What is vaginitis?
Vaginitis is inflammation or infection of the vagina that is associated with numerous possible symptoms (see below). Like any surface or opening of our body, the vagina normally has a balanced complement of healthy bacteria called its microbiome. Vaginitis is usually associated with a loss of this balance and often the development of an abnormal or unhealthy mixture of bacteria or an infection with yeast or a parasite.
What is the normal vaginal microbiome?
The normal vaginal microbiome has a predominance of lactobacillus bacteria. These healthy bacteria convert the normal sugar (glycogen) of the vaginal cells into lactic acid which causes the vaginal fluid to have a mildly acidic nature that prevents the growth of unhealthy bacteria and enables normal vaginal secretions and discharge.
How common is vaginitis?
Vaginitis is one of the most common reasons for a woman to visit a gynecologist. It is estimated that more than half of all women will have vaginitis at some time during their lives.
What are the symptoms of vaginitis?
There are numerous types of vaginitis and a resulting spectrum of symptoms. These include abnormal discharge, irritation, burning, itching, foul odor, baseline discomfort, and pain with intercourse. These symptoms can overlap among the various causes of vaginitis, so an accurate specific diagnosis usually requires an examination and probably testing.
What are the common causes of vaginitis?
More than 70% of cases of vaginitis are due to one or more of three specific conditions:
- Bacterial vaginosis – an important imbalance of the vaginal microbiome where other bacteria “outgrow” the healthy lactobacillus and the vagina becomes less acidic. This often involves an irritating watery, grayish discharge with a foul “fishy” odor, but it can be asymptomatic.
- Yeast (vulvovaginal candidiasis) – an infection with candida yeast that may involve no discharge or have a thick, whitish, curd-like discharge and bothersome itching, burning, or pain with intercourse or urination.
- Trichomoniasis – an infection with a microscopic one-celled parasite may cause itching, irritation, an abnormal odor, painful urination, and a frothy discolored discharge.
What are other causes of vaginitis?
There are other, rarer, forms of vaginitis as well as disorders of the vulva (the vaginal opening and the surrounding skin folds) that can mimic the symptoms of vaginitis. Some of these are primary skin diseases and some can be cancerous or precancerous, so it’s important to get further evaluation when episodes of vaginitis persist or don’t respond to standard treatments.
How is vaginitis diagnosed?
There are several steps in the diagnosis of vaginitis:
- History – A careful history is taken from the patient regarding her description of the nature and timing of the symptoms, including any discharge.
- Physical exam – The vulva is examined carefully for any signs of disease. Then the vagina is examined with a speculum and the secretions or discharge are sampled with a cotton swab.
- Office analysis – The secretions are tested for pH and then examined under a microscope.
- Clinical laboratory – In many cases, the specimen will be sent to the lab to be tested for trichomonas and yeast and evidence of bacterial vaginosis. This is especially important for recurrent cases where resistant types of yeast can be identified. If a person is sexually active, samples may also be tested for chlamydia and gonorrhea, sexually transmitted infections (STIs) that can cause symptoms similar to vaginitis.
How is vaginitis treated?
Let’s review the treatments for the common causes:
- Bacterial vaginosis – This is treated with vaginal or oral administration of either metronidazole, tinidazole, or clindamycin. Each patient and physician should discuss the choice of medication and dosage schedule.
- Yeast (vulvovaginal candidiasis) – Effective over-the-counter medications are available for treatment. These are convenient for patients who have had previous medical diagnosis of candidiasis, have a recurrence with similar symptoms, and whose vaginitis responds well to the medication. For other situations, a medical appointment and diagnosis is recommended to rule out other conditions or medication-resistant yeast.
- Trichomoniasis – Trichomoniasis is treated only with oral metronidazole. Because it is most often transmitted through sex, intimate partners should also receive treatment to prevent recurrence.
Recurrent, chronic, and complicated vaginitis and the doctor-patient relationship
Fortunately, most cases of vaginitis are straightforward in diagnosis and treatment. However, some patients experience frequent recurrence of symptoms that seriously degrade their quality of life. This is especially true in some cases of bacterial vaginosis or vulvovaginal candidiasis, or when a specific diagnosis cannot be determined.
These situations can be extremely challenging for both the patient and the gynecologist. The patient may be constantly uncomfortable, self-conscious about odor or intimacy, or have interrupted sleep and the gynecologist frustrated with their inability to provide lasting relief.
There are numerous possible remedies including testing for drug resistance and trials of longer or intermittent courses of medication. These are times when an open and trusting doctor-patient relationship are paramount. The doctor must listen attentively, never give up on the patient, and take her description of her symptoms at face value, and the patient may have to accept a trial-and-error approach to find what regimen will provide relief.
Summary
Vaginitis is a common gynecological disorder with numerous bothersome symptoms. It involves a shift in the normal bacterial environment of the vagina and/or an infection with bacteria, yeast, or parasites. These are three main common types of vaginitis: bacterial vaginosis, yeast (vulvovaginal candidiasis), and trichomoniasis.
The diagnosis and treatment of vaginitis are usually straightforward, but some women have recurrent or chronic vaginitis that can seriously impact their quality of life. These cases require a trusting and respectful relationship in which the physician listens carefully and openly, and doesn’t give up, and the patient accepts some degree of trial-and-error in discovering a resolution.
If you have questions about or trouble with vaginitis, please call us at 919-916-3333.
Note: Vaginitis can be a straightforward or a complex and frustrating gynecological problem and cannot be covered comprehensively in this format. The discussion above is intended for information and orientation and an introduction to the approach of this practice.
