Vaginitis is any inflammation of the vagina. It is not a sexually transmitted infection (STI), but sometimes sexual activity can lead to vaginal infections, which in turn causes inflammation.
Vaginitis is a common condition that is relatively easy to treat; an estimated 30% of people with vulvas will get vaginitis at some time in their lives.
What are the different types of vaginitis?
Bacterial vaginosis (BV). Bacterial vaginosis, bacterial vaginitis, or simply vaginosis occurs when certain types of normal vaginal bacteria grow out of control and cause inflammation. Bacterial vaginosis is linked to sexual activity, but it’s not considered a sexually-transmitted infection (STI).
Candida (yeast) infection. This is caused by one of the many types of fungus known as candida. Candida fungi normally live in the vagina in small numbers. Vaginal candidiasis infection happens when something upsets the vagina’s normal balance of yeast. For example, antibiotics can kill bacteria that normally balances the amount of yeast in the vagina. Too much yeast grows, causing a candida infection. Another cause can be pregnancy, or some health problems such as diabetes.
Noninfectious vaginitis. This is vaginal irritation without an infection. It’s most often caused by an allergic reaction or irritation. Chemicals in vaginal cream, vaginal spray, douches, spermicidal products, as well as perfumed soaps, detergents, or fabric softeners can cause vaginal irritation. Even chemicals in clothing can cause symptoms.
A type of noninfectious vaginitis called atrophic vaginitis happens when your body makes too little of the hormone estrogen. This can happen from menopause, surgical removal of the ovaries, radiation therapy. It can even happen after childbirth, particularly while breastfeeding. Lack of estrogen causes vaginal dryness and thins the vaginal tissue.
Recurrent vaginitis. If you have vaginitis more than four times over the course of a year, you have recurrent vaginitis, which can appear as desquamative inflammatory vaginitis (an uncommon form of chronic vaginitis with pus). If you do not finish your vaginitis treatment, you are more likely to have it come back.
Trichomoniasis (trichomonas vaginalis). Trichomonas vaginalis, commonly known as Trich, is an STI caused by a parasite. This parasite passes between partners during sexual intercourse.
Penile trichomoniasis does not present any symptoms, therefore the infection is often not diagnosed until someone experiences vaginitis symptoms.
Viral vaginitis (infectious vaginitis). Herpes is most commonly spread through sexual contact. The herpes simplex virus (HSV) is an STI that can cause infectious vaginitis.
Symptoms of vaginitis
The symptoms of vaginitis can vary based on the person and the underlying cause. Make sure to see your healthcare provider for a diagnosis and to differentiate the type of vaginitis you may have based on your vaginal symptoms.
Typical symptoms for different vaginal infections appear below.
- A thick, gray or green fluid from the vagina.
- Thin, white vaginal discharge.
- Vaginal secretions that give off a fishy odor.
- Abnormal discharge from the vagina.
- Spotting after sex, if the cause is atrophic vaginitis.
- Uncomfortable, even painful sex.
- Vaginal itching, soreness, burning, or dryness.
- Abdominal or pelvic pain.
- Burning when you urinate.
- Frothy, greenish-yellow, abnormal vaginal discharge.
- Itching or burning in and around the vaginal area.
- Light bleeding or spotting, especially after sex.
- Musty vaginal odor.
- Pain during sex.
- Swelling or redness at the opening of the vagina (vulva).
In some cases people with this infection display no symptoms.
- Pain in the genital area from sores, if the cause is herpes simplex virus (HSV).
- Painless genital warts on the vagina, rectum, vulva, or groin, if the cause is Human Papillomavirus (HPV). Note that HPV can be present without visible warts.
- A thick, white, odorless vaginal discharge, like cottage cheese.
- Itching and redness of the vulva and vagina.
- Pain with urination or sex.
What can cause vaginitis?
Bacteria (gardnerella vaginalis), yeast, viruses, and parasites can lead to common vaginal infections, including vaginal yeast infection (vulvovaginal candidiasis), bacterial vaginosis, or trichomonas vaginalis. Medication can also cause these conditions, as some antibiotics alter the bacteria that keeps vaginal yeast in check.
Certain health conditions can cause vaginitis, or make it more likely to come back. Diseases like diabetes or HIV can weaken the immune system and create an imbalance in the vagina’s yeast and bacteria.
Hormones especially influence vaginal health. Lack of estrogen, for example, can lead to a type of vaginitis called atrophic vaginitis, or vaginal atrophy. Vaginal atrophy presents itself with irritation but no abnormal discharge. Atrophic vaginitis is a result of the hormonal changes associated with childbirth, breastfeeding, menopause, or damage to the ovaries.
Some chemicals in creams or sprays, scented hygiene products such as tampons, spermicides, douching products, and even clothing can cause vaginitis. Allergic reactions to some products or exacerbated skin conditions can cause the vaginal irritation or even infection.
Sometimes sexual activity and the health of your sexual partner can cause vaginitis. Your partner’s genital chemistry can alter the balanced vaginal flora, or germs can be passed between sexual partners. In some instances, your partner’s semen or the materials that make up safe sex supplies (condoms, dental dams, diaphragms) and sex toys can create an allergic reaction that leads to vaginitis.
Those at risk for developing vaginitis
You are more at risk for vaginitis if you:
- Are using high-estrogen contraceptives.
- Are using spermicide or intrauterine devices (IUDs) as contraceptives.
- Are sensitive to chemicals in things such as perfumes, body sprays, laundry soap, or douches.
- Have changes in hormone levels from pregnancy, breastfeeding, or menopause.
- Have diabetes that is not well-controlled.
- Have poor personal hygiene.
- Have recently taken antibiotics.
- Have a weak immune system. For example, from certain diseases such as HIV or from taking medicine, that weakens your immune system (such as corticosteroid therapy).
- Have more than one sexual partner or practice unsafe intercourse without a condom.
Vaginitis diagnosis and treatment
Your healthcare provider will review your health history and do a physical and pelvic exam. They may also examine the vaginal discharge with a microscope to determine the cause.
In some instances, your doctor may also request a urine sample or perform a pH test to determine if you may have trich or vaginosis.
Depending on the type and severity of the diagnosis, there are different cures for vaginitis.
For vaginitis caused by candidiasis, bacterial vaginosis, or trich, your doctor may prescribe over the counter medications, creams, or suppositories for treatment. Sometimes vaginosis also requires antibiotics to re-balance the bacteria. Since trichomoniasis is a sexually transmitted disease variant, it’s also important that your sexual partner(s) get treated as well.
If an allergy or sensitivity is causing your vaginitis, it will typically go away on its own once you stop using the products that are causing a reaction. Sometimes a cream may be recommended to help relieve symptoms. However, emergency medical help may be needed for severe allergic reactions.
Hormonal causes of vaginitis can be treated by getting a prescription of pills, cream, or a vaginal ring to slowly release estrogen in the body.
Questions and answers (FAQs) about vaginitis
What are the complications of vaginitis?
If left untreated, vaginitis can become a more severe problem depending on the type you may have.
Those with trichomoniasis or bacterial vaginosis are more likely to get an STI due to the inflammation the disorders cause. Vaginosis is also often associated as a cause of pelvic inflammatory disease (PID), a serious infection that can cause infertility and chronic pain. For those who are pregnant, both trich and vaginosis are associated with premature deliveries and low birth-weight infants.
How long does vaginitis last?
With proper treatment, 90% of vaginal infections go away within two weeks or less depending on the type. Untreated vaginal infections can last with or without symptoms for years.
It is recommended that while taking treatments for vaginitis you practice the following:
- Do not insert anything into the vagina except for medicine or tampons.
- Use pads during menstruation if you are using medicine or creams within the vagina for treatment.
- Take a break from sexual activity until symptoms clear up.
What's the best way to prevent getting vaginitis?
The best way to maintain vaginal health and prevent vaginitis is to avoid anything that creates an imbalance within the vagina or anything that may irritate it.
Some recommended best-practices for prevention:
- Avoid using scented hygiene products including pads, tampons, or deodorants.
- Avoid using scented bath products such as bath bombs, scented soaps, scented detergents, or scented toilet paper which may cause irritation.
- Don’t use irritating lubricants or spermicides, or use a different brand if you are experiencing a reaction to them.
- Do not use a vaginal douche, as a douche washes away healthy flora from the vagina and creates an imbalance. Douching can also exacerbate pre-existing infections.
- Clean the exterior of the genitals (vulva) with an unscented and mild soap or plain water, since the inside of the vagina is self-cleaning.
- Keep the genital area as dry as possible, as vaginitis develops in moist areas (such as when wearing damp or uncomfortably tight clothes).
- Wear breathable underwear, such as cotton, and change it daily to keep the vulva dry.
- Keep an eye on your genitals to notice any irregular smells or discharge.
- Change menstrual products every four to eight hours, and clean menstrual cups or sex toys according to their instruction.
- Wipe carefully after bowel movements to avoid spreading fecal matter to the vagina.
- Use condoms to prevent STIs such as trich.
Get a regular gynecological exam, including screening for cervical cancer and a PAP smear if recommended by your doctor.
American College of Obstetricians and Gynecologists. Vaginitis Frequently Asked Questions (https://www.acog.org/womens-health/faqs/vaginitis)
American Academy of Family Physicians. Vaginitis: Diagnosis and Treatment (https://www.aafp.org/pubs/afp/issues/2018/0301/p321.html)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Vaginitis (https://www.ncbi.nlm.nih.gov/books/NBK470302/)