Overview of Vaginitis

The most common causes of vaginitis vary by patient age. Vulvitis and vulvovaginitis have some of the same causes.

Vaginitis causes vaginal discharge Vaginal Itching and Discharge Vaginal itching (pruritus), discharge, or both result from infectious or noninfectious inflammation of the vaginal mucosa ( vaginitis), often with inflammation of the vulva (vulvovaginitis)... read more , which must be distinguished from normal discharge. In children, normal discharge is common when estrogen levels are high—eg, during the first 2 weeks of life because maternal estrogen is transferred before birth (slight bleeding often occurs when estrogen levels abruptly decrease) and during the few months before menarche, when estrogen production increases.

Normal vaginal discharge is commonly milky white or mucoid, odorless, and nonirritating; it can result in vaginal wetness that dampens underwear.

Discharge due to vaginitis is accompanied by pruritus, erythema, and sometimes burning, pain, or mild bleeding. Pruritus may interfere with sleep. Dysuria or dyspareunia may occur. In atrophic vaginitis, discharge is scant, dyspareunia is common, and vaginal tissue appears thin and dry. Although symptoms vary among particular types of vaginitis, there is much overlap (see table Common Types of Vaginitis Common Types of Vaginitis ).

Vulvitis can cause erythema, pruritus, and sometimes tenderness and discharge from the vulva.

Vaginitis is diagnosed using clinical criteria and in-office or laboratory testing.

First, vaginal secretions are obtained with a water-lubricated speculum, and pH paper is used to measure pH in 0.2 intervals from 4.0 to 6.0. Then, secretions are placed on 2 slides with a cotton swab and diluted with 0.9% sodium chloride on one slide (saline wet mount) and with 10% potassium hydroxide on the other (KOH wet mount). The KOH wet mount is checked for a fishy odor (whiff test), which results from amines produced in trichomonal vaginitis or bacterial vaginosis. The saline wet mount is examined microscopically as soon as possible to detect trichomonads, which can become immotile and more difficult to recognize within minutes after slide preparation. Potassium hydroxide dissolves most cellular material except for yeast hyphae, making identification easier.

Clinical criteria and in-office testing are the most cost-effective way to diagnose infectious vaginitis. However, if findings are inconclusive, the discharge may be cultured for fungi or trichomonads. Also, some relatively new diagnostic tests are commercially available for clinical use (1–5 Diagnosis references Vaginitis is infectious or noninfectious inflammation of the vaginal mucosa, sometimes with inflammation of the vulva. Symptoms include vaginal discharge, irritation, pruritus, and erythema... read more ).

Other causes of discharge are ruled out:

If children have trichomonal vaginitis, evaluation for sexual abuse is required. If they have unexplained vaginal discharge, cervicitis, which may be due to a sexually transmitted infection, should be considered. If women have bacterial vaginosis or trichomonal vaginitis (and thus are at increased risk of sexually transmitted infections), cervical tests for Neisseria gonorrhoeae and Chlamydia trachomatis, common causes of sexually transmitted PID, are done.

The vulva should be kept as clean as possible. Soaps and unnecessary topical preparations (eg, feminine hygiene sprays) should be avoided. Intermittent use of ice packs or warm sitz baths with or without baking soda may reduce soreness and pruritus.

If symptoms are moderate or severe or do not respond to other measures, drugs may be needed. For pruritus due to noninfectious conditions, topical corticosteroids (eg, topical 1% hydrocortisone twice a day as needed) can be applied to the vulva but not in the vagina. Oral antihistamines decrease pruritus and cause drowsiness, helping patients sleep.

Any infection (eg, bacterial vaginosis Treatment Bacterial vaginosis is vaginitis due to a complex alteration of vaginal flora in which lactobacilli decrease and anaerobic pathogens overgrow. Symptoms include a gray, thin, fishy-smelling vaginal... read more , candidal vaginitis Treatment Candidal vaginitis is vaginal infection with Candida species, usually C. albicans. (See also Overview of Vaginitis.) Most fungal vaginitis is caused by C. albicans ( candidiasis)... read more , trichomoniasis Treatment Trichomoniasis is infection of the vagina or male genital tract with Trichomonas vaginalis. It can be asymptomatic or cause urethritis, vaginitis, or occasionally cystitis, epididymitis... read more ) or other cause is treated. Foreign bodies are removed.

Prepubertal girls are taught good perineal hygiene (eg, wiping front to back after bowel movements and voiding, washing hands, avoiding fingering the perineum). If chronic vulvar inflammation is due to being bedbound or incontinent, better vulvar hygiene may help.