Vaginitis is defined as inflammation of infection of the vagina, and symptoms can occur year round. Vaginal discomfort and pain are some of the most frequent reasons why patients visit their obstetrician-gynecologist, and can result in decreased productivity and sexual function, lost days from work and school, and a negative self image.
1) What are the different types of vaginitis and what are some symptoms?
The more common causes of vaginitis include yeast infections, bacterial vaginosis, and trichomoniasis. Bacterial vaginosis occurs in up to 50% of all cases and is the most common type of infection, followed by yeast infections, and lastly trichomoniasis.(1) In addition, individuals can have vulvovaginal irritation due other reasons, such as skin disorders, sexually transmitted diseases, and skin changes due to menopause. We will focus on the top three causes in this article. The symptoms are varied and may include vulvar or vaginal burning, itching, redness, irritation, pain with sex, abnormal odor, and abnormal discharge. Bacterial vaginosis may present with a fishy odor and a grayish discharge. Yeast infections have a cottage cheese discharge and can be white/yellow/green in color. Trichomonas usually present with copious amounts of watery/greenish discharge.
2) What causes these infections?
Firstly, one must understand the role of estrogen in the vaginal environment. Estrogen increases glycogen content in the vaginal cells, and encourages colonization of the vagina with lactobacilli. This bacteria is normal, and leads to lactic acid production resulting in a decrease of vaginal pH to less than 4.5. Therefore, during the reproductive years, the vagina is acidic, which helps to protect against the growth of unwanted pathogens. In prepubertal and menopausal women who lack estrogen, the pH in the vagina is higher than 4.5 and more basic, and therefore these age groups are less likely to have vaginal infections colonized by candida and bacteria. In bacterial vaginosis, there is an overgrowth of certain bacterial families that normally do not colonize the vaginal tract and a lack of the normal lactobacilli. This occurs because of a change in the pH due to a number of different factors (eg. sexual activity, changes in soaps or detergents). In yeast, there is overgrowth of the Candida species, which can occur if there is prolonged exposure to a moist and heated environment (eg. excessive sweating/swimming/sauna activity). Trichomoniasis is caused by a protozoan parasite Trichomonas vaginalis and is considered a sexually transmitted disease.
3) How are these infections treated?
Bacterial vaginosis is usually treated with antibiotics, either in a pill or vaginal gel insert. The antibiotics arm to reduce the overgrowth of the bacteria that normally does not grow in the vagina. Antibiotics such as Flagyl or metronidazole can interact with alcohol, so it is important to abstain for the duration of treatment. Yeast infections are treated with antifungal agents, either in a pill form or vaginal creams. Diflucan or Terazol cream is commonly prescribed. There are also milder forms of the vaginal creams that are available over the counter without a prescription, and are usually miconazole generic or branded as Monistat. Trichomonas is treated with antibiotics as well in the tablet form, typically metronidazole or tinidazole.
4) What are some ways to prevent these infections?
For bacterial vaginosis, prevention of any activity that may alter the vaginal pH can decrease incidence of infection. This may be more difficult, as common activities such as sexual intercourse, use of tampons, and certain soaps may cause the infection. It also does help to take probiotics that contain lactobacilli to help encourage the normal vaginal flora to replenish itself. Yeast infections can be prevented by keeping the genital area clean, dry, and free from moist, damp, and warm environments. Decreasing carbohydrate intake may help as well. Diabetics are more prone to yeast infections due to the elevation of sugar in their body, so excellent sugar control is important in prevention of yeast infections. Trichomonas can be entirely prevented by using condoms and exercising caution in selecting your sexual partners.
As always, consult your physician for additional information on this topic, and seek medical attention if you are having significant vaginal pain or discomfort.
For the most up-to-date information regarding this topic, please see the Centers for Disease Control and Prevention (CDC) webpage, which is located at https://www.cdc.gov/std.
(1) ACOG Practice Bulletin Number 215, Vol 135, No. 1, January 2020.
Jennifer E. Cho, MD, FACOG
