Vaginitis

What is vaginitis?

Vaginitis is an inflammation of the vagina caused by infection, poor hygiene, medical conditions, or changes in the normal vaginal flora. Signs and symptoms include vaginal discharge, odor, itching, pain or discomfort.

There are several types of vaginitis. The most common are:

• Atrophic vaginitis (or senile vaginitis) – Menopausal women should be evaluated for atrophic vaginitis, which is a common diagnosis in this age group due to the decrease of estrogen levels.
• Bacterial vaginosis – This is attributed to the change of numbers and types of bacteria in the vagina, especially when the number of lactobacilli is reduced.
• Trichomoniasis – The most common non-viral sexually-transmitted disease (STD) worldwide. It may infect other parts of the urogenital tract, including the urethra as well as the vagina.
• Candida albicans – Candida is considered part of the normal vaginal flora, but overgrowth of the organism and penetration of superficial epithelial cells can result in vulvovaginitis. Candida albicans accounts for 80 to 92 percent of episodes of vulvovaginal candidiasis.

What causes vaginitis?

The vaginal ecosystem is nominally acidic. This acidity helps maintain the normal vaginal flora and inhibits growth of pathogenic organisms. Disruption of the normal ecosystem can develop favorable conditions for vaginitis. Vaginitis can cause by those potentially disruptive factors which may include phase of the menstrual cycle, sexual activity, contraceptive choice, pregnancy, foreign bodies (tampon), estrogen level, sexually transmitted diseases, and use of hygienic products or antibiotics.

Over 90 percent of vaginitis is related to bacterial vaginosis, candida vulvovaginitis, and trichomoniasis. There are also less common causes of vaginitis such as gonorrhea, chlamydia, mycoplasma, herpes, parasites, and poor hygiene.

What are the symptoms of vaginitis?

Women with vaginitis typically exhibit one or more of the following vulvovaginal symptoms:

●Vaginal discharge volume, with a change of color or odor

●Pruritus

●Burning

●Irritation

●Erythema

●Dyspareunia

●Spotting

●Dysuria

How is a diagnosis made?

Normally discharges changed when you got vaginitis. But the appearance of the discharge is unreliable and cannot be the basis for diagnosis. For this reason, all women with suspected vaginitis should undergo appropriate testing.

Studies show that an initial office evaluation (history and physical examination; pH, wet mount microscopy, and whiff test of vaginal discharge) correctly diagnosed 60% of candidal vulvovaginitis, 70% of trichomoniasis, and 90% of bacterial vaginosis.

There are three main steps in the evaluation of women with symptoms of vaginitis:

●Obtain a history and perform a physical examination.

Vulvovaginal inflammation and the characteristics of the vaginal discharge, and also the presence of lesions or foreign bodies will be the focus of physical examinations. There are some other potentially significant findings such as signs of cervical inflammation and pelvic or cervical motion tenderness.

●Vaginal PH measurement and other laboratory testing like microscopy, wet mount, culture for bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Because of over 90% of vaginitis in premenopausal women are related to these disorders.

Examining the vaginal discharge for pH and fishy odor, and by microscope, may lead to a definitive diagnosis.

The normal vaginal secretions pH in premenopausal women is 4.0 to 4.5, bacterial vaginosis (pH>4.5), trichomoniasis (pH 5 to 6), candida vulvovaginitis (pH 4 to 4.5). Vaginal pH may be altered by some other factors.

●If this evaluation does not lead to a diagnosis, then your doctor will evaluate for less common and rare causes of vaginitis, such as group A streptococcal vaginitis, estrogen status, and sexual practices.

If a woman had minimal symptoms at the initial evaluation and the evaluation was nondiagnostic, the physician may repeat the evaluation at a second visit when she is symptomatic.

How is vaginitis treated?

Women with a confirmed diagnosis should be treated appropriately.

For diagnosed vaginitis, your doctor will treat you according to the type of infection you have. Antibiotics may be used. Your sexual partners should be referred for specific testing and may need treatment as well in order to avoid intercourse infection.

If the inflammation and vaginal discharge changed without pathological causes, the vaginitis may be due to changes in diet, sexual activity, medication, or stress. Your doctor may suggest you to change your lifestyle. You should discuss your medical history with your physicians carefully.

Can vaginitis be prevented?

You can help to prevent abnormal vaginal discharge in the following ways:

●Taking baths in plain warm water, and not using scented bath products

●Not douching

●Wear loose clothing

●Not wiping with baby wipes or scented toilet paper after you use the toilet

●Not having a lot of sex partners, using condoms