Your Complete Guide to Vaginitis

Clinical Editor: Christine Boyer, PA-C

It’s an issue that many people with vaginas may not know the name of, but they likely know how it feels (and it isn’t pleasant): vaginitis. Considered one of the most common reasons people visit their healthcare providers, vaginitis is a general term for vaginal disorders caused by infection, inflammation, or changes in bacteria. While there are many forms of vaginitis, certain characteristics differentiate the condition from other gynecological problems. Understanding the nuances and defining symptoms of vaginitis can help you better identify the condition and protect your health.

Vaginitis is an inflammation or infection of the vagina. The condition can also affect the external part of the female genitals, known as the vulva (when both the vagina and vulva are involved, it’s known as vulvovaginitis).

Anyone who’s ever experienced vaginitis knows that it can be unpleasant — the condition can cause discharge, itching, pain, and odor. But “vaginitis” isn’t just one thing — it’s a word used to describe a variety of disorders that can cause infection or inflammation of the vagina, all of which can be caused by a variety of sources like organisms (think: bacteria, yeast, or viruses), or by irritations (like from personal care products).

There are a variety of reasons someone might develop vaginitis, but it’s most often caused by an infection. Some vaginal infections are sexually transmitted and some occur if there is a change in the balance of the normal flora bacteria in the vagina.

The most common causes of vaginitis include:

• One particular form of vaginitis known as bacterial vaginosis (BV) occurs when there’s an imbalance between “good” and “bad” naturally occuring bacteria in the vagina. It’s the most common vaginal infection in those between the ages of 15 to 44. There are many reasons the balance of bacteria in the vagina can shift, including the use of antibiotics, douching, using an intrauterine device (IUD), having unprotected sex with a new partner, and having multiple sexual partners.
• Candida or "yeast" infection is another common cause of vaginitis and occurs when there’s an overgrowth of Candida, a type of yeast naturally found in the vagina. Yeast infections can also occur for a variety of reasons including pregnancy, the use of antibiotics, diabetes (especially if not well-controlled), and the use of corticosteroid medications.
• Trichomoniasis is another common cause of vaginitis and is a sexually transmitted disease caused by a parasite.

These are just the most common causes of vaginitis — there are plenty of other reasons it can occur as well. For some people, an allergy or sensitivity to specific products like vaginal sprays, soaps, detergents, and spermicides can cause the signature burning, itching, and discharge associated with vaginitis. Hormonal changes from events like pregnancy, menopause, and breastfeeding can also cause vaginal irritation.

The symptoms of vaginitis can vary significantly depending on the cause. The most common ones include:

• Abnormal vaginal discharge with an unpleasant odor. Discharge is considered a normal product of the vagina when it is clear or slightly cloudy in color and has minimal odor (it can, however, change in color, consistency, and scent throughout the menstrual cycle). However, vaginal discharge accompanied by unpleasant odor or that is irritating is typically considered abnormal.
• A burning sensation outside of the vagina during urination
• Itching around the outside of the vagina
• Light vaginal bleeding or spotting
• Vaginal pain or discomfort

If you suspect you have some form of vaginitis, it’s important to seek help from a medical professional right away. During your appointment, your provider will ask you about your symptoms, your medical history, and may perform a pelvic exam in order to observe the color, qualities, and/or odor of any vaginal discharge. Your provider may also study a sample of your vaginal fluid under a microscope or order additional tests.

A proper diagnosis is vital for effectively treating vaginitis. Because the same symptoms can occur across multiple forms of vaginitis, it can be tough to land on an accurate diagnosis right away, but tracking your symptoms as they develop can help your provider evaluate your condition.

Treatment will greatly depend on the type of vaginitis you have, but some of the most common treatments for each type include:

• Bacterial vaginosis: Your provider may prescribe oral metronidazole (Flagyl) tablets or metronidazole (MetroGel) gel or clindamycin (Cleocin) cream to apply to the vagina.
• Yeast infections: You may be able to use an over-the-counter antifungal cream or suppository like miconazole (Monistat 1), clotrimazole, butoconazole, or tioconazole (Vagistat-1). In some cases, your provider may prescribe an oral antifungal medication, like fluconazole (Diflucan).

Trichomoniasis: Your provider may prescribe metronidazole (Flagyl) or tinidazole (Tindamax) tablets.

Some people are at a higher risk of developing vaginitis for a variety of reasons, including pregnancy, uncontrolled diabetes, thyroid disorders, and more. But there are certain measures you can take that may reduce your risk of developing vaginitis, even if you are at higher risk for the condition. If you frequently experience yeast infections, for example, try avoiding clothes that retain heat and moisture and always practice good hygiene. Avoiding vaginal sprays, heavily scented soaps, and douches can also help prevent vaginitis. If you’re nearing menopause or have decreased estrogen levels for any reason, talk with your provider about options to help keep your vagina healthy and lubricated to avoid vaginitis and other complications.

Having a solid relationship with your primary care provider can go a long way in helping to prevent, diagnose, and treat issues like vaginitis. Be sure to talk to your provider about scheduling screening for cervical cancer, and if you have multiple sexual partners, consider requesting screening for sexually transmitted infections (STIs). Taking these steps can help you stay healthy and infection-free so you can feel comfortable and confident in your own skin.