Learn more about bacterial vaginosis (BV) from Caroline Mitchell, MD, director of the Vulvovaginal Disorders Program at Massachusetts General Hospital.
Vaginitis is any inflammation or infection of the vagina. It's common in women of all ages. Learn more about symptoms, diagnosis, and treatments.
The General Gynecology Program at the Massachusetts General Hospital Department of Obstetrics & Gynecology delivers compassionate, expert care for the full range of gynecologic issues.
What is vaginitis?
Vaginitis is any inflammation or infection of the vagina. It's common in women of all ages. About 30% of women have vaginitis at some time in their lives.
What causes vaginitis?
Bacteria, yeast, viruses, parasites, and chemicals in creams or sprays, and even clothing can cause vaginitis. Sometimes it occurs from germs that are passed between sexual partners. Also, many things can affect the health of your vagina. These include your overall health, your personal hygiene, medicines, hormones (especially estrogen), and the health of your sexual partner. Changes in any of these things can cause vaginitis.
These are the most common types of vaginitis:
Candida (yeast) infection. This is caused by one of the many types of fungus known as candida. These normally live in the vagina in small numbers. Infection happens when something upsets the vagina’s normal balance of yeast. For example, antibiotics can kill bacteria that normally balances the amount of yeast in the vagina. Too much yeast grows, causing an infection. Another cause can be pregnancy, or some health problems such as diabetes.
Bacterial vaginosis (BV). This occurs when certain types of normal vaginal bacteria grow out of control and cause inflammation. BV is linked to sexual activity. But it's not a sexually transmitted infection.
Trichomoniasis (trich). This is a sexually transmitted infection caused by a parasite. This parasite passes between partners during sexual intercourse. Most men don’t have symptoms with trichomoniasis. So the infection is often not diagnosed until a woman has vaginitis symptoms.
Viral vaginitis. Herpes is most commonly spread through sexual contact. The herpes simplex virus (HSV) can cause viral vaginitis.
Noninfectious vaginitis. This is vaginal irritation without an infection. It’s most often caused by an allergic reaction or irritation. Chemicals in vaginal sprays, douches, or spermicidal products can cause it. It may also be caused by perfumed soaps, detergents, or fabric softeners. Even chemicals in clothing can cause symptoms. A type of noninfectious vaginitis called atrophic vaginitis happens when your body makes too little of the hormone estrogen. This can happen from menopause, surgical removal of the ovaries, radiation therapy. It can even happen after childbirth, particularly in breastfeeding women. Lack of estrogen dries and thins the vaginal tissue.
Who is at risk for vaginitis?
You are more at risk for vaginitis if you:
Have recently taken antibiotics
Have changes in hormone levels from pregnancy, breastfeeding, or menopause
Have diabetes that is not well-controlled
Are using high-estrogen contraceptives
Are sensitive to chemicals in things such as perfumes, body sprays, laundry soap, spermicides, or douches
Have poor personal hygiene
Have a weak immune system. For example, from certain diseases such as HIV or from taking medicine, that weakens your immune system (such as corticosteroid therapy).
What are the symptoms of vaginitis?
The symptoms of vaginitis can be like other health conditions and can be different for each woman. Make sure to see your healthcare provider for a diagnosis.
Yeast infection symptoms include:
A thick, white, odorless vaginal discharge that is like cottage cheese
Itching and redness of the vulva and vagina
Pain with urination or sex
Bacterial vaginosis symptoms include:
A thin, white fluid from the vagina
A thick, gray or green fluid from the vagina
Fishy smell to the fluid
Trichomoniasis symptoms include:
Frothy, greenish-yellow fluid from the vagina that smells musty
Itching or burning in and around the vagina and vulva
Swelling or redness at the opening of the vagina
Light bleeding, especially after sex
Burning when you urinate
Pain in the lower belly (abdomen)
Pain during sex
No symptoms, in some cases
Viral vaginitis symptoms include:
Pain in the genital area from sores, if the cause is HSV
Painless warts on the vagina, rectum, vulva, or groin, if the cause is HPV. But HPV can be present without visible warts.
Noninfectious vaginitis symptoms include:
Vaginal itching, soreness, burning, or dryness
Fluid from the vagina
Uncomfortable, even painful sex
Spotting after sex with atrophic vaginitis
How is vaginitis diagnosed?
Your healthcare provider will review your health history and do a physical and pelvic exam. He or she may also examine the vaginal discharge with a microscope to determine the cause.
How is vaginitis treated?
Treatment will depend on your symptoms, age, and general health. It will also depend on the cause of your vaginitis and how severe it is. If medicines are prescribed, talk with your healthcare provider about the risks, benefits, and possible side effects of all medicines.
Treatment may include:
Antifungal vaginal creams and suppositories
Antifungal medicines that are taken by mouth (oral)
Treatment is done with antibiotics.
Treatment is done with oral antibiotics. All sexual partners need to be treated. This is to prevent the infection occurring again.
Treatment depends on the virus:
Antiviral medicines may be used for genital herpes (HSV). These medicines don’t kill HSV. But they can decrease the pain and shorten the length of the outbreak.
Treatment for HPV may include medicines applied to the warts. Or it may include procedures to remove the warts, including freezing, heat, lasers, or surgery.
Noninfectious vaginitis caused by an irritant is treated by finding out what caused the reaction or irritation, and removing it from use. For atrophic vaginitis, your healthcare provider may recommend products to relieve vaginal dryness. These may include vaginal creams, lotions, lubricants, or hormone therapy.
What are possible complications of vaginitis?
Without treatment, vaginitis caused by bacterial vaginosis (BV) or trichomoniasis (trich) can increase the risk of more serious health problems such as:
Pelvic inflammatory disease (PID)
Giving birth to a baby early if you’re pregnant (preterm delivery)
HIV and certain other sexually transmitted infections (STIs)
A common cause of viral vaginitis is HPV. Certain types of HPV can cause cell changes that increase the chance of getting cervical cancer. An HPV vaccine can prevent infection by the types of HPV that cause most cervical cancers but is only effective if the vaccination is given prior to exposure to HPV.
What can I do to prevent vaginitis?
Follow these tips to help prevent vaginitis.
Stay away from chemicals. Don’t use vaginal sprays. Don’t use scented toilet paper or scented tampons. Sprays and scents have chemicals that can irritate your vagina.
Don’t douche unless you are told to by your healthcare provider. Douching is rarely needed. And it upsets the normal balance in the vagina.
Wash yourself well. Wash the outer vaginal area (vulva) every day with mild, unscented soap. Keep it as dry as possible.
Wipe correctly. Make sure to wipe from front to back after a bowel movement. This helps keep from spreading bacteria from your anus to your vagina.
Change your tampon often. During your period, make sure to change your tampon as often as directed on the package. This allows the normal flow of vaginal discharge and blood.
Limit your number of sexual partners. The more partners you have, the greater your risk of infection. Using condoms helps reduce your risk.
Get enough sleep. Sleep helps keep your body’s immune system healthy. This helps you fight infection.
Lose weight, if needed. Excess weight can reduce air circulation around your vagina. This can increase your risk of infection.
Exercise regularly. Regular activity helps keep your body healthy.
Take antibiotics only as directed. Antibiotics can change the normal chemical balance in the vagina.
Don’t sit in wet clothes. Yeast thrives when it’s warm and damp.
Don’t wear tight pants. And don’t wear tights, leggings, or hose without a cotton crotch. These types of clothing trap warmth and moisture.
Wear cotton underwear. Cotton lets air flow around the vagina. Change your underwear every day.
Key points about vaginitis
Vaginitis is any inflammation or infection of the vagina. It is common in women of all ages.
Causes can include infections, chemicals, hormone changes, and poor personal hygiene.
Symptoms can include pain, itching, burning, sores, and vaginal discharge.
Treatment may include medicines. The type of medicine depends on the cause.
Bacterial vaginosis, herpes, candida, and trichomoniasis, can all cause vaginitis. Treating these conditions is important to prevent other serious health problems.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
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