Vaginitis

Vaginitis, a most commonly encountered gynecological problem is an inflammation of the vagina that causes symptoms such as abnormal discharge, vulvovaginal discomfort or itching, and pain.

Normal vaginal discharge appears clear or milky with no bad odor. A imbalance of healthy vaginal bacteria or an infection could result in a change in the color, smell, and amount of the discharge along with itching or burning sensation leading to vaginitis.

The reduced levels of estrogen hormone in menopausal women may lead to vaginitis. Vaginitis is caused by an infection with microorganisms such as yeast, bacteria, or Trichomonas. It may also result due to physical or chemical irritation of the area.

The most common types of vaginitis include:

• Bacterial vaginosis: It results from overgrowth of one among the microorganisms normally present in your vagina.
• Vaginal candidiasis: It is an infection caused by a naturally occurring fungus called Candida albicans.
• Trichomoniasis: It is caused by a parasitic organism, and is a sexually transmitted disease.
• Atrophic vaginitis: It occurs after menopause when the estrogen levels are decreased.
• The treatment of vaginitis depends on its cause, and is targeted to eliminate the causative pathogen.

The signs and symptoms of vaginitis include:

• Abnormal vaginal discharge: Change in the color, odor, and amount of discharge from your vagina
• Vaginal itching, burning or irritation
• Pain during sexual intercourse
• Pain while passage of urine
• Spotting or slight vaginal bleeding

The characteristics of vaginal discharge differ in each type of vaginitis. Examples include:

• Bacterial vaginosis: You may develop a thin, grayish-white or yellowish-white colored, foul-smelling discharge. The odor, often resembles that of a fish, becomes more obvious after sexual intercourse. Itchiness may be present. This type of vaginitis is more common during pregnancy and is often associated with premature labor.
• Vaginal candidiasis: The major symptom is itching, which is associated with thick, white colored vaginal discharge that appears like a cottage-cheese. The discharge may be minimal and without any malodor.
• Trichomoniasis: It is a T. vaginalis infection, which causes a frothy greenish yellow colored discharge. Other symptoms include pain and irritation in the vagina.

When to see a Doctor

Consult your doctor if you experience any unusual vaginal discomfort, especially in the following situations:

• You have never had a vaginal infection before: Evaluation by your doctor can help you find out the cause and be aware of the signs and symptoms.
• You have had vaginal infections before, but this time, it seems to be different.
• You have had multiple sex partners or a recent new partner: You could have a sexually transmitted disease. The signs and symptoms of sexually transmitted infections sometimes resemble those of a vaginal candidiasis or bacterial vaginosis.
• You have taken a course of the over-the-counter anti-fungal medication, but your symptoms still persist, and you have developed fever and particularly unpleasant vaginal odor. These may be signs of infection caused by a resistant strain of yeast or a microorganism other than yeast.

Wait-and-see approach

You may not need to consult your doctor every time you have vaginal irritation with abnormal discharge, particularly if:

• You have had a diagnosis of vaginal fungal infection before, and your signs and symptoms are similar to your previous infection
• You are aware of the signs and symptoms of a fungal infection, and you are confident enough that you have a fungal infection

The cause varies with the type of vaginitis you have.

Bacterial vaginosis

Bacterial vaginosis is caused due to an overgrowth of organisms that are normally present in your vagina such as Mycoplasma hominis, Gardnerella vaginalis, Mobiluncus species, and Peptostreptococcus species.

Normally, the "good" bacteria (lactobacilli) outnumber "bad" bacteria (anaerobes) in your vagina. But, in situations where anaerobic bacteria grow more in number, they upset the balance in the normal flora leading to bacterial vaginosis. This type of vaginitis is linked to sexual intercourse, especially if you have multiple sex partners or a new sex partner.

Other risk factors include frequent douching, use of intrauterine device (IUD), and pregnancy.

Vaginal candidiasis

Vaginal candidiasis occurs when there is an overgrowth of C. albicans, a fungus that is a natural inhabitant of your vagina. Other fungi that may cause vaginal candidiasis include C. glabrata or C. parapsilosis, which belong to the candida species.

This fungal infection is often caused due to factors such as diabetes, HIV or other immunocompromised conditions, long- term use of antibiotics, use of oral contraceptives or IUDs, young age during first sexual intercourse, and pregnancy.

Trichomoniasis

Trichomoniasis is a common sexually transmitted infection caused by a microscopic, single-celled parasitic organism called Trichomonas vaginalis. This organism spreads through sexual intercourse with an already infected individual.

In men, the infection usually affects the urinary tract, but often there are no symptoms. In women, trichomoniasis usually infects the vagina, and causes symptoms.

Risk factors include unprotected sexual intercourse with multiple partners, and the use of an IUD.

Noninfectious vaginitis

Noninfectious vaginitis occurs due to an allergic reaction or irritation caused by vaginal sprays, douches, perfumed soaps, scented detergents, and spermicidal products.

Thinning of the vaginal lining due to deficient estrogen hormone levels, either after menopause or surgical removal of your ovaries can cause vaginal itching and burning.

You can consult your family physician, gynecologist or general medical practitioner for initial diagnosis and treatment of vaginitis.

What you can do?

Getting ready for your appointment:

• Note down your symptoms and the duration of each.
• Note your key medical information, including other conditions for which you are undergoing treatment, and the names of the medications, vitamins or other supplements you take regularly.
• Avoid use of tampons or douches before your appointment so that your doctor can assess the type of vaginal discharge you have.

List down the questions you may want to ask your doctor in the order of their importance.

For vaginitis, some basic questions include:

• How can I prevent vaginitis?
• What signs and symptoms should I watch for?
• Do I need to take any medicines?
• Should I follow some special instructions while using the medicine?
• Are over-the-counter products available to treat my condition?
• What should be done if my symptoms come back even after treatment?
• Does my partner need to undergo tests or treatment?

Questions that your doctor may ask include:

• What are your symptoms?
• For how long do you have your symptoms?
• Have you got a strong vaginal odor?
• Are your symptoms related to your menstrual cycle? For example, are your symptoms more intense just before or after getting your periods?
• Have you tried any over-the-counter products for your condition?
• Are you sexually active?
• Are you pregnant? 
• Do you use products such as scented soap or bubble bath, douches, and feminine hygiene sprays?

Generally the signs and symptoms are suggestive of vaginitis. Your doctor will make a diagnosis of vaginitis based on the following information:

• Review of your past medical history: This includes your history of vaginal or sexually transmitted infections.
• A careful pelvic examination: During the pelvic examination, your doctor will remove a sample of your cervical or vaginal discharge. This sample is sent to laboratory for microscopic examination, culture, or other specialized investigations to identify the infective pathogen and confirm the type of vaginitis you have.

As vaginitis is caused by a variety of factors and conditions, its treatment depends upon the specific cause. The guidelines of treatment for each type of vaginitis include:

Bacterial vaginosis

For this type of vaginitis, your doctor may prescribe metronidazole tablets (Flagyl) that are taken orally, metronidazole gel (MetroGel) or clindamycin cream (Cleocin) for topical application to your vagina.

Medications are usually used once or twice in a day for a period of five to seven days.

Vaginal candidiasis

This fungal infection is usually treated with an antifungal cream or suppository, such as miconazole (Monistat), clotrimazole (Gyne-Lotrimin) or tioconazole (Vagistat).

Your doctor may also prescribe a prescription oral antifungal medication, such as fluconazole (Diflucan). A disadvantage of using over-the-counter products to treat your fungal infection is that it is common to identify other types of vaginitis as candidiasis. Using an inappropriate medicine can cause delay in accurate diagnosis and treatment.

Trichomoniasis

To treat this infection, your doctor may advise metronidazole (Flagyl) or tinidazole (Tindamax) tablets.

Thinning of vaginal lining (vaginal atrophy)

Hormonal therapy is suggested either as topical creams or tablets to be taken through oral route.

Estrogen hormone may be supplemented as vaginal creams, tablets or rings to effectively treat atrophic vaginitis. This treatment is available on prescription from your doctor. In addition, non-hormonal vaginal lubricant products may be helpful.

Noninfectious vaginitis

To treat this type of vaginitis, the source of the irritation is to be recognized and avoided.

Possible sources are a new scented soap, laundry detergent, sanitary napkins or tampons. Your doctor may advise application of topical estrogen available as a cream to ease your symptoms.

Maintaining good hygiene is the best possible method that hepls prevent some types of vaginitis from recurring, and may relieve some of your symptoms.

Here are some hygienic practices you can follow to avoid vaginal inflammation:

• Avoid bubble baths, hot tubs, and whirlpool spas.
• Rinse off soap from your outer genital area after a bath, and keep the area dry to prevent irritation.
• Avoid using scented or harsh soaps with deodorant or antibacterial ingredients.
• Avoid use of scented tampons and pads that could irritate your genital area.
• Always wipe from the front to back after using the toilet to avoid spread of fecal bacteria to your vagina.

Other things that may help prevent vaginitis include:

• Avoid douching: Your vagina does not need any cleansing more than normal bathing. Douching will not help in clearing up a vaginal infection, instead repeated douching will disturb the balance of normal organisms that reside in your vaginal area, and can increase your risk of vaginal infection.
• Practice safe sex by use of a latex condom: Male and female latex condoms can help prevent infections that spread through sexual contact.
• Avoid tight undergarments, and wear 100% cotton underwear. Cotton garments reduce moisture build-up and increase air flow.
• Skip wearing an underwear at night when you sleep.

Lifestyle modifications are necessary in order to cope with vaginitis.

You will need to see a doctor and take prescription medications for the treatment of some types of vaginitis such as trichomoniasis, bacterial vaginosis and vaginal atrophy.

If you are sure that you have vaginitis caused by a fungus (vaginal candidiasis), you may try over-the-counter medications and follow certain self-care measures:
Use an over-the-counter medication developed specifically to treat fungal infections:

• The options available include, one-day, three-day or seven-day courses of topical antifungal creams or vaginal suppositories. The active ingredient in each product differs, and may include clotrimazole (Gyne-Lotrimin), miconazole (Monistat) or tioconazole (Vagistat). Some products include an external application cream to be applied to the labia and opening of the vagina. Follow the directions of use given in the package and ensure that you complete the course of treatment, even if you feel better after some time.
• Apply a cold compress using a washcloth, to the labial area to reduce some discomfort.

There are certain factors that have been identified to increase your risk of developing vaginitis, and include:

• Hormonal changes associated with conditions such as pregnancy, use of birth control pills or menopause
• Frequent unsafe sexual activity
• Having a sexually transmitted infection
• Long term use of medications such as antibiotics and steroids
• Uncontrolled diabetes
• Use of hygiene products such as bubble bath, vaginal sprays or vaginal deodorants
• Repeated douching
• Wearing damp or tight-fitting undergarments
• Use of an intrauterine device (IUD) for contraception

Vaginal infections respond well to treatment, and do not cause any serious complications. If left untreated, vaginal infections may spread upwards to affect other pelvic organs leading to a condition called pelvic inflammatory disease (PID).

PID can be very serious and cause fertility problems. Symptomatic bacterial vaginosis and trichomoniasis occurring in pregnant women have been associated with pre-term delivery with low birth weight infants.

Women with trichomoniasis or bacterial vaginosis are at an increased risk of contracting HIV and other sexually transmitted diseases.