Vaginitis: Overview

Vaginitis is the medical term for inflammation or infection of the vagina, or birth canal. It typically occurs when there is an infection or a decrease in the acidity, and therefore an increase in pH level, of the vagina. In premenopausal women, the normal pH level of the vagina is approximately 4.0 on the 0.0 to 14.0 pH scale, which ranges, respectively, from acid to alkaline. This acidity normally limits the development of infectious bacteria, fungi and parasites. Vaginitis may also result from reduced levels of estrogen occurring after menopause.

The glands inside the vagina and cervix (the bottom part of the uterus, or womb) produce small amounts of fluid. The fluid is discharged from the vagina daily, carrying out old cells that have been shed from the vaginal lining. This is the body's way of ensuring that the vagina remains clean and healthy.

Vaginal discharge is typically clear or milky in appearance and odorless. The color and consistency of the discharge may change during menstruation and become thicker during ovulation, breastfeeding and sexual arousal. Other changes in the discharge, such as a difference in color or odor, often indicate that a woman has vaginitis or a sexually transmitted disease.

Vaginitis does not typically cause serious complications. However, some types have been associated with pelvic inflammatory disease and an increased risk of sexually transmitted diseases, including human immunodeficiency virus, or HIV. In addition, some types of vaginitis may pose certain risks for pregnant women, such as premature delivery and low-birth-weight babies.

Bacterial vaginosis

There are three vaginal infections that are typically classified as vaginitis. The most common of these is bacterial vaginosis. Bacterial vaginosis is caused by an overgrowth of one of several organisms, or bacteria, that are usually present in the vagina. Normally, the "good" bacteria in the vagina outnumber the "bad" bacteria. If, however, the bad bacteria become too abundant, they can upset the bacterial balance or pH of the vagina, resulting in bacterial vaginosis.

Although bacterial vaginosis accounts for more cases, it is less understood than yeast infection or trichomoniasis, the other common types of vaginitis. It is also ignored and misdiagnosed more often than these conditions. Left untreated, bacterial vaginosis can lead to the following significant health complications:

• Pelvic inflammatory disease. Also known as PID, this infection of the upper genital tract may lead to infertility.
• Surgical complications. Bacterial vaginosis can lead to complications following surgeries such as abortion, hysterectomy and other procedures.

While further study is needed, experts also believe that bacterial vaginosis may be associated with increased susceptibility to human immunodeficiency virus. This virus, often abbreviated as HIV, is the virus that causes acquired immune deficiency syndrome, or AIDS.

According to the U.S. Centers for Disease Control and Prevention (CDC), bacterial vaginosis affects up to 16 percent of expectant mothers in the United States, although many are not even aware they have the condition. Pregnant women with bacterial vaginosis are at increased risk of the following:

• Premature delivery
• Postpartum infection
• Post-surgical complications after a cesarean section

Although bacterial vaginosis can be transmitted through sexual intercourse, it is not generally considered a sexually transmitted disease. Approximately one-quarter of women treated for bacterial vaginosis will have a recurrence within one month.

Other types of vaginitis

The two other main types of vaginitis include:

• Yeast infection. Also called candidiasis, this condition is caused by an overabundance of candida, a microscopic fungus that normally inhabits the vagina. There are four types of candida. A variety called Candida albicans, or C. albicans, causes the vast majority of vaginal yeast infections. This fungus, which also grows normally in the mouth and digestive tract, can infect other moist regions of the body as well, including the skin folds and nail beds. When the mouth is infected, the condition is called thrush.

  Almost 75 percent of all adult women will have a yeast infection at some point in their lives, according to the CDC, and approximately 5 percent of these women will develop a condition called recurrent vulvovaginal candidiasis, or RVVC. RVVC is classified as more than three symptomatic vaginal yeast infections over the course of a year. Women who experience RVVC should notify their gynecologist, who will attempt to identify the underlying cause of the condition. Although yeast infection is not generally considered a sexually transmitted disease, in rare instances it may be transmitted to male partners through sexual intercourse.

• Trichomoniasis. This condition is caused by a parasite in the vagina, typically Trichomonas vaginalis. This protozoan, or single-celled organism, primarily resides in a woman's genitourinary tract, where it finds the moisture and warmth it needs to develop and multiply. Trichomoniasis is typically transmitted through sexual intercourse with a partner who is already infected. Because the parasite can live for several hours on a damp washcloth, towel or bathing suit, it can also be spread by sharing these items with a person who is infected.

  Trichomoniasis affects an estimated 5 million people, and approximately 5 to 10 percent of women, in the United States. This is more than any other nonviral sexually transmitted disease. Left untreated, trichomoniasis does not typically produce symptoms. However, it may cause vaginitis in some women, and some men with the condition may develop nongonococcal urethritis, which is a type of urethral infection. Additionally, recent research indicates that pregnant women with trichomoniasis may experience preterm delivery, and individuals who are infected may be two to four times more likely to acquire other sexually transmitted diseases, including HIV. However, more research is needed.

Other, less common forms of vaginitis include:

• Atrophic vaginitis. This condition typically results from a decline in estrogen levels occurring after menopause. Estrogen is a female reproductive hormone. Reduction of the hormone may cause changes in the skin around the vagina, vulva, urethra or bladder.
• Noninfectious vaginitis. This condition occurs when products such as perfumed soaps, douches and vaginal sprays irritate the skin around the vagina or cause an allergic reaction.
• Chlamydia. This infection is primarily transmitted through sexual intercourse.
• Viral vaginitis. This is caused by viral infection, such as the herpes simplex virus or the human papillomavirus (HPV).

It is possible for women to experience multiple types of vaginitis at the same time. Therefore, a diagnosis of bacterial vaginosis does not necessarily preclude a diagnosis of yeast infection.

Different types of vaginitis have different causes and risk factors. For instance, yeast infections may be found more frequently as a result of hormonal changes, such as those associated with pregnancy. On the other hand, trichomoniasis is typically transmitted through sexual intercourse with a partner who is already infected. Signs and symptoms typically vary according to the type of vaginitis. Common symptoms may include a change in the amount, color or odor of vaginal discharge. Vaginitis can also result in symptoms such as itching or burning inside or around the vagina.

Diagnosis of vaginitis depends on which type of vaginitis is suspected. In order to determine the correct diagnosis, doctors will take a medical history and perform a pelvic examination. Microscopic analysis of vaginal discharge is also required. Treatment also depends on which type of infection is present. Many forms of treatment are available in oral or topical form. Prevention methods include practicing safe sex, clean toilet habits and avoiding use of vaginal sprays, deodorants and douches.

Vaginitis is a very common condition that affects most women at some point in some form or another. Many women may have already developed vaginitis and recovered without ever realizing it. Others may currently have the condition without knowing it. You may be very aware of vaginitis, given the highly annoying symptoms that may accompany the condition. However, vaginitis is typically quick and easy to treat. Once cured, there are many steps you can take to prevent getting the condition again.