Sometimes referred to as: vaginal discharge, vaginal irritation, vaginal infection, yeast infection, vulvovaginal candidiasis, bacterial vaginosis (BV), trichomonas, atrophic vaginitis
Vaginitis is an inflammation of the vagina. It can be internal or external, and can cause a variety of symptoms such as redness, pain, swelling, irritation, urinary discomfort, discharge, and itching. There are both infectious and non-infectious causes.
Most types of vaginitis are not considered reportable, but an overall (rough) estimate for incidence of new cases of vaginitis in women of reproductive age is around 25 million per year.
75% of women experience at least one episode of vaginitis in a lifetime.
Vaginitis is frequently associated with (for differing reasons) pregnancy, menopause, douching, antibiotic use, and unprotected sex
Billions of beneficial bacteria inhabit the human body. They appear in particularly high concentrations in certain areas, such as the gastrointestinal system and the vagina. When the bacterial balance in the vagina is thrown off–which can happen for a variety of reasons–the result is that one strain of bacteria or fungus dominates, thereby causing an infection.
When a bacterial infection is the cause of vaginitis, the diagnosis is termed “bacterial vaginosis” (BV). No one knows exactly why some women are more susceptible than others to the bacterial imbalance that leads to BV, but it is extremely common–in fact, BV is the single most common type of vaginitis.
BV triggers include douching and vaginal sprays, washing with harsh soap, and having sex without a condom, particularly with a new partner.
Symptoms are typically a fishy odor, thin discharge, and itching/irritation.
It’s important to note that BV is not an STD and is not transmitted from one partner to another. It’s simply the result of a disruption of the bacterial balance in the vagina, which can happen when partners and/or sex toys introduce a different proportion of bacteria.
First, and importantly, sperm do not transmit BV. When bacteria from one person’s innate system is shared with another person during sex, the result can be the disruption of the recipient’s natural bacterial balance. But the bacteria that’s introduced from one person to another is on the skin (or an object), rather than in semen.
Seminal fluid can, however, change vaginal pH balance, thereby contributing another risk factor for the development of BV. And when semen comes into contact with vaginal fluid that is already infected with BV, it can release a fishy odor (this may give the sense that sperm is causing an infection, even though the infection is already present).
Women who struggle with BV often find consistent condom use to be helpful. In addition to preventing contact with semen, condoms act as a barrier between the exchange of skin bacteria (and viruses).
When fungus (most often the candida strain) is to blame for vaginitis, it is called a yeast infection. Like BV, yeast infections are extremely common. Fungus thrives in darkness and moisture, so a typical way to develop a yeast infection would be to sit in a wet bathing suit for a while after swimming, or to not change clothing promptly after exercise.
Another common culprit in the development of yeast is antibiotic use. Antibiotics are effective in the treatment of bacterial infections because they kill bacteria. But antibiotics kill “good” bacteria along with the “bad” bacteria they are intended to treat. When the bacterial balance in the vagina is disrupted in this way, fungus can overgrow, thereby leading to a yeast infection.
Symptoms of yeast infections include intense itching, thick discharge (white, clumpy, sometimes blood-tinged), external vaginal swelling, and small cuts (fissures) on labia.
Vaginitis can also be caused by infection with microbes that are sexually transmitted–namely, gonorrhea, chlamydia, and trichomonas.
Symptoms of gonorrhea and chlamydia include discharge (sometimes malodorous), urinary discomfort, pelvic pain, and bleeding after sex. Symptoms of trichomonas involve itching/irritation, thin discharge (usually foul-smelling), and spotting.
Sometimes, vaginitis arises without an infectious cause. Declining estrogen levels during and after menopause can lead to a type of vaginal inflammation known as atrophic vaginitis. As estrogen levels drop, the natural lubrication of the vagina decreases, resulting in dryness and thinning of the skin.
These changes can cause discomfort, itching, and sometimes pain with urination and/or sex. Symptoms of atrophic vaginitis are itching/irritation, urinary discomfort, and pain with intercourse.
Jamila Schwartz, MD and Nora Lansen, MD are both members of the Galileo Clinical Team. Connect with one of our physicians about Vaginitis or any of the many other conditions we treat.Join Today