What is Vaginitis?

Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection.

Vaginitis can also result from reduced oestrogen levels after menopause.

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The most common types of vaginitis are :

i) Bacterial vaginosis – This type of vaginitis results from overgrowth of one of several organisms normally present in the vagina, upsetting the natural balance of vaginal bacteria. Many pregnant women have bacterial vaginosis, though many are not aware of it.

ii) Yeast infections – A naturally occurring fungus called Candida albicans usually causes this type of vaginitis. An estimated 3 out of 4 women will have a yeast infection in their lifetime.

iii) Trichomoniasis – This type is caused by a parasite and is commonly transmitted by sexual intercourse.

iv) Atrophic vaginitis – This type results from reduced oestrogen levels after menopause. The vaginal tissues become thinner and drier, which may lead to itching, burning or pain.

Vaginitis can also be due to mixed or simultaneous infections with at least 2 of the above mentioned pathogens. Vaginitis is very common and most women have some kind of vaginitis at least once in their lifetime.

The Gardnerella vaginalisorganism – a cause of bacterial vaginosis.

Signs and Symptoms

Vaginitis symptoms may include :

* Change in colour, odour or amount of discharge from the vagina
* Vaginal itching or irritation
* Pain during intercourse
* Painful urination
* Light vaginal bleeding

Additional signs and symptoms, depending on the type of vaginitis, include :

* Bacterial vaginosis – A grayish-white, foul-smelling discharge. The odour, often described as fish-like, may be more obvious after sexual intercourse.
* Yeast infections – The main symptom is itching, but there may also be a white, thick discharge that resembles cottage cheese.
* Trichomoniasis – This infection can cause a greenish yellow, sometimes frothy discharge.


The cause depends on the type of vaginitis a woman has.

Bacterial vaginosis

Bacterial vaginosis results from an overgrowth of one of several organisms normally present in the vagina.

Usually, 'good' bacteria outnumber 'bad' bacteria in the vagina. But if bad bacteria become too numerous, they upset the balance and bacterial vaginosis results. This type of vaginitis can spread during sexual intercourse, but it also occurs in people who are not sexually active.

Women with new or multiple sex partners, as well as women who douche or use an intrauterine device (IUD) for birth control, have a higher risk of bacterial vaginosis.

The Candida fungus can cause yeast vaginitis.

Yeast infections

Yeast infections occur when certain internal or external factors change the normal environment of a woman's vagina and trigger an overgrowth of a microscopic fungus – the most common being Candida albicans.

A yeast infection is not considered a sexually transmitted disease. Besides causing most vaginal yeast infections, Candida albicans also causes infections in other moist areas of the body, such as in the mouth (thrush), skin folds and fingernail beds. The fungi can also cause diaper rash.

Factors that increase a woman's risk of yeast infections include :

* Medications, such as antibiotics and steroids
* Uncontrolled diabetes
* Hormonal changes, such as those associated with pregnancy, birth control pills and menopause
* Bubble baths, vaginal contraceptives, damp or tight fitting clothing and feminine hygiene products, such as sprays and deodorants, do not cause yeast infections, but they may increase a woman's susceptibility to infection.

The Trichomonas vaginalisorganism – commonly transmitted by sexual intercourse.


Trichomoniasis is a common sexually transmitted disease (STD) caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection.

The organism usually infects the urinary tract in men, but often causes no symptoms in men. Trichomoniasis typically infects the vagina in women.

Mixed infections

Vaginitis due to simultaneous infection with at least two pathogens (e.g. bacterial vaginosis in a woman with vulvovaginal candidiasis) is also highly prevalent and makes up approximately 30% of all cases.

Screening and Diagnosis of Vaginitis

To diagnose vaginitis, a doctor may review a woman's history of vaginal infections or sexually transmitted diseases and conduct a pelvic examination.

The doctor may take a sample of a cervical or vaginal discharge for laboratory analysis. However, laboratory tests take time or may not be available in some cases.

In such cases, making an accurate diagnosis is not easy especially when it is a mixed infection.


Generally, vaginal infections do not cause serious complications. In pregnant women, however, both bacterial vaginosis and trichomoniasis have been associated with premature deliveries and low birth weight babies.

Pelvic inflammatory disease (PID) may also occur through an ascending infection into the pelvis via the cervix, uterus and fallopian tubes. Once PID sets in, it is difficult to eradicate and a woman's ability to conceive may be compromised.


The type of medication used for vaginitis treatment depends on which type a woman has :

# Bacterial vaginosis – For this type of vaginitis, the doctor may prescribe tablets or vaginal gels or creams.

# Yeast infections – Yeast infections usually are treated with an antifungal cream or suppository. Yeast infections may also be treated with an oral antifungal medication. It is possible to mistake a yeast infection for other types of vaginitis or other conditions that need different treatment. Using the wrong medicine may delay a proper diagnosis and the most appropriate treatment, and can lead to complications.

# Trichomoniasis – A doctor may prescribe metronidazole tablets.

# Atrophic vaginitis – Oestrogen, in the form of vaginal creams, tablets or rings, can effectively treat atrophic vaginitis. This treatment is available by prescription.

# Mixed infection – Effective treatment depends on accurate diagnosis. Combination therapy may be the most viable option in such cases.


Good hygiene may prevent some types of vaginitis from recurring and may relieve some symptoms :

* Avoid baths, hot tubs and whirlpool spas. A woman should take care to rinse soap from her outer genital area after a shower, and dry the area well to prevent irritation. Avoid scented and harsh soaps, such as those with deodorant or antibacterial action.

* Avoid irritants. These include scented tampons and pads.

* Wipe from front to back after using the toilet. Doing so avoids spreading faecal bacteria to the vagina.

Other things that may help prevent vaginitis include :

* Do not douche. A woman's vagina does not require cleansing other than normal bathing. Repetitive douching disrupts the normal organisms that live in the vagina and can actually increase the risk of vaginal infection. Douching will not clear up a vaginal infection.

* Use a male latex condom. This helps avoid infections spread by sexual contact.

* Wear cotton underwear and pantyhose with a cotton crotch. Do not wear underwear to bed. Yeast thrives in moist environments.

* Eat yoghurt that contains active lactobacillus cultures. This sometimes may help reduce recurrent vaginal yeast infections. Lactobacillus is a type of 'good' bacteria that is common in the vagina.

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