Vaginitis: Understanding, Treating, and Preventing Vaginal Infections

What is Vaginitis?

One of the most common gynecologic complaints from women is vaginitis, which, quite literally, means “infection of the vagina.” While this may sound rather scary, as many as 75% of women will experience at least one vaginal infection in their lifetime. 40-50% of women will experience two or more infections in their lifetime. Although often associated with women of reproductive age, it can occur in young women who are not sexually active and in older women who are postmenopausal.

Strictly speaking, vaginitis is an inflammatory process of the vaginal area. To the average female patient, it can mean vaginal symptoms such as discharge, dryness, odor, or burning. It can cause pain with intercourse (called dyspareunia), itching, urinary symptomatology, and pelvic pain. It has not been associated with an increased risk for cancer, infertility, or long-term damage; however, having vaginitis can increase a women’s risk of contracting other STDs such as HIV, Chlamydia, and Gonorrhea, when exposed. Vaginitis has a significant impact on a woman’s daily quality of life. It can also have profound effect on intimacy and sexual relationships.

Types of Vaginitis

There are several types of vaginitis:

Yeast infections (VVC – vulvovaginal candidiasis) are familiar to most women. There are several over the counter (OTC) medications now available to treat these infections. When uncomplicated, one treatment of OTC medication may be all that is necessary for a woman to return to her busy life without inconvenience. Seek medical care if one treatment does not resolve the problem or if you are known to have recurrent infections.
Bacterial Vaginosis (BV) is an imbalance in the bacterial growth in the vagina causing an increased number of certain bacteria present which can cause odor, discharge, irritation, and pain. There are no OTC medications one can buy to treat these infections. Years ago, both the patient and her sexual partners were treated as it was thought to be a sexually transmitted infection (STI). Research has dispelled this myth and has shown us that treating partners does not result in an improved rate of cure in the woman. Bacterial Vaginosis has been associated with prenatal complications such as preterm labor and is treated in pregnancy when found.
Trichomoniasis Vaginalis, “Trich,” or Trichomonas is a sexually transmitted infection that can cause discharge, inflammation, odor, and pain. It can be harbored in the vagina for months or years and can go undetected. When treating a woman, the plan always involves treatment of the sexual partners and abstinence until the infection has been proven to have been eradicated.
Atrophic Vaginitis is an inflammation of the vagina that can be associate with discharge, irritation, and pain. It is caused by vaginal dryness and seen in postmenopausal women. It does not require infection treatment but rather estrogen replacement to resolve the symptoms.

What should I do if I think I have vaginitis?

It is important to correctly diagnose what is going on when you suspect an infection. Some women may choose to try OTC medication if they suspect a yeast infection. However, if the first try doesn’t work, do not re-treat, but take the time to get evaluated by your gynecologist or women’s health practitioner. It is impossible to correctly diagnose or differentiate the type of vaginitis by symptoms alone. When visiting your provider for evaluation, do not put anything in the vagina for 3-5 days to improve the ability to find clues and make a diagnosis. Inspection, collection of specimens, and an in-office microscope exam may help in your diagnosis. These cannot be done with recent sex, medication use, or if you are on your menses.

How can I prevent future infections?

We know that antibiotic use, an immunocompromised state, illness, diabetes and pregnancy can predispose a woman to infection. However, this question can be hard to answer in some women. There are many resources for information available. Stress can play a big role in how our bodies combat infection. Additionally, excessive sweating and moisture presence, high carbohydrate diets, restrictive clothing, douching, tub bathing, spermicides/lubricants and use of scented items have all been suggested as being influential. Often your practitioner will talk to you about lifestyle, stress management and individualize the counseling based on your personal discussion.

What treatments are used for vaginitis?

Vaginal infections are treated with various medications such as antifungals (yeast, VVC), antibacterial medications (Bacterial Vaginosis and Trichomoniasis), and estrogens (Atrophic Vaginitis). Sometimes multiple therapies or longer-term treatment plans must be put into place. In complicated cases, a referral to a specialist may be needed. The Center for Disease Control (CDC) has recommended treatment guidelines. Longer term therapies are individualized based on the patient and her presentation.

How can I prevent vaginitis?

Keeping yourself generally healthy will always help you in the fight against infection. This means treating any underlying medical problems, maintaining a healthy well-balanced diet, exercising regularly but not excessively, and managing daily stress. Avoiding cigarettes, alcohol, and other substance abuse is a must. Being sexually responsible in that you use condoms, and avoiding multiple partners and STD exposure will also keep you healthy.

Talk to your health care practitioner and be honest about your lifestyle and habits. This will help them personalize your care and work toward resolution of the problem. Excellent gynecologic health is a team approach. Your GYN provider is not about judging you, but rather helping you be the best you!