surgery, or radiation therapy may result in a fistula (abnormal connection) between the intestine and internal reproductive organs, which can allow bacteria from the intestine to infect them.
Some Types of Vaginitis
Infection | Symptoms | Potential Complications | Treatment |
|---|---|---|---|
Yellow-green or gray, thin, cloudy discharge, often with a fishy odor, which may become stronger after sexual intercourse or during menstrual periods Sometimes, irritation | For pregnant women: Infection of the membranes around the fetus (intra-amniotic infection) Infections of the uterus after delivery of a baby or after an abortion Preterm labor and delivery | ||
Usually a profuse, greenish yellow, frothy discharge Sometimes a fishy smell Sometimes itching and irritation Pain during sexual intercourse and urination | For pregnant women: Preterm labor and delivery | ||
Yeast infection (candidiasis) | Thick, white, curd-like discharge Moderate to severe itching and burning (but not always) Usually redness and swelling of the genital area | No serious complications |
Symptoms of Vaginitis
Typically, vaginal infections cause a vaginal discharge that differs from normal vaginal discharge.
It is normal for women in their childbearing years to have a vaginal discharge. Normal vaginal discharge is clear, white, or pale yellow. It may occur every day or intermittently, usually in a small amount. Abnormal discharge is usually accompanied by itching, redness, and sometimes burning or soreness in the genital area and may have a fishy odor. The appearance and amount of the discharge may vary depending on the cause.
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 of Vaginitis
A doctor's evaluation
Examination and testing of sample of the discharge and/or fluid from the cervix
Girls or women who have a vaginal discharge with itching or a fishy odor or who have other vulvar or vaginal symptoms, such as redness, burning, soreness, or pain during sexual intercourse, should see a doctor.
Medical history
To determine the cause, the doctor asks questions about the discharge (if present), about possible causes of the symptoms, and about hygiene. The doctor may ask a woman the following:
When did the discharge begin?
What does the discharge look like and does it have an odor?
Is the discharge accompanied by itching, burning, pain, or a sore in the genital area?
Does the discharge come and go, or is it always present?
When do symptoms occur in relation to the menstrual period?
Has there been exposure to new soaps, detergents, vaginal lotions, or other products?
Has an abnormal discharge occurred before, and if so, what was the diagnosis and how did it respond to treatment?
Have any treatments (including home remedies) been used to try to relieve the symptoms?
What kind of birth control has been and is being used?
The doctor also asks about the possibility of a sexually transmitted infection (STI). For example, a woman may be asked whether she is sexually active and, if so, whether she has had sexual activity without a condom, whether she or her partner have more than one partner, and if a partner has symptoms of an STI. This information helps the doctor determine whether the symptoms may be caused by an STI and if other people require treatment.
Physical examination and testing
The doctor performs a pelvic examination. Using a speculum (a metal or plastic instrument that spreads the walls of the vagina apart), the doctor examines the deeper areas of the vagina and the cervix (the lower part of the uterus). 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 information from this examination, the doctor can usually determine whether the cause is bacterial vaginosis, trichomonal 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 infections.
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.
If the cause may be irritation or an allergic reaction, doctors advise stopping the use of products that are possible causes (for example, new soaps, detergents, vaginal products). If symptoms resolve, each product may be used again one at a time to check whether it was the cause of the symptoms.
Evaluation of children
In children, pelvic examination must be done by an experienced clinician. If speculum examination is required, this is usually done under anesthesia.
If children have trichomonal vaginitis, doctors evaluate them to determine whether sexual abuse could be the cause. Doctors also consider abuse if the child has unexplained vaginal discharge that may be due to a sexually transmitted infection.
Treatment of Vaginitis
Treatment of cause
Treatment of symptoms
Avoidance or irritants or allergens
Vaginal infections (such as bacterial vaginosis, trichomonal vaginitis, and yeast infections) are treated with antibiotics or antifungal medications.
If a foreign body is present, it is removed.
If symptoms are found to be due to irritation or an allergy, the product identified as the cause should be avoided.
Sometimes, if a cause has not yet been identified or it is taking time for a treatment to work, comfort measures may help ease symptoms. Placing ice packs on the genital area, applying cool compresses, or sitting in a cool sitz bath 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 relieve soreness and itching.
Medications may also be needed to lessen symptoms. Antihistamines taken by mouth help relieve itching. They also cause drowsiness and may be useful if symptoms interfere with sleep.
Prevention of Vaginitis
Prevention includes the following:
Keeping the genital area clean and dry to avoid irritation and changes in the balance of bacteria (washing with a mild, nonscented soap and rinsing and drying thoroughly are recommended)
Wiping from front to back after urinating or having a bowel movement to prevent bacteria in fecal matter from being moved to the vagina
Avoiding douching because 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 safer sex
