Vaginitis is the medical term for generalized inflammation or swelling of the vagina. It usually presents with associated vulvar swelling and irritation, and hence, is also known as vulvovaginitis. This condition results in vaginal discharge, itching and pain. Vaginitis occurs when the normal balance of healthy vaginal bacteria is disturbed, leaving the region susceptible to infections and overgrowth of other organisms. There are three main categories of infectious vaginitis, bacterial vaginosis, vaginal candidiasis or yeast infection, and trichomoniasis. Atrophic vaginitis is a non-infectious process that occurs mostly in post-menopausal women as result of reduced levels of estrogen.
Causes
The two basic causes of vaginitis are poor personal hygiene and infections. The causes for the different types of vaginitis are different. Bacterial vaginosis is caused by overgrowth of anaerobic bacteria in the vaginal region. Typically, there is an abundance of lactobacilli that contributes to the health of the vaginal flora by keeping other organism growth in check.
When this balance is disrupted, bacterial vaginosis develops. While this condition is not caused by sexual activity, it has been found to occur more frequently in women with new or multiple sexual partners. Use of contraceptive intrauterine devices has also been linked to higher risk for bacterial vaginosis.
Candidiasis or yeast infection is the most common form of vaginal infection among young women, and afflicts nearly 75% of women at some point in their lives. It is caused by the overgrowth of Candida albicans, an yeast. This happens when the antifungal bacterial normally present in the vaginal flora gets destroyed either by the ingestion of antibiotics or by disease processes such as uncontrolled diabetes or hormonal changes of pregnancy, birth control or menopause. This form of vaginitis is not considered a sexually transmitted infection.
Trichomoniasis is a sexually transmitted infection that causes little or no symptoms in men whose urinary tracts it infects. This condition can also be transmitted through vaginal contact with damp or wet objects like towels which might have been used by an infected person.
Atrophic vaginitis is caused by decreased or absent levels of estrogen. This commonly manifests in women after menopause, but can also occur sometimes immediately after childbirth. In rare cases, it has been documented in girls who are yet to reach puberty.
Symptoms
The most important symptom of vaginitis is a noticeable change in odor, color, or quantity of vaginal discharge. The general constellation of symptoms for all types of vaginitis also includes itching and irritation, swelling and redness of the external genitalia, dyspareunia or pain with intercourse, painful or burning urination, and vaginal bleeding or spotting outside your menstrual period. The nature of your discharge is usually a clear indicator as to which type of vaginitis you might be having. Bacterial vaginosis presents with a grayish discharge with a fishy smell that is usually more noticeable after sexual intercourse. In the case of yeast infection, your primary symptom would be itchiness, with a thick whitish discharge that is often described as resembling cottage cheese. Trichomoniasis can sometimes go undetected for years without any symptoms, but its discharge is usually greenish yellow with a frothy appearance and an unpleasant odor.
Diagnosis
Your physician will undertake a detailed review of your history in order to better understand your sexual and gynecologic health condition. This will be accompanied by a pelvic examination to physically inspect your genitalia and pelvic region. In addition, a sample of your vaginal smear may be collected for microscopic evaluation to determine what specific type of infection you have. This is also called a wet prep or a wet mount. Some physicians may want to culture this sample to identify the particular strain of infection and to what medication it may be sensitive. In the event that no infection is found, your physician may want to send a tissue sample for biopsy.
Treatment
Treatment of vaginitis differs depending on the type of vaginitis you have. For bacterial vaginosis, the standard approach is to treat it with a combination of oral and topical metronidazole or topical clindamycin applied to the vaginal area. Candida or yeast infections are usually treated by topical antifungals such as miconazole, clotrimazole or tioconazole. They may also be treated oral antifungals like fluconazole. Trichomoniasis is usually treated with metronidazole or tinidazole. In addition, antihistamines and cortisone creams may also be prescribed. In case of atrophic vaginitis, estrogen replacement therapy and topical estrogen creams may be prescribed. For infectious vaginitis, it may be recommended that your partner also undergo appropriate diagnosis and treatment in order to prevent chances of recurrence and relapse.
Prevention
The key to preventing vaginitis is developing good sexual and personal hygiene. Infections and bacterial overgrowth tends to take place in moist environments. Avoid long soaks in hot baths. Wash soap thoroughly off your pelvic area after a shower. Wipe your genital area dry before wearing clothes. Avoid tight fitting and synthetic clothes and underwear that reduce ventilation to your pelvic area. Switch over to cotton panties or cotton-crotched pantyhose instead. Wipe from front to back after using the toilet in order to avoid contamination from fecal bacteria. Eliminate the use of harsh soaps, personal products and detergents. Do not use scented tampons. Do not douche. Use condoms during intercourse. These common health safeguards can significantly reduce the chance of your developing vaginitis.