Inflammation or infection of the vagina (birth canal) is known as vaginitis. This common condition can occur when there is a decrease in the acidity of the vaginal environment. It can also be caused by other factors, such as several types of infection or reduced levels of estrogen that can occur after menopause.

Bacterial vaginosis (BV) is the most common type of vaginitis. It is caused by an overgrowth of one of several organisms (bacteria) that are normally present in the vagina. Other common types of vaginitis include:

• Yeast infection (genital candidiasis). Caused by an overabundance of Candida, a microscopic fungus that normally inhabits the vagina.
• Trichomoniasis. Caused by a parasite in the vagina, typically the Trichomonas vaginalis.

Different types of vaginitis have different causes and risk factors. For instance, yeast infections may be found more frequently as a result of hormonal changes, such as those associated with pregnancy, whereas trichomoniasis is typically transmitted through sexual intercourse with an infected partner. Signs and symptoms typically vary according to the type of vaginitis. Common symptoms may include a change in the amount, color or odor of vaginal discharge. Vaginitis can also result in symptoms such as itching or burning inside or around the vagina.

In order to determine the cause of vaginitis, physicians will take a medical history and perform a pelvic examination. Microscopic analysis of vaginal discharge is also required. Treatment of vaginitis depends on the type of infection that is present. Many forms of treatment are available in oral, suppository or topical form. Prevention methods include practicing safe sex, exercising proper toilet habits and avoiding use of vaginal sprays, deodorants and douches.

Vaginitis is the medical term for inflammation or infection of the vagina (birth canal). It typically occurs when there is a decrease in the acidity (increase in pH level) of the vagina or an infection. In premenopausal women, the normal pH level of the vagina is approximately 4.0 on the 0 to 14 pH scale that goes from acid to alkaline. This acidity normally limits the development of infectious bacteria, fungi and parasites. Vaginitis may also result from reduced levels of estrogen  that occur after menopause.

The glands inside the vagina and cervix (the bottom part of the uterus) produce small amounts of fluid. The fluid is discharged from the vagina daily, carrying out old cells that have been shed from the vaginal lining. This is the body’s way of ensuring that the vagina remains clean and healthy.

Vaginal discharge is typically clear or milky in appearance and odorless. The color and consistency of the discharge may change during menstruation and become thicker during ovulation, breastfeeding and sexual arousal. Other changes in the discharge, such as a difference in color or odor, often indicate that a woman has vaginitis or a sexually transmitted disease (STD).

There are several types of vaginitis. The three most common types are:

• Bacterial vaginosis (BV). Caused by an overgrowth of one of several organisms (bacteria) that are usually present in the vagina.
  
  
• Yeast infection (genital candidiasis). Caused by an overabundance of Candida, a microscopic fungus that normally inhabits the vagina.
  
  
• Trichomoniasis. Caused by a parasite in the vagina, typically the Trichomonas vaginalis.

It is possible for women to experience multiple types of vaginitis at the same time. Therefore, a diagnosis of BV does not necessarily preclude a diagnosis of yeast infection.

Vaginitis does not typically cause serious complications in patients. However, some types have been associated with pelvic inflammatory disease (PID) and an increased risk of STDs, including the human immunodeficiency virus (HIV). In addition, some types of vaginitis may pose certain risks for pregnant women, such as premature delivery and low birth weight babies (weighing less than 5 pounds, 8 ounces, or 2,500 grams at birth).

There are three vaginal infections that are typically classified as vaginitis. The most common of these is bacterial vaginosis (BV). BV is caused by an overgrowth of one of several organisms (bacteria) that are usually present in the vagina. Normally, the “good” bacteria in the vagina outnumber the “bad” bacteria. However, if the bad bacteria become too abundant, they can upset the bacterial – or pH – balance of the vagina, resulting in BV.

Although BV accounts for more cases, it is less understood than yeast infection or trichomoniasis, the other common types of vaginitis. It is also undetected and misdiagnosed more often than these conditions. Left untreated, BV can lead to the following significant health complications:

• Pelvic inflammatory disease (also known as PID, an infection of the upper genital tract that may cause infertility)
  
  
• Complications following surgeries (abortion, hysterectomy and other procedures)

Experts also believe that BV may be associated with increased susceptibility to the human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS). However, further study is needed to confirm this link.

According to the Centers for Disease Control and Prevention, BV affects up to 16 percent of expectant mothers in the United States, although many are not even aware they have the condition. Pregnant women with BV are at increased risk of the following:

• Premature delivery
• Postpartum infection
• Post-surgical complications (after Caesarean-section)

Although BV can be transmitted through sexual intercourse, it is not generally considered a sexually transmitted disease (STD). Approximately one-quarter of women treated for BV will have a recurrence within one month.

The two other main types of vaginitis include:

• yeast infection (genital candidiasis). Caused by an overabundance of Candida, a microscopic fungus that normally inhabits the vagina. There are four types of Candida. A variety called Candida albicans (C. albicans) causes the vast majority of vaginal yeast infections. This fungus, which also grows normally in the mouth (a condition called thrush) and digestive tract, can infect other moist regions of the body as well, including the skin folds and nail beds.
  
  Almost 75 percent of all adult women will have a yeast infection at some point in their lives, according to the CDC, and approximately 5 percent of patients will develop a condition called recurrent vulvovaginal candidiasis (RVVC). RVVC is classified as more than three symptomatic vaginal yeast infections over the course of one year. Patients who experience RVVC should notify their gynecologist (a physician that specializes in treating disorders of the female reproductive system) who will attempt to identify the underlying cause of the condition. Although yeast infection is not generally considered an STD, it may be transmitted to male partners through sexual intercourse in rare instances.
  
  
• trichomoniasis. Caused by a parasite in the vagina, typically the Trichomonas vaginalis. This protozoan (single-cell organism) primarily resides in a woman’s genitourinary tract, where it finds the moisture and warmth it needs to develop and multiply. Trichomoniasis is typically transmitted through sexual intercourse with a partner who is already infected. Because the parasite can live for several hours on damp washcloths, towels and bathing suits, it can be spread when these items are shared. Trichomoniasis affects approximately 5 to 10 percent of women in the United States.
  
  Trichomoniasis affects more people (an estimated 7.4 million) than any other nonviral STD in the United States. Left untreated, trichomoniasis does not typically produce symptoms. However, it may cause vaginitis in some women, and some men with the condition may develop nongonococcal urethritis (a type of urethral infection). Additionally, recent research indicates that pregnant women with trichomoniasis may experience preterm delivery, and individuals who are infected may be two to four times more likely to acquire other STDs, including HIV. However, more research is needed.

Other, less common forms of vaginitis include:

• Atrophic vaginitis. Typically results from a decline in estrogen (a female reproductive hormone) levels occurring after menopause. Reduction of the hormone may cause changes in the skin around the vagina, vulva, urethra and/or bladder.
  
  
• Noninfectious vaginitis. Occurs when products such as perfumed soaps, douches and vaginal sprays irritate the skin around the vagina or cause an allergic reaction.
  
  
• Chlamydia. Primarily transmitted through sexual intercourse.
  
  
• Viral vaginitis. Caused by viral infection, such as the herpes simplex virus (HSV) or the human papillomavirus (HPV).

Different types of vaginitis have different causes and risk factors. Bacterial vaginosis (BV) occurs when the “bad” bacteria in the vagina become too numerous. Although BV can be transmitted through sexual intercourse, it can also affect individuals who are not sexually active. Therefore, it is not generally considered a sexually transmitted disease (STD). Other risk factors include:

• Having a new sex partner
• Having multiple sex partners
• Having unprotected sex
• Douching
• Exposure to irritants, such as bubble baths, deodorized tampons, feminine hygiene sprays, harsh soaps and others
• Using an intrauterine device (IUD) for contraception

In addition, race is a significant risk factor for BV. African-American women are three times more likely to develop the condition than other women, although the reason for this disparity remains unclear.

Yeast infection is caused by an overabundance of a microscopic Candida fungus in the vagina. Yeast infections are not considered STDs although, very rarely, they may be spread to male partners through sexual intercourse. Yeast infection may be caused by a variety of factors, including, but not limited to:

• Hormonal changes, including those associated with birth control pills and pregnancy
  
  
• Diabetes, HIV and other conditions that affect the immune system
  
  
• Medications, such as steroids and antibiotics
  
  
• Vaginal contraceptives
  
  
• Feminine hygiene products, such as deodorants and sprays
  
  
• Bubble baths

Trichomoniasis typically occurs when the Trichomonas vaginalis parasite is spread to the vagina through sexual intercourse with a partner who has the infection. Because the parasite can live several hours on damp washcloths, towels and bathing suits, it can be spread if these items are shared among individuals. Trichomoniasis is most common in individuals who are at their sexual peak. Risk factors for trichomoniasis include:

• Unprotected sex
• Infection with another STD
• Having multiple sex partners

Atrophic vaginitis usually results from a decline in estrogen (a female reproductive hormone) levels after menopause. Reduction of the hormone may cause changes in the skin around the vagina, vulva, urethra and/or bladder. Although menopause is the primary cause of this condition, atrophic vaginitis may also be associated with:

• Breastfeeding
  
  
• The use of injectable contraceptives
  
  
• Oophorectomy (also called ovariectomy, the surgical removal of the ovaries)

Noninfectious vaginitis may be caused by any of the following products, which can irritate the skin around the vagina or cause an allergic reaction:

• Vaginal sprays
• Douches
• Perfumed soaps
• Scented detergents
• Spermicidal products

Common indicators of vaginitis may include:

• Change in amount of vaginal discharge
• Change in color and/or odor of vaginal discharge
• Itching and/or burning inside or around the vagina
• Pain during vaginal intercourse (dyspareunia)
• Pain during urination (dysuria)
• Light bleeding from the vagina

Additionally, some types of vaginitis may be accompanied by unique signs and symptoms. For instance:

• Bacterial vaginosis (BV). In addition to vaginal itching or irritation, this type of vaginitis may result in foul-smelling discharge that is grayish-white in color. The odor, which is frequently similar to strong fish, is often more obvious after vaginal intercourse. It is important to note that approximately half of all women with BV do not experience any symptoms.
  
  
• Yeast infection. The primary signs and symptoms of this condition are itching (pruritus) and burning inside and around the vagina. However, yeast infection is often also characterized by a thick, white, cottage cheese-like discharge. Many times the affected area will also become extremely red and irritated.
  
  
• Trichomoniasis. This form of vaginitis may cause a greenish-yellow discharge that is sometimes frothy in appearance. Soreness and itching of the vulva and vagina and burning during urination are also common, and some women with trichomoniasis may experience abdominal pain. It is important to note that one-third to one-half of all women with trichomoniasis do not experience any symptoms.
  
  
• Atrophic vaginitis. In addition to the signs and symptoms that accompany most types of vaginitis, such as itching and/or burning, spotting/bleeding, and pain during intercourse and/or urination, atrophic vaginitis may be accompanied by frequent urination, urinary urgency or the inability to urinate.
  
  
• Viral vaginitis. Indicators of viral vaginitis typically depend on the type of virus present. For instance, the herpes simplex virus (HSV) is accompanied by painful lesions or sores, whereas the human papillomavirus (HPV) may be accompanied by genital warts.

Individuals should immediately notify their gynecologist (a physician who specializes in treating disorders of the female reproductive system) if they experience any of these signs and symptoms.

Routine gynecological examinations can often identify vaginitis that is not accompanied by noticeable symptoms. Therefore, it is important for women to annually visit their gynecologist (a physician who specializes in treating disorders of the female reproductive system). Women who experience signs and symptoms of vaginitis should immediately notify their gynecologist unless they have been previously diagnosed with a yeast infection and the signs and symptoms are identical.

Diagnosis of vaginitis typically begins with a medical history, followed by a pelvic examination. Women should avoid douching or using deodorant sprays before their medical examination because these products can impede the diagnosis of vaginitis.

If bacterial vaginosis (BV) is suspected, the gynecologist will measure the acidity or pH level of the patient’s vagina using narrow-range pH paper. The normal vaginal pH of premenopausal women is approximately 4.0 on the 0 to 14 pH scale, with 7.0 being neutral. A pH of 4.5 or greater may indicate that the patient has BV. The gynecologist will also typically take a sample of the patient’s cervical or vaginal discharge for analysis under a microscope. The sample will be examined for “clue cells,” bacteria-covered cells in the patient’s vaginal lining that indicate the presence of BV. In addition, the gynecologist may add potassium hydrochloride to a vaginal discharge specimen and check its odor (whiff test).

Women who have had yeast infections in the past often believe that they can diagnose an infection without consulting their gynecologist. However, misdiagnosis of yeast infection is common. Therefore, women should schedule a gynecological appointment unless they are certain that they have a yeast infection, and not another condition that presents similar symptoms.

To diagnose a yeast infection, the gynecologist will examine the vagina for abnormal discharge or inflammation. The physician will also collect secretions from the vaginal area and view the specimens under a microscope to determine if the infection is present due to a yeast organism (slide test). This test is generally sufficient for diagnosing yeast infections in first-time sufferers and those with occasional infections. However, cases of recurrent or resistant yeast infections may require further analysis in the form of a vaginal culture, which is used to identify the presence of other forms of vaginitis as well as sexually transmitted diseases.

Trichomoniasis may also be detected by measuring the acidity or pH level of the patient’s vagina using pH paper. However, the condition is typically diagnosed by examining a vaginal fluid sample under a microscope for the presence of parasites (protozoa). This technique, called a “wet mount,” is accurate only about 50 percent of the time because the protozoa can be difficult to find, and are often mistaken for normal cells. Researchers are developing more reliable tests for diagnosing this condition.

Diagnosis of viral vaginitis typically depends on the type of virus present. For instance, the human papillomavirus (HPV) can sometimes be detected along with a Pap smear (a screening procedure that detects changes in the cervix) or through special DNA probe tests that can determine the type of HPV virus.

The main goal of treating all forms of vaginitis is symptom relief. Treatment of vaginitis depends on its type as well as the patient’s preference. For instance:

• Bacterial vaginosis (BV) can be treated with oral antibiotics, vaginal creams or vaginal gels prescribed by a physician. Treatment for BV is effective in most cases. If symptoms disappear, follow-up visits are not usually necessary. For recurrent cases, a more powerful antibiotic may be prescribed.
  
  During treatment for BV, women may be advised to refrain from sexual intercourse or ask male partners to use condoms. Routine treatment of male sexual partners is not usually necessary. Pregnant women who are symptomatic for BV, or have previously delivered a premature baby, should be screened and tested for the condition during their first prenatal visit. Pregnant women with symptomatic BV should be treated in the beginning of the second trimester with oral medication only. There is controversy regarding the treatment of pregnant women with nonsymptomatic BV.
  
  
• Yeast infections can be treated with antifungal creams, vaginal suppositories or oral antifungal medication. Creams and suppositories can be purchased over-the-counter (OTC). However, a physician must prescribe oral medication. Patients should seek medical advice before using OTC products if they:
  
  
• Have not previously had a yeast infection
  
  
• Have abdominal pain and/or fever
  
  
• Are pregnant or nursing
  
  
• Have diabetes or human immunodeficiency virus (HIV)
  
  
• Used an OTC treatment but symptoms did not disappear or returned immediately
  
  
Women may be advised to refrain from sexual intercourse while being treated for a yeast infection. Treatment can last anywhere from one to 14 days. Yeast infections generally respond to treatment within a few days. Routine treatment of male sexual partners is generally not recommended.


• Trichomoniasis is typically treated with oral medication (antibiotics) prescribed by a physician. Routine treatment of male sexual partners is advisable otherwise reinfection will likely occur. A follow-up visit is not necessary if symptoms were not evident before treatment or disappear afterward.
  
  
• Atrophic vaginitis can be treated with estrogen replacement therapy (ERT) in oral form, or in the form of a transdermal patch, vaginal rings, tablets or creams. ERT is prescribed by a physician.
  
  
• Noninfectious vaginitis can be treated by identifying and avoiding the source of the irritation (e.g., perfumed soaps, deodorized tampons).

In addition, vaginitis caused by chlamydia infection is also treated with antibiotics. Viral vaginitis caused by the herpes simplex virus (HSV) or the human papillomavirus (HPV) cannot be cured. However, both types of viral vaginitis can be controlled with medications. Treatment varies according to the type of vaginitis and the method of delivery. However, individuals are instructed to complete the entire course of treatment, even if symptoms subside before treatment has concluded.

Vaginitis cannot always be prevented. However, adhering to the following guidelines may reduce a woman’s risk of developing vaginitis:

• Practice safe sex
  
  
• Eat a healthy diet
  
  
• Reduce stress
  
  
• Wear loose-fitting undergarments
  
  
• Wear only undergarments composed of 100 percent cotton or other natural fibers
  
  
• Avoid use of vaginal sprays/deodorants and douches
  
  
• Avoid use of deodorized tampons
  
  
• Avoid hot tubs, whirlpool spas and bubble baths
  
  
• Immediately change out of a wet bathing suit after swimming or exercise clothing
  
  
• Exercise proper toilet habits (e.g., wipe from front to rear)
  
  
• Do not insert dry objects (e.g., unlubricated penis or condoms) into the vagina
  
  
• Do not engage in sexual intercourse multiple times each day
  
  
• Eat yogurt with live lactobacillus (a “good” bacteria) cultures regularly 
  
  
• Use a vaginal moisturizer after menstruation or sexual intercourse

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about vaginitis:

1. How do I know if I have vaginitis?
   
   
2. What type of vaginitis do I have?
   
   
3. What may have caused my condition?
   
   
4. What is the best treatment for my condition?
   
   
5. What are the risks associated with this treatment?
   
   
6. When can I expect to have relief from vaginitis?
   
   
7. What steps will be taken if my condition does not improve?
   
   
8. Does my vaginitis place me at risk for other conditions?
   
   
9. How will my treatment change if I’m pregnant or breastfeeding?
   
   
10. Does my condition place my partner at risk?
    
    
11. What steps can I take to help prevent vaginitis?
    
    
12. Am I at greater risk for developing vaginitis in the future?
    
    
13. I’m pregnant. Will my vaginitis affect my unborn baby?