By Joy Jensen, MN, RN

What is Vaginitis?

Vaginitis in an inflammation of the vagina that can result in discharge, itching, abnormal discharge and pain. Infection is the most common cause of vaginitis, but it may also result from poor hygiene, an allergic reaction, exposure to vaginal irritants or low estrogen levels (especially with menopause). Symptoms of vaginitis often extend to the vulva (outside the vagina).

The Role of Bacteria

All parts of the body have bacteria, and while most are beneficial others may be harmful. When there is an overgrowth of the harmful bacteria then problems can arise. The vagina contains mostly good bacteria, called lactobacilli, which produce lactic acid and help to prevent the overgrowth of bacteria that cause symptoms. When the protective lactobacilli levels drop, then bacteria such as Gardnerella vaginalis or yeast (Candida) can proliferate. At that time women are also more susceptible to sexually transmitted infections such asNeisseria gonorrhoeae, Chlamydia trachomatis, and trichomoniasis (which can also cause vaginitis). A few reasons why women may develop an imbalance of vaginal bacteria include: antibiotic use, hormonal changes related to puberty, pregnancy, menopause, implanted birth control devices, and certain medical conditions such as diabetes.

Vaginal Hygiene, Contact Irritants, and Allergic Reactions

Sexual intercourse may provoke vaginitis, as can exposure to irritants and lack of adequate hygiene. Allergic reaction to topical medications, perfumes and artificial colors in products, and latex condoms or spermicides may also cause vaginitis. Care of the vulva (outside the vagina) is also necessary to reduce symptoms.

The list of possible vaginal and vulvar irritants is long: body soaps; bath salts/bombs/bubbles; perfumed sanitary pads, tampons, laundry detergent or dryer sheets; flavored/colored condoms, spermicides or lubricants; specific or excess use of essential oils; vaginal deodorants; latex in condoms or underwear, sweat in and prolonged wearing of moist tight (workout) clothing; topical anesthetics, antibacterial, antifungals, or corticosteroids; and rough or perfumed toilet paper, baby wipes or perineal care products.

Poor or excessive hygiene can cause or aggravate vulvar-vaginal irritation (not wiping properly after toileting, lack of cleanliness with sexual activity, failure to change tampons and pads frequently, douching, using too much soap, drying with too much rubbing and failure to change out of wet clothing).

Symptoms of Vaginitis

Vaginitis symptom quantity and quality vary, but commonly include:

• irritation of the genital area (itching, pain)

• discharge that may be white, gray, watery, or foamy (some secretions are normal)

• inflammation, leading to redness and swelling of the external genitalia

• dysuria, which is pain or discomfort when urinating

• painful sexual intercourse, known as dyspareunia

• foul or fishy vaginal odor

Treatment of Vaginitis

Treatment depends on the cause. Bacterial vaginosis (BV) is usually treated with oral antibiotics including metronidazole (Flagyl) or vaginal clindamycin cream. Yeast infections are most often treated with oral fluconazole (Diflucan) or vaginal butoconazole (Monistat). Chlamydia and gonorrhea are usually treated with the oral antibiotics Azithromycin or Doxycycline. Other options may include cortisone cream to treat severe irritation, antihistamines if the inflammation appears to stem from an allergic reaction, and topical estrogen cream if the vaginitis is due to low estrogen levels. A pregnant woman should tell her doctor right away if she has vaginitis, as some medications may not be appropriate and some bacterial infections are associated with pre-term labor.

Prevention of Vaginitis (and Vulvar Irritation)

The following best practices may help prevent vaginitis, and also some bladder infections:

• practicing thorough and timely overall hygiene primarily with plain water when bathing

• using mild soaps without irritants or scents, in only small amounts if needed at all

• wearing cotton underwear and loose clothing to promote air circulation and dryness

• avoid vaginal douching

• avoid irritating feminine products such as perfumed soaps, tampons, pads, and deodorants

• wiping from front to back when toileting, to avoid spreading bacteria from the anus to the vagina and urethra

• practicing sex with a condom (use lambskin condoms if you have a latex allergy)

• using adequate and non-irritating lubrication for intercourse

• urinating and peri-care immediately after intercourse

• thorough vaginal rinsing with water after a bath when using essential oils, bath salts, bombs, or bubbles

• thorough rinsing and drying of clothing (especially underwear) to ensure detergents are removed

• using antibiotics only when necessary AND completing the full course of prescribed antibiotics

• have sexually transmitted infection (STI) testing per public health agency recommendations

Complications of Untreated Vaginitis

Women with trichomoniasis or bacterial vaginosis are at a greater risk of acquiring sexually transmitted infections or pelvic inflammatory disease because of the inflammation caused by these disorders. Untreated vaginitis may allow harmful bacteria (STI’s) to move up into a woman’s fallopian tubes and cause scarring, which may impact future fertility. Pregnant women with untreated vaginitis may be at risk for premature deliveries and low birth weight babies.

When to Call Your Doctor

See your doctor if you develop unusual vaginal discomfort, especially if:

• You have a particularly unpleasant vaginal odor, discharge or itching

• You have pain or discomfort when urinating or with sexual intercourse

• You’ve had multiple sex partners or a recent new partner

• You’ve completed a course of over-the-counter anti-yeast medication and symptoms persist

• You have a fever or chills

What to Expect at 3W Medical for Women

After a full review of your medical history, allergies, medications, and risk factors you will have a consultation with our licensed provider and a physical exam.

Individual recommendations may include STI testing, assessment of discharge through on-site microscopic evaluation or testing sent to an outside lab, antibiotic treatment as needed, and appropriate follow-up.

If you have any questions please contact us at 206-588-0311.