Vaginitis, also called colpitis, is a condition which happens when the vagina gets inflamed. Sometimes the reason is a sexually transmitted infection. More often it happens when too much Candida fungi or bacteria grow in the vagina.
Normally, there are good bacteria in the vagina that stop too much Candida or bacteria from growing. But sometimes, these good bacteria can't keep up and there is an overgrowth of bad bacteria or fungi, which causes vaginitis.
Almost every woman, regardless of her hygienic routine, can face this disease. Reduced oestrogen levels after menopause and some skin disorders also can cause vaginitis.
Types of vaginitis
Vaginitis is a general term used to describe inflammation or irritation of the vagina. Here are the most common types of vaginitis:1
- Сandida or yeast infections
Candida or yeast infection is one of the most common causes of vaginitis.3 Candida is a type of fungus that naturally lives in the vagina, mouth, and digestive tract of all people. Infection occurs when a change in the vaginal pH balance takes place, allowing the normally occurring candida to overgrow and cause bothersome symptoms. Factors that can disbalance the vaginal pH include antibiotic use, pregnancy, and diabetes.
Up to 75% of women experience at least one vaginal yeast infection in their life, and over half get two or more cases in their lifetime. The highest risk of candida infection is during the period after puberty and before menopause.
- Bacterial vaginosis
Bacterial vaginosis (BV) is the most common vaginal infection in women of reproductive age. It is caused by a combination of several bacteria that typically live in the vagina. It manifests itself with off-white or grey vaginal discharge that smells “fishy.” BV is not a sexually transmitted infection (STI) but there is a correlation between sexual activity and chances of getting sick. More sexually active people tend to experience BV more often. Risk factors for BV include new or multiple sexual partners, douching, and cigarette smoking. Despite myths, BV can’t be caused by hot tubs, swimming pools or toilet seats.
- Trichomoniasis vaginitis
Trichomoniasis (trich) is a quite common STI.2 Trichomoniasis is caused by a protozoan organism Trichomonas vaginalis (trich). Most people who have trich don’t experience any symptoms which makes this STI a very transmittable one since it’s too easy to contaminate sexual partners unconsciously. Only 30% of people have noticeable symptoms.
- Chlamydia or gonorrhoea
Chlamydia is the most common STI and is most common in young adults aged 15 to 24. Chlamydia can be transmitted through intercourse, oral sex or anal sex. Because chlamydia often doesn’t cause symptoms, many people who have chlamydia unknowingly infect other people. To reduce chlamydia spreading, doctors recommend regular screenings.
Gonorrhoea is an STI affecting both males and females. Gonorrhoea typically affects the urethra, rectum, throat or cervix.
- Viral vaginitis
Herpes simplex virus is a common cause of viral vaginitis and leads to inflammation of the genitals. To decrease the risk of getting herpes, you should use condoms and dental dams during sex. There are two types of herpes known. HSV-1, which affects the mouth and face and HSV-2 which affects the genital area. Herpes is a lifelong condition, this virus can’t be eliminated from the body. Sometimes people experience no herpes symptoms, sometimes they have sores that last for up to 10 days. People usually use antiviral treatment, such as acyclovir or valacyclovir to reduce outbreaks.
- Non-infectious vaginitis
Non-infectious vaginitis manifests as inflammation and vaginal dryness without having an infection. The most common cause is an allergic reaction or irritation from sprays, douches, spermicidal products, or other products. The skin around the vagina and vaginal flora can also be sensitive to perfumed soaps, feminine products and wipes, lotions, sexual lubricants, detergents, and fabric softeners. There is a form of noninfectious vaginitis called "atrophic vaginitis”. It occurs when hormone level goes down because of menopause, surgical removal of the ovaries, radiation therapy, or childbirth (particularly in breastfeeding women). Lack of oestrogen causes dryness and thinness of the vaginal tissue, and may also cause spotting.
Causes of vaginitis
Vaginitis can be caused by a variety of factors, depending on the specific type of disease. Yeast infections and bacterial vaginosis, two of the most common types, occur when there are changes in vaginal flora. Candida fungus overgrowth causes yeast infections, while for BV the reasons are Gardnerella vaginalis bacteria and other BV-associated bacteria overgrowth. Both candida and Gardnerella vaginalis are naturally occurring bacteria in the vagina and contribute to vaginal health, but an excess of either can lead to infection.3
Sexually transmitted infections can also cause vaginitis, as parasites, bacteria and viruses that cause infection can be transmitted through fluids. Additionally, products with chemical irritants
can cause vaginitis. Unmanaged diabetes and a weakened immune system, as can occur with diseases such as HIV or AIDS, can also impact the vaginal microbiome and lead to yeast infections.
Signs and symptoms of vaginitis
There are various types of vaginal infections, each with its own set of symptoms, which can range from none to difficult-to-identify symptoms even for experienced clinicians. It's possible to have more than one type of vaginitis at the same time. Some of the common vaginal infections and their symptoms include:
- Candida or "yeast" infections:
Thick, white vaginal discharge with the consistency of cottage cheese, watery and odourless discharge, itchy, red, and swollen vulva or vagina, small cuts on the vulva, and burning sensation during urination.
- Bacterial vaginosis:
No noticeable symptoms or an abnormal smelling, thin and milky discharge that worsens after sex or menstruation, a fishy odour that becomes more noticeable after intercourse, uncommon red or itchy vagina unless co-infected with yeast.
Frothy, greenish-yellow discharge with a foul smell, itching and soreness of the vagina and vulva, burning during urination, discomfort and pain during intercourse and after menstruation.
Often no noticeable symptoms, occasional vaginal discharge, light bleeding after intercourse, and lower abdominal and pelvic pain.
- Herpes vaginitis (HSV):
Pain associated with visible lesions or sores on the vulva or vagina, sometimes inside the vagina and only detectable during a gynecologic examination.
- Non-infectious vaginitis:
Itching, burning, and irritation in the vulva and vagina, urinary urgency and frequency.
Depending on the type of vaginitis, the characteristics of the discharge might indicate the condition.
Management and treatment for vaginitis
It is crucial to follow the instructions provided by your healthcare provider and the drug instructions when treating vaginitis. Even when your symptoms have disappeared, do not stop taking the medication without consulting. If you’re prescribed antibiotics therapy, cancelling it too early will only make bacteria resistant, i.e. stronger. If chemical irritants are causing your symptoms, you should avoid them to alleviate the symptoms. Bacterial and antifungal medications may take up to two weeks to cure the infection, while antiviral medications cannot cure viral vaginitis but can ease the symptoms.
Additionally, inform sexual partners from the last three months of your infection and encourage them to get tested and treated. Regular screening and immediate treatment can prevent further harm to your body caused by bacteria or parasites.
Diagnosis of vaginitis
Whether you are experiencing vaginitis for the first time or suffer from a chronic condition, it’s important to see a doctor. To accurately diagnose and treat your condition, your healthcare providers will begin by asking you questions. During this conversation, they may inquire about your symptoms, the duration and frequency of your symptoms, previous medications tried, personal habits and self-care routines, and your sexual history. Based on this information, your provider will likely be able to identify the type of vaginitis you are experiencing.
If necessary, they may also perform a pelvic exam using a speculum (a steel or plastic instrument gynaecologists use) to examine your vagina for infection, inflammation, or abnormal discharge. Additionally, they may collect a specimen from your vagina to view under a microscope, or order a fungal culture to further investigate the cause of your vaginitis.
As mentioned earlier, vaginitis doesn’t correlate with the level of hygiene. There are the following groups with higher chances of developing vaginitis:
- Pregnant women:
Changes in hormones and the vaginal pH during pregnancy can disrupt the balance of bacteria in the vagina.
- People who have multiple sex partners or avoid barrier methods of contraception
- People with an intrauterine device (IUD):
While IUDs are generally safe and effective, they can increase the risk of BV in some cases.
- People who use douches often:
Douching can upset the natural balance of bacteria in the vagina and increase the risk of BV
- Patients on antibiotics therapy, patients with a weakened immune system
It's not a good idea to wait for vaginitis to go away on its own since it causes complications. While some mild yeast infections may clear up without treatment, not all cases do. Bacterial vaginosis may also go away without treatment, but if left untreated, it can increase your risk of contracting sexually transmitted infections and lead to complications if you're pregnant.2 The symptoms of viral vaginitis may also disappear on their own, but it's crucial to inform your healthcare provider about any STIs you have, so they can monitor any cell changes. Some types of high-risk HPV cause cervical cancer.
How can I prevent vaginitis?
Tips to reduce the risk of vaginitis:
- Wear loose, breathable clothing made of cotton or other natural fibres
- Change out of wet bathing suits or sweaty workout clothes promptly
- Add yoghourt or probiotics containing lactobacillus to your diet
- Avoid using perfumed soaps or sprays on your vaginal area
- Avoid douching
- Practise safe sex by using condoms and dental dams
- Have regular gynecologic examinations, including screenings for STIs and cervical cancer
How common is vaginitis
3 out of 4 women have experienced at least one vaginitis episode in their lives.
When should I see a doctor?
If you feel such symptoms as vaginal irritation, vaginal itching, or pain during sexual intercourse or your vaginal fluid seems unusual, take some time to see a doctor.
Vaginitis is a condition of vaginal inflammation. It can be caused by a variety of factors. Some common types of vaginitis include candida or yeast infections, bacterial vaginosis, trichomoniasis vaginitis, chlamydia or gonorrhoea, viral vaginitis, and non-infectious vaginitis. Symptoms can be difficult to identify, but common symptoms include vaginal discharge and itching. Vaginitis can be caused by changes in vaginal flora, sexually transmitted infections, chemical irritants, unmanaged diabetes, and a weakened immune system. Treatment options include antifungal or antibiotic medication, depending on the type of vaginitis.
- Paladine, Heather L., и Urmi A. Desai. «Vaginitis: Diagnosis and Treatment». American Family Physician, 97, 2018 [cited 2018 Mar]; 5:321–29.
- Schwebke, Jane R., Donald Burgess. «Trichomoniasis». Clinical Microbiology Reviews, 2004 [cited 2004 Oct]; 17(4):794–803. Available from: https://doi.org/10.1128/CMR.17.4.794-803.2004.
- Fernandes, Mariana Zagalo. «Uncovering the Yeast Diversity in the Female Genital Tract: An Exploration of Spatial Distribution and Antifungal Resistance». Pathogens (Basel, Switzerland), 2023 [cited 2023 Apri]; 12(4):595. Available from: https://doi.org/10.3390/pathogens12040595