Vaginitis
Encyclopedia
Vaginitis is an inflammation of the vagina
. It can result in discharge
, itching and pain, and is often associated with an irritation or infection of the vulva
. It is usually due to infection. The three main kinds of vaginitis are bacterial vaginosis (BV), vaginal candidiasis, and trichomoniasis. A woman may have any combination of vaginal infections at one time. The symptoms that arise vary with the infection, although there are general symptoms that all vaginitis infections have and infected women may also be asymptomatic. Testing for vaginal infections is not a part of routine pelvic exams; therefore, women should neither assume their health care providers will know of the infection, nor that they will provide appropriate treatment without their input.
. The following symptoms may indicate the presence of infection, which should be followed up with a professional health care practitioner for diagnosis and treatment:
Other less common infections are caused by gonorrhea
, chlamydia, Mycoplasma
, herpes, Campylobacter
, improper hygiene
, and some parasites
, notably Trichomonas vaginalis
.
Vaginal infection are often (varies between countries between 20 to 40% of vaginal infections) a mix of various etiologies, which present challenging cases for treatment. Indeed, when only one cause is treated, the other pathogens can gain in resistance and induce relapses and recurrences. The key factor is therefore to get a precise diagnosis and treat with broad spectrum anti-infective (often also inducing adverse effects).
Further, either a change in pH balance or introduction of foreign bacteria in the vagina can lead to infection known as vaginitis. There are physical factors that can contribute to development of infection, such as constantly wet vulva due to tight clothing, chemicals coming in contact with the vagina via scented tampons, antibiotics, birth control pills, or a diet favoring refined sugar and yeast (Northrup 297-299). There is also psychological and emotional dimension to vaginitis. Dr. Christiane Northrup argues, “some women respond to a perceived boundary violation with a vaginal infection” (Northrup 298). The two dimensions of vaginitis have important implications regarding treatment.
Pre-pubescent girls
The pH balance in adolescent girls' bodies is not conducive to the growth of Candida albicans
, so they are unlikely to contract a yeast infection.
women. Sometimes it can occur in young girls before puberty
. In these situations the estrogen
support of the vagina is poor.
s, soaps, perfumes, douche
s, lubricants and semen
. It can also be caused by hot tubs, abrasion, tissue, tampons or topical medications.
(mostly by vaginal wet mount
) and culture
of the discharge after a careful history and physical examination have been completed. The color, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent.Determining the agent is especially important because women may have more than one infection, or have symptoms that overlap those of another infection, which dictates different treatment processes to cure the infection. For example, women often self-diagnose for yeast infections but due to the 89% misdiagnosis rate, self-diagnoses of vaginal infections are highly discouraged.
The International Statistical Classification of Diseases and Related Health Problems codes for the several causes of vaginitis are:
Further, there are complications which lead to daily discomfort such as:
Often, after an anti-infective treatment, the vaginal flora (aka Döderlein flora) is disturbed. The cause is the reduced density of live flora (physiological barrier against pathogens) and the reduction of the vaginal epithelium (physical barrier against pathogens). As a result, post antiinfective treatment also requests the strengthening of the natural vaginal flora, which is done with local administration of lactobacillus and potentially low dose of hormone (e.g. estriol) to increase the proliferation of the epithelial cells.
The following are typical treatments for trichomoniasis, bacterial vaginosis, and yeast infections:
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
. It can result in discharge
Vaginal discharge
Vaginal discharge is term given to biological fluids contained within or expelled from the vagina.While most discharge is normal and can reflect the various stages of a woman's cycle, some discharge can be a result of an infection, such as a sexually transmitted disease.The term blennorrhea is...
, itching and pain, and is often associated with an irritation or infection of the vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
. It is usually due to infection. The three main kinds of vaginitis are bacterial vaginosis (BV), vaginal candidiasis, and trichomoniasis. A woman may have any combination of vaginal infections at one time. The symptoms that arise vary with the infection, although there are general symptoms that all vaginitis infections have and infected women may also be asymptomatic. Testing for vaginal infections is not a part of routine pelvic exams; therefore, women should neither assume their health care providers will know of the infection, nor that they will provide appropriate treatment without their input.
Symptoms
A woman with this condition may have itching or burning and may notice a dischargeDischarge
Discharge in the context to expel or to "let go" may refer to:* A military discharge, issued when a member of the armed forces is released from service* Termination of employment, the end of an employee's duration with an employer...
. The following symptoms may indicate the presence of infection, which should be followed up with a professional health care practitioner for diagnosis and treatment:
- irritation and/or itching of the genital area
- inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area
- vaginal discharge
- foul vaginal odor
- pain/irritation with sexual intercourse
Causes
Vulvovaginitis can affect women of all ages and is very common. Specific forms of vaginitis are:Infection
Infectious vaginitis accounts for 90% of all cases in reproductive age women and is represented by the triad:- CandidiasisCandidiasisThrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...
: vaginitis caused by Candida albicansCandida albicansCandida albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Systemic fungal infections including those by C...
(a yeast). - Bacterial vaginosisBacterial vaginosisBacterial vaginosis or less commonly vaginal bacteriosis is a disease of the vagina caused by bacteria. The U.S. Centers for Disease Control and Prevention states it is not clear what role sexual activity plays in the development. However, it is known that BV is associated with having a new sex...
: vaginitis caused by GardnerellaGardnerellaGardnerella is a genus of gram-variable-staining facultative anaerobic bacteria of which G. vaginalis is the only species.Once classified as Haemophilus vaginalis and afterwards as Corynebacterium vaginalis, Gardnerella vaginalis grows as small, circular, convex, gray colonies on chocolate agar; it...
(a bacterium).
Other less common infections are caused by gonorrhea
Gonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
, chlamydia, Mycoplasma
Mycoplasma
Mycoplasma refers to a genus of bacteria that lack a cell wall. Without a cell wall, they are unaffected by many common antibiotics such as penicillin or other beta-lactam antibiotics that target cell wall synthesis. They can be parasitic or saprotrophic. Several species are pathogenic in humans,...
, herpes, Campylobacter
Campylobacter
Campylobacter is a genus of bacteria that are Gram-negative, spiral, and microaerophilic. Motile, with either unipolar or bipolar flagella, the organisms have a characteristic spiral/corkscrew appearance and are oxidase-positive. Campylobacter jejuni is now recognized as one of the main causes...
, improper hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
, and some parasites
Parasitism
Parasitism is a type of symbiotic relationship between organisms of different species where one organism, the parasite, benefits at the expense of the other, the host. Traditionally parasite referred to organisms with lifestages that needed more than one host . These are now called macroparasites...
, notably Trichomonas vaginalis
Trichomonas vaginalis
Trichomonas vaginalis is an anaerobic, flagellated protozoan, a form of microorganism. The parasitic microorganism is the causative agent of trichomoniasis, and is the most common pathogenic protozoan infection of humans in industrialized countries. Infection rates between men and women are the...
.
Vaginal infection are often (varies between countries between 20 to 40% of vaginal infections) a mix of various etiologies, which present challenging cases for treatment. Indeed, when only one cause is treated, the other pathogens can gain in resistance and induce relapses and recurrences. The key factor is therefore to get a precise diagnosis and treat with broad spectrum anti-infective (often also inducing adverse effects).
Further, either a change in pH balance or introduction of foreign bacteria in the vagina can lead to infection known as vaginitis. There are physical factors that can contribute to development of infection, such as constantly wet vulva due to tight clothing, chemicals coming in contact with the vagina via scented tampons, antibiotics, birth control pills, or a diet favoring refined sugar and yeast (Northrup 297-299). There is also psychological and emotional dimension to vaginitis. Dr. Christiane Northrup argues, “some women respond to a perceived boundary violation with a vaginal infection” (Northrup 298). The two dimensions of vaginitis have important implications regarding treatment.
Pre-pubescent girls
- Bacterial vaginosisBacterial vaginosisBacterial vaginosis or less commonly vaginal bacteriosis is a disease of the vagina caused by bacteria. The U.S. Centers for Disease Control and Prevention states it is not clear what role sexual activity plays in the development. However, it is known that BV is associated with having a new sex...
: vaginitis caused by Streptococcus spp.StreptococcusStreptococcus is a genus of spherical Gram-positive bacteria belonging to the phylum Firmicutes and the lactic acid bacteria group. Cellular division occurs along a single axis in these bacteria, and thus they grow in chains or pairs, hence the name — from Greek στρεπτος streptos, meaning...
. - Improper hygiene, which may introduce bacteria or other irritants from the anal regionHuman anusThe human anus is the external opening of the rectum. Like other animals, its closure is controlled by sphincter muscles...
to the vaginal area.
The pH balance in adolescent girls' bodies is not conducive to the growth of Candida albicans
Candida albicans
Candida albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Systemic fungal infections including those by C...
, so they are unlikely to contract a yeast infection.
Hormonal
Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal or postpartumPostnatal
Postnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother...
women. Sometimes it can occur in young girls before puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
. In these situations the estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
support of the vagina is poor.
Irritation/allergy
Irritant vaginitis can be caused by allergies to condoms, spermicideSpermicide
Spermicide is a contraceptive substance that eradicates sperm, inserted vaginally prior to intercourse to prevent pregnancy. As a contraceptive, spermicide may be used alone. However, the pregnancy rate experienced by couples using only spermicide is higher than that of couples using other methods...
s, soaps, perfumes, douche
Douche
A douche is a device used to introduce a stream of water into the body for medical or hygienic reasons, or the stream of water itself.Douche usually refers to vaginal irrigation, the rinsing of the vagina, but it can also refer to the rinsing of any body cavity. A douche bag is a piece of...
s, lubricants and semen
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
. It can also be caused by hot tubs, abrasion, tissue, tampons or topical medications.
Foreign body
Foreign body vaginitis: foreign bodies (most commonly retained tampons or condoms) cause extremely malodorous vaginal discharges. Treatment consists of removal, for which ring forceps may be useful. Further treatment is generally not necessary.Diabetes
Women who have diabetes develop infectious vaginitis more often than women who do not.Diagnosis
Women must alert doctors of symptoms that may indicate infection, so that the health care practitioner may proceed with appropriate procedures to detect the type of infection present. Diagnosis is made with microscopyMicroscopy
Microscopy is the technical field of using microscopes to view samples and objects that cannot be seen with the unaided eye...
(mostly by vaginal wet mount
Vaginal wet mount
A vaginal wet mount is a gynecologic test wherein a sample of vaginal discharge is observed by wet mount microscopy by placing the specimen on a glass slide and mixing with a salt solution...
) and culture
Microbiological culture
A microbiological culture, or microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory conditions. Microbial cultures are used to determine the type of organism, its abundance in the sample being tested,...
of the discharge after a careful history and physical examination have been completed. The color, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent.Determining the agent is especially important because women may have more than one infection, or have symptoms that overlap those of another infection, which dictates different treatment processes to cure the infection. For example, women often self-diagnose for yeast infections but due to the 89% misdiagnosis rate, self-diagnoses of vaginal infections are highly discouraged.
The International Statistical Classification of Diseases and Related Health Problems codes for the several causes of vaginitis are:
| Condition | Description | pH | |
|---|---|---|---|
| Candida vaginitis | Commonly referred to as a yeast infection, Candidiasis Candidiasis Thrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common... is a fungal infection that usually causes a watery, white, cottage cheese-like vaginal discharges. The discharge is irritating to the vagina and the surrounding skin. |
low (4.0-4.5) | |
| Atrophic vaginitis Atrophic vaginitis Atrophic vaginitis is an inflammation of the vagina due to the thinning and shrinking of the tissues, as well as decreased lubrication... (or Senile vaginitis) |
usually causes scant vaginal discharge with no odor, dry vagina and painful intercourse. These symptoms are usually due to decreased hormones usually occurring during and after menopause Menopause Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining... . |
||
| Bacterial vaginitis Bacterial vaginosis Bacterial vaginosis or less commonly vaginal bacteriosis is a disease of the vagina caused by bacteria. The U.S. Centers for Disease Control and Prevention states it is not clear what role sexual activity plays in the development. However, it is known that BV is associated with having a new sex... . |
Gardnerella Gardnerella Gardnerella is a genus of gram-variable-staining facultative anaerobic bacteria of which G. vaginalis is the only species.Once classified as Haemophilus vaginalis and afterwards as Corynebacterium vaginalis, Gardnerella vaginalis grows as small, circular, convex, gray colonies on chocolate agar; it... usually causes a discharge with a fish-like odor. It is associated with itching and irritation, but not pain during intercourse. |
elevated | |
| Trichomonas vaginalis Trichomonas vaginalis Trichomonas vaginalis is an anaerobic, flagellated protozoan, a form of microorganism. The parasitic microorganism is the causative agent of trichomoniasis, and is the most common pathogenic protozoan infection of humans in industrialized countries. Infection rates between men and women are the... |
can cause a profuse discharge with a fish-like odor, pain upon urination, painful intercourse, and inflammation of the external genitals. | elevated (5.0-6.0) |
Complications
Recent studies have shown that vaginal infections left untreated can lead to further complications, especially for the pregnant woman. For bacterial vaginosis, these include "premature delivery, postpartum infections, clinically apparent and subclinical pelvic inflammatory disease, [as well as] postsurgical complications (after abortion, hysterectomy, caesarian section), increased vulnerability to HIV infection and, possibly, infertility" Studies have also linked trichomoniasis with increased likelihood of acquiring HIV; theories include that "vaginitis increases the number of immune cells at the site of infection, and HIV then infects those immune cells."Further, there are complications which lead to daily discomfort such as:
- persistent discomfort
- superficial skin infection (from scratching)
- complications of the causative condition (such as gonorrhea and candida infection)
Treatment
The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed.Often, after an anti-infective treatment, the vaginal flora (aka Döderlein flora) is disturbed. The cause is the reduced density of live flora (physiological barrier against pathogens) and the reduction of the vaginal epithelium (physical barrier against pathogens). As a result, post antiinfective treatment also requests the strengthening of the natural vaginal flora, which is done with local administration of lactobacillus and potentially low dose of hormone (e.g. estriol) to increase the proliferation of the epithelial cells.
The following are typical treatments for trichomoniasis, bacterial vaginosis, and yeast infections:
- Trichomoniasis: Single oral doses of 2 grams of either metronidazole, or tinidazole.
- Bacterial vaginosis: The most commonly used antibiotics are metronizadole, available in both pill and gel form, and clindamycin available in both pill and cream form.
- Yeast infections: Anti-fungal medications, which are available in over the counter form, are generally used to treat yeast infections. Treatment may last anywhere between one, three, or seven days.
Prevention
Prevention of candidiasis, the most common type of vaginitis, starts with good hygiene: drying completely after bathing, wearing fresh undergarments, and wiping from front to rear after defecation all help to prevent contamination of the vagina with harmful bacteria. Douching is never recommended, as it often does more harm than good, by upsetting the normal balance of yeast in the vagina. Prevention of bacterial vaginosis includes healthy diets and behaviors as well as minimizing stress as all these factors can affect the pH balance of the vagina. Consuming good bacteria in products with live-culture, such as yogurt, sauerkraut and kimchi, or simply through probiotic supplements, one can reduce the likelihood of developing vaginitis due to antibiotics. Prevention of trichomoniasis revolves around avoiding other people's wet towels and hot tubs, and safe-sex procedures, such as condom use.See also
- Atrophic vaginitisAtrophic vaginitisAtrophic vaginitis is an inflammation of the vagina due to the thinning and shrinking of the tissues, as well as decreased lubrication...
- Vulvovaginal healthVulvovaginal healthVulvovaginal health is the health and sanitation of the human female vulva and vagina.-Conditions:Problems affecting this area include:*Infection with Candida albicans...