Vaginal Infections & Bacterial Vaginosis

Vaginitis is a medical term used to describe various conditions that cause infection or inflammation of the vagina. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from a vaginal infection caused by organisms such as bacteria, yeast or viruses, as well as by irritation from chemicals in creams, sprays, or even clothing that is in contact with this area. In some cases, vaginitis results from organisms that are passed between sexual partners.

Symptoms of Vaginitis?

The symptoms of vaginitis can vary depending on what is causing the infection. Some women have no symptoms at all. Some of the more common symptoms of vaginitis include:

  • abnormal vaginal discharge with an unpleasant odour
  • burning sensation during urination,
  • itching around the outside of the vagina,
  • discomfort during intercourse.

Vaginal Discharge

A woman's vagina normally produces a discharge that can usually be described as clear or slightly cloudy, non-irritating, and odour-free. During the normal menstrual cycle, the amount and consistency of discharge can vary. At one time of the month there may be a small amount of a very thin or watery discharge; and at another time, a more extensive thicker discharge may appear. All of these descriptions could be considered normal.

A vaginal discharge that has an odour or that is irritating is usually considered an abnormal discharge. The irritation might be itching or burning, or both. The itching may be present at any time of the day, but it is often most bothersome at night. These symptoms are often made worse by sexual intercourse. It is important to seek medical advice if there has been a change in the amount, colour or smell of the discharge.

Common types of vaginitis

The six most common types of vaginitis are:

  • Candida or "yeast" infections
  • Bacterial vaginosis
  • Trichomoniasis vaginitis
  • Chlamydia vaginitis (see also under PID)
  • Viral vaginitis
  • Non-infectious vaginitis.

Although each of these types of vaginitis can have different symptoms, it is not always easy for a woman to work out which type she has. In fact, diagnosis can even be tricky for an experienced doctor. Part of the problem is that sometimes more than one type can be present at the same time. And, an infection may even be present without any symptoms at all.

To help you better understand these six major causes of vaginitis, we will look briefly at each one of them and how they are treated.

Thrush – Vaginal Yeast Infection – Candida

Yeast is the most common cause of vaginal infection. A fungus causes vaginal yeast infections, which occur inside the vagina and in the vulvar area that surrounds the vagina. Three out of four women have at least one vaginal yeast infection during their lifetimes. The symptoms of vaginal yeast infections include vaginal itching; a thick, white vaginal discharge that may look like cottage cheese; pain during sexual intercourse; redness; burning; soreness; swelling; and general vaginal irritation. Not every woman experiences all these possible symptoms of vaginal yeast infection. Many women frequently experience yeast infections, so they are familiar with their symptoms and the course of treatment recommended for them. But if this is the first time you are having such symptoms, it's important to see your doctor to get a formal diagnosis and rule out other possibilities.

What factors increase your risk of vaginal yeast infections?

Several things will increase your risk of contacting a yeast infection, including:

  • Recent treatment with antibiotics. For example, a woman may take an antibiotic to treat an infection, and the antibiotic kills her "friendly" bacteria that normally keep the yeast in balance. As a result, the yeast overgrows and causes the infection.
  • Uncontrolled diabetes. This allows for too much sugar in the urine and vagina.
  • Pregnancy, which changes hormone levels.

Other factors Include:Oral contraceptives ( birth control pills), Disorders affecting the immune system, Thyroid or endocrine disorders and steroid therapy.

How are vaginal yeast infections treated?

Yeast infections are most often treated with medicine that you put into your vagina. This medicine may be in cream or pessary form and many are available over-the-counter. Medicine in a pill form that you take by mouth is also available.

What should I do to prevent vaginal yeast infections?

To prevent yeast infections, you should:

  • Wear loose clothing made from natural fibres (such as cotton, linen and silk).
  • Avoid wearing tight trousers.
  • Do not douche. (Douching can kill bacteria that control fungus.)
  • Limit the use of feminine deodorant.
  • Limit the use of deodorant tampons or pads to the times when you need them.
  • Change out of wet clothing, especially swimsuits, as soon as you can.
  • Avoid frequent jacuzzis.
  • Wash underwear in hot water.
  • Eat a well-balanced diet.
  • Eat yoghurt.
  • If you have diabetes, keep your blood sugar level as close to normal as possible.

If you get frequent yeast infections, seek medical advice. Certain tests may be needed to rule out other medical conditions.

Bacterial Vaginosis (BV)

BV is the most common cause of vaginal discharge in women during their reproductive years. It is not an infection. Rather, BV develops when the normal balance of bacteria that colonize in the vagina gets thrown off by overgrowth. While there is not a definitive answer about what causes BV, a few factors are known to raise risk including having a new or multiple sexual partners, using vaginal douches, having an IUD, and failure to practice safe sex by not using a condom during every act of sexual intercourse. The most common symptom of BV a fish-like vaginal odor, as well as an abnormal vaginal discharge that is white or gray and that can be either watery or foamy.

What is Bacterial Vaginosis?

Although 'yeast' is the name most women think of when they think of vaginal infections, bacterial vaginosis (BV) is a very common type of vaginal infection in women of reproductive age. BV is caused by a combination of several bacteria. These bacteria seem to overgrow in much the same way as Candida do when the vaginal balance is upset. The exact reason for this overgrowth is not known.

BV is not transmitted through sexual intercourse but is more common in women who are sexually active. It is also not a serious health concern but can increase a woman's risk of developing other sexually transmitted infections and may increase the risk of pelvic inflammatory disease (PID) following surgical procedures such as abortion and hysterectomy. BV may increase the risk of early labour and premature births in women who have the infection during pregnancy.

Symptoms of bacterial vaginosis

Up to 50% of women who have bacterial vaginosis do not have any symptoms, but if symptoms do appear, they can include:

  • white or discoloured, often grey, discharge
  • discharge that smells "fishy", that is often strongest after sex
  • pain during urination
  • itchy and sore vagina.

Diagnosis of Bacterial Vaginosis

Your doctor can tell you if you have BV. He or she will examine you and will take a sample of fluid from your vagina. The fluid is viewed under a microscope. In most cases, your doctor can tell immediately if you have BV.

Treatment of Bacterial Vaginosis

Bacterial Vaginosis can be treated with medicine prescribed by your doctor. The most common medicines prescribed for BV are antibiotics called metronidazole and clindamycin . These may be taken orally or used as a vaginal cream or gel.

Prevention of Bacterial Vaginosis

Ways to prevent BV are not yet known. It is possible to reduce the risk of developing BV by not douching and not using scented soaps or vaginal deodorants.

Sexually Transmitted Vaginitis

There are several vaginal infections that are transmitted through sexual contact.

Trichomoniasis

Trichomoniasis is an sexually transmitted infection (STI) and the most common curable STI. It is caused by a tiny single-celled organism that infects the vagina, The time between exposure to trichomoniasis and the onset of symptoms is from 5 to 28 days. While some women don't experience any symptoms, other women have symptoms such as a frothy yellowish-greenish vaginal discharge, a foul vaginal odor, pain during sexual intercourse, pain during urination, vaginal itching and general irritation and soreness of the vagina and vulva, and rarely pelvic pain. If you suspect you may have trichomoniasis, you should discontinue sexual intercourse and see your doctor immediately. If your doctor diagnoses trichomoniasis, your sexual partner(s), should be diagnosed and receive treatment. Sexual intercourse should not resume until both you and your partner are treated and symptom-free.

Chlamydia

Chlamydia is another sexually transmitted form of vaginitis. Unfortunately, most women with chlamydia infection do not have symptoms, which makes diagnosis difficult. A vaginal discharge is sometimes present, but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18 to 35 years) who have multiple sexual partners. If you fit this description, you should request screening for chlamydia from your doctor or local sexual health clinic. If left untreated, chlamydia can cause damage to a woman's reproductive organs, and can make it difficult for a woman to become pregnant.

Chlamydia

Chlamydia is another sexually transmitted form of vaginitis. Unfortunately, most women with chlamydia infection do not have symptoms, which makes diagnosis difficult. A vaginal discharge is sometimes present, but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18 to 35 years) who have multiple sexual partners. If you fit this description, you should request screening for chlamydia from your doctor or local sexual health clinic. If left untreated, chlamydia can cause damage to a woman's reproductive organs, and can make it difficult for a woman to become pregnant.

Viral Vaginitis

Several sexually transmitted viruses cause vaginitis, including the Herpes Simplex Virus (HSV) and the Human Papilloma Virus (HPV). The primary symptom of herpes is pain associated with lesions or sores. These sores are usually visible on the vulva or the vagina but occasionally are deep inside the vagina and can only be seen during a gynaecological examination.

HPV - sometimes referred to as genital warts - can cause warts to grow in the vagina, rectum, vulva or groin. These warts, when visible, are usually white to grey in colour, but they may be pink or purple. When warts are not visible, a cervical smear, or a more specialised HPV test may be the only way to detect the virus.

Non-infectious / Chemical Vaginitis?

Occasionally, a woman can have itching, burning, and even a vaginal discharge without having an infection. The most common cause is an allergic reaction or irritation from vaginal sprays, douches, or spermicidal products. Additionally, the skin around the vagina can be sensitive to perfumed soaps, detergents and fabric softeners.

Another non-infectious form of vaginitis results from a decrease in hormones because of menopause or because of surgery that removes the ovaries. In this form, the vagina becomes dry. This is referred to as atrophic vaginitis. The woman may notice pain, especially during sexual intercourse, as well as vaginal itching and burning.

Treatment of Vaginitis

The key to proper treatment of vaginitis is proper diagnosis. This is not always easy since the same symptoms can exist in different forms of vaginitis. You can greatly assist your doctor by paying close attention to exactly which symptoms you have and when they occur, along with a description of the colour, consistency, amount, and smell of any abnormal discharge. Do not douche before visiting your doctor as it will make accurate testing difficult or impossible. Some doctors ask that you abstain from sex for 24 hours before your appointment.

Because different types of vaginitis have different causes, the treatment needs to be specific to the type of vaginitis present. It is best to seek medical advice before self-treating with over-the-counter medications.

'Non-infectious' vaginitis is treated by changing the probable cause. If you recently changed your soap or laundry detergent or have added a fabric softener, you might consider stopping the use of the new product to see if the symptoms improve. The same instruction would apply to a new vaginal spray, douche, sanitary napkin or tampon. If the vaginitis is due to hormonal changes, oestrogen may be prescribed to help reduce symptoms.

Prevention of Vaginitis

There are certain things that you can do to decrease the chance of getting vaginitis. If you suffer from yeast infections, it is usually helpful to avoid garments that hold in heat and moisture. The wearing of nylon underwear, tights without a cotton panel, and tight jeans can lead to yeast infections. Good hygiene is also important. In addition, doctors have found that if a woman eats yoghurt that contains active cultures (read the label) she may get fewer infections.

Because they can cause vaginal irritation, most doctors do not recommend vaginal sprays or heavily perfumed soaps for cleansing this area. Likewise, douching may cause irritation or, more importantly, may hide a vaginal infection. Douching also removes the healthy bacteria that help keep the vagina clean. Removing these bacteria can result in, or worsen, vaginitis.

Safe sexual practices can help prevent the passing of infections between partners. The use of condoms is particularly important.

If you are approaching menopause, have had your ovaries removed or have low levels of estrogen for any reason, discuss with your doctor the use of oestrogen in the form of pills, creams, or vaginal rings to keep the vagina lubricated and healthy.

Good health habits are important. Have a cervical smear as often as advised. If you have multiple sexual partners, you should request screening for sexually transmitted infections.