The vagina is the part of the female reproductive system that connects the cervix (entrance to the uterus) with the vulva (folds of skin around the vaginal and urethral openings). Under normal conditions the vagina, which is self-cleaning, flushes out dead cells and secretions in the form of a discharge. The amount, color, and texture of this discharge vary according to a woman’s monthly cycle and her stage of life, but it is usually clear or milky white in appearance and watery or slightly viscous.
Vaginitis is an inflammation of the vaginal lining that typically includes an abnormal discharge along with itching or burning of the genital area. Most often the problem is caused by an infection, but certain irritants also can trigger it, as can hormonal changes. At some point in their lives, about one-third of women must deal with this common problem. Though usually not a threat to health, vaginitis is uncomfortable and can be painful. Repeated bouts are common.
What causes vaginitis?
Three types of infection are the most common causes of vaginitis:
Bacterial (or nonspecific) vaginosis has no established cause, but it is associated with various types of bacteria that, for reasons not always clear, multiply excessively in the vagina. It’s possible that the infection—which is the most common vaginal infection in women of childbearing age—can be spread by sexual intercourse, though this hasn’t been clearly established. But women who have never had sexual intercourse rarely have this disease.
Yeast infections are caused by fungi that grow normally in the vagina. The most common yeast infection—known as candidiasis—results from Candida albicans, one of several species of a fungus called Candida. Several factors are associated with sudden and excessive growth of the fungus. Taking antibiotics increases the risk of yeast infections because the medications kill vaginal bacteria that ordinarily subdue the growth of Candida.
Recurrent attacks are common among pregnant women, since pregnancy disturbs the acidic balance and moisture in the vagina, thereby encouraging the fungal growth. Birth control pills disrupt vaginal chemistry and are associated with an increased risk of infection. Also at greater risk are people with diabetes, possibly because high sugar levels in the vagina promote yeast growth, and those with weakened immune systems, such as people with HIV/AIDS or people undergoing chemotherapy.
Trichomoniasis is an infection by a tiny protozoan parasite called Trichomonas vaginalis. The infection, which typically occurs in the vagina in women, is usually passed through sexual contact. (A man also can be infected but will seldom show symptoms. If not treated, he can infect other sexual partners.) An estimated 1 million new cases of trichomoniasis occur each year in the U.S.
What are the symptoms?
The most common symptom is an abnormal vaginal discharge that varies depending on the cause of infection:
- Bacterial vaginosis: thin, watery discharge, heavier than usual, grayish white or yellow, often with a strong fishy odor; possible mild burning or irritation of the vulva and vagina, often without redness or itching. (Some women with bacterial vaginosis report no signs or symptoms.)
- Yeast infection: odorless, white, thick discharge (texture like cottage cheese); possible redness as well as itching and burning sensations.
- Trichomoniasis: yellow-gray or green-tinged discharge with intense unpleasant odor; vaginal and vulvar pain and itching, especially on urination; redness and swelling of the vulva.
Symptoms may be more severe just prior to and after menstruation.
Some cases of vaginitis are mild and will resolve by avoiding irritants, or by using proper hygiene. Other types of inflammation are more stubborn and carry more serious risk. Both bacterial vaginosis and trichomoniasis increase a woman’s risk of acquiring HIV infection if she is exposed to HIV. Both types of infection can also cause complications in women who are pregnant. A heavy discharge and burning pain during urination also can be signs of gonorrhea. Therefore, it is important to see your doctor if you notice symptoms.
Self-treatment is advisable only when you have symptoms consistent with a mild to moderate yeast infection, you have had the condition before, and it has been diagnosed previously by a physician. In this case, over-the-counter antifungal medications are available in both cream and suppository form. Otherwise, you should consult your doctor and be diagnosed in order to match the treatment with the cause—particularly the first time you have symptoms. A vaginal discharge can be a symptom of a sexually transmitted disease (for example, chlamydia or gonorrhea), in which case both you and your partner will require diagnosis and treatment.
When to call your doctor
Call your doctor if you experience any of the symptoms of vaginitis for the first time or if you notice any abnormal vaginal discharge. The most common forms of vaginitis have overlapping symptoms. Also call your doctor if you are taking medication for vaginitis and see no improvement after three days; another drug may be more effective or you may have another condition.
What your doctor will do. Your doctor will perform a pelvic examination and take a sample of vaginal discharge to test vaginal acidity and to inspect secretions under a microscope. If the diagnosis is unclear, other tests may be performed on vaginal discharges and on the cervix.
Once the doctor has reached a diagnosis, the appropriate medication can be prescribed. Metronidazole (Flagyl or Metrogel) and clindamycin (Cleocin) are the most effective treatments for bacterial vaginosis. Both medications are available as pills, vaginal creams, or gels. Metronidazole is also used against trichomoniasis, as is tinidazole (Tindamax). Your sexual partner should also be treated if you are diagnosed with trichomoniasis.
If you have had recurrent yeast infections, talk to your doctor about taking preventive doses of medication. For women who occasionally have yeast infections, an antifungal pill called fluconazole (Diflucan) is available by prescription only. Pregnant women should not take fluconazole, and women who are sensitive to other antifungals may react adversely.
How to prevent vaginitis
A number of steps can decrease your likelihood of getting vaginitis:
- Shower or bathe daily. Use a mild, unscented soap to gently wash the vaginal area, and dry thoroughly.
- Don’t use vaginal sprays, douches, or scents. And avoid irritants like perfumed soaps and pantiliners. The vagina cleanses itself, so there’s no need to clean it artificially and risk irritation.
- Dry well after swimming or exercise. Air drying is helpful, or you can use a hair dryer to gently blow dry the vaginal area.
- Practice careful hygiene. When you wipe yourself after a bowel movement, wipe from front to back to avoid spreading bacteria from the rectum to the vagina.
- Don’t wear tight clothing—and stick to cotton. Tight pants and underpants made of nylon, silk, or certain synthetics can trap moisture in the genital area. Wear underpants and pantyhose with a cotton crotch.
- Use condoms during sex if you are undergoing treatment for vaginitis. Also use condoms if you have recurrent infections or more than one sexual partner.
- Consider precautions during antibiotic treatment. If you are prescribed antibiotics for another infection and you’re prone to yeast infections when taking antibiotics, over-the-counter antifungal remedies may be recommended during the period you are taking antibiotics.
- Complete your treatment. If you are being treated for vaginitis, it’s important that you finish taking the medication and follow any other instructions from your doctor—even if symptoms disappear.
Also see Vaginal Odor: Causes and Remedies.