In this article I will cover the three main causes of vaginal inflammation, something I have seen people get wrong all the time. There is also a lot of bogus information on the topic on other blogs. I hope this article will answer all your questions; vaginal inflammation causes, symptoms & treatment.
What is vaginal inflammation (vaginitis)?
Vaginitis is, by definition, inflammation impacting the vagina. Inflammation in this sensitive area can cause additional symptoms, including itching, discharge, soreness, and pain during urination, pain during intercourse, or minor instances of bleeding or spotting. It can affect women of all ages. Apart from these physical issues, vaginitis can result in loss of days from school or work, issues with sexual functioning and with self-image.
Vaginitis is a quite common. According to the American College of Obstetricians and Gynacologists, almost one third of all women will have vaginitis sometime in their life. As reported in 1991 by Kent from USA, more than 10 million visits to the physician and 10% of the total outpatient visits in the USA annually are due to vaginitis.
While a yeast infection is a type of vaginal inflammation, there are several different types of vaginitis. A lot of women who have discharge and feel itchy automatically assume they have a yeast infection, but that’s not always the case. A 2002 study by Ferris and colleagues from USA showed that 50% of women who self-diagnose and use OTC anti-fungal product for treatment do not have yeast infection. It’s therefore important to identify what type of condition you are actually suffering from so that you can get the correct treatment right away.
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What are the causes?
There are three main types of vaginitis – Atrophic vaginitis, Irritant vaginitis, and Infectious vaginitis. While atrophic and irritant vaginitis both are physiological and non-infectious types of vaginitis, infectious vaginitis involves infection by a microorganism. Let us look at the three major causes in a bit more detail.
1. Atrophic vaginitis: This is caused by a decrease in estrogen. Estrogen keeps the tissues of vagina well lubricated and healthy – it stimulates the lining of vagina to produce a clear, lubricating fluid. If there is a reduction in levels of estrogen, the vaginal tissue shrinks and becomes thinner and there is vaginal dryness. This can make the vagina more prone to inflammation and also more prone to other infections including yeast infections.
Low estrogen levels are common in postmenopausal women or women who have undergone hysterectomy (surgical removal of uterus) or oophorectomy (surgical removal of ovaries). Medicines or hormones used in treatment of endometriosis, breast cancer, fibroids or infertility can also lead to a drop in levels of estrogen. Other reasons for low estrogen levels can be radiation treatment to pelvic area, chemotherapy and severe stress, depression or intense exercise.
Symptoms of atrophic vaginitis include vaginal dryness, vaginal itch or burning sensation, painful sexual intercourse and light bleeding after sexual intercourse.
Based on your age, symptoms and medical history, your doctor may suspect atrophic vaginitis and will perform a pelvic examination to check for thinning of vaginal lining and signs of redness. Other biochemical tests may also be performed on the vaginal discharge to rule out other types of vaginitis.
Atrophic vaginitis can be prevented by using a water soluble vaginal lubricant – this will prevent painful sexual intercourse and inflammation from occurring. Regular sexual activity can also help prevent the symptoms as it improves blood circulation to the vagina which maintains the health of vaginal tissue.
Conventional treatment will generally include a vaginal estrogen cream which will be prescribed and monitored by your doctor. Go and see your naturopath or herbalist if you want a more natural (and side-effect free) option here. You do not necessarily need to take synthetic hormones to get a good result with atrophic vaginitis.
2. Irritant vaginitis: Irritant vaginitis is often caused by just that – some sort of irritant. You may be sensitive to a chemical you are using or you may be having an allergic reaction to something you’ve come into contact with. This can be caused by a number of chemicals or physical agents, including your tampons, the chemicals in scented feminine hygiene products, the type of personal lubricant you’re using, or even the harshness of the chemicals in the detergent you’re using to wash your undergarments. Majerovich, Canty and Miedema from Canada published a case study in 2010, where they found the patient with chronic vulvar irritation was sensitive to bleached toilet paper.
Symptoms of irritant vaginitis include red, painful or itching vulva, and increased vaginal discharge. As it often affects the vulva as well, it is often mistaken for yeast infections.
If both, atrophic and infectious vaginitis, are ruled out in your case, think about the personal hygiene products that you use. Try to find the culprit by changing to a different product. This type of vaginitis can usually be resolved with a few lifestyle changes. Some women find it helpful to wash their underwear separately from other clothing, with a special detergent with fewer chemicals (for example, those for sensitive skin or allergies). Others use natural oils instead of chemical lubricants. Many switch to cloth pads and organic tampons. You should talk to your physician or naturopath about the changes that might be best for your situation.
3. Infectious vaginitis: Infectious vaginitis is any type of vaginitis that comes from some sort of infection – fungal, bacterial, or otherwise. These include gardenerella (a bacterial infection), any type of virus, STDs (like chlamydia, gonorrhea, or trichomoniasis), and vaginal yeast infections. More than 90% of infectious vaginitis cases are related to bacterial vaginosis (BV), fungal infections (candidiasis) and parasitic infections (trichomoniasis). Of these three, BV is the most common cause.
Normal vaginal ecosystem is important for vaginal health and a disruption in this ecosystem changes the microbes that normally live in the vagina, changes the vaginal pH and makes one prone to infectious vaginitis.
The cases of infectious vaginitis I see are often trickiest. This is where most women end up assuming they have a yeast infection instead of going to a doctor to be checked out. This is why it is important to know the difference between infectious vaginitis to be able to make an educated guess about what kind of infection you might be having before you go and buy OTC products for self-medication.
a) Bacterial vaginosis (BV) related vaginitis: This is caused when the normal lactobacilli in the vagina are replaced by bacteria like Prevotella, Mobiluncus, Gardernella, Ureaplasma, Mycoplasma etc. According to Centers for Disease Control (CDC), BV is the most common vaginal infection in women between the age of 15 and 44. CDC mentions that having a new sex partner or multiple sex partners and douching can upset the bacterial balance in the vagina and increase the risk of getting BV. BV is not considered an STD but having BV can surely increase the chances of getting STDs.
If you have BV and have symptoms (BV sometimes is asymptomatic), your symptoms may include thin discharge, odor, pain, itching or burning in or outside the vagina. You may experience a strong fish-like odour especially after sexual intercourse and burning when urinating.
For diagnosis, your doctor/healthcare provider will examine the vagina for signs of BV and perform diagnostic tests on the vaginal fluid to check if it indeed is BV that you are suffering from. They will check for the tell-tale signs of BV that include homogenous, thin white discharge; epithelial cells of the vagina studded with bacteria (clue cells) seen under the microscope; increased pH of vaginal fluid; and fishy odour of the discharge before or after adding 10% KOH (whiff test)
BV sometimes goes away on its own without any treatment, if you have continued symptoms, it is important that the condition is treated especially if you are pregnant or the symptoms are particularly bothersome. Treatment is especially recommended for pregnant women as they have increased risk of preterm birth if BV is not treated. CDC does not recommend treatment of non-pregnant women with BV unless the symptoms are severe and bothersome. This is because treatment for BV with antibiotics can increase the risk of vaginal candida infections.
If needed, following the guidelines of CDC, you may be prescribed a course of the antibiotic metronidazole for oral or superficial application or clindamycin cream for application. You must remember that the infection may recur even after the treatment.
There are no OTC products that you can use for treating BV by yourself apart from lactobacillus and cranberry suppositories that have been found to be useful in treating BV. Using OTC antifungal agents can actually make the BV worse according to Cleveland Clinic.
According to Cleveland Clinic, best ways to prevent BV are not yet known. However, it is recommended that you do not smoke or use alcohol or drugs; practice safe sex and limit the number of sexual partners; and clean and maintain hygiene of any sex toys. It is also recommended to maintain an overall good health by having a well-balanced diet, regular exercise, and managing stress levels. A recent 2015 study by Modarres and colleagues from Iran found in their placebo-controlled randomized clinical trial that treatment of vitamin D deficiency can be an effective method for eliminating asymptomatic BV. Thus vitamin D deficiency does seem to play a role in BV by impacting the immune system. It may therefore be important to find out your vitamin D levels and if low, increase your exposure to sun or take an oral dose.
b) Trichomonas vaginitis: This is caused by the parasite trichomonas that can infect the vagina. This is a sexually transmitted disease (STD) and can be transmitted by a man to a woman or by a woman to a woman through sexual intercourse. Infected people even without symptoms can pass on the infection to their sexual partner. According to CDC this is a very common but easily curable disease. Older women are more likely to be infected with trichomonas as compared to younger women.
Almost 15-20% of all vaginitis is trichomonas vaginitis, however, it is underdiagnosed due to lack of confirmatory testing. Nearly 70% people infected with trichomonas do not have any symptoms. Others may have symptoms that develop 5-28 days after infection while some others may take even longer (up to 6 months) to show any symptoms. Symptoms of trichomonas vaginitis include itching, burning, redness or soreness of vagina, burning during urination, thin discharge that can be clear, white, yellowish or greenish and may have an unusual smell. It can also cause painful sexual intercourse.
Your healthcare provider will need to run some laboratory tests to diagnose trichomonas vaginitis because of a couple of reasons as described by Petrin and colleagues from Canada in 1998:
- all the classic symptoms are not always observed
- the symptoms may be similar to symptoms in other STDs
Trichomonas vaginitis can be treated with a single dose of the antibiotic metronidazole and thus is rather easy to cure if diagnosed correctly. While I do not recommend antibiotics there are cases when a small dose can get rid of the issue, just make sure to take probiotics. I recommend CanXida Restore for at least 3 months.
Untreated tricomonas vaginitis increases the risk of getting other STDs including BV as was described in 2002 by Moodley and colleagues from South Africa. Cotch and colleagues from USA showed in 1997 that this infection in pregnant women increases the risk of preterm delivery and the babies are likely to have low birth weight.
As this is an STD, it can be prevented by taking safe sex precautions like using condoms – however, CDC mentions that as condoms do not cover everything, it is possible to get this infection even with condom use. So, avoiding sex entirely or talking to a new sexual partner about STDs and making informed choices about the risk you take are the only other options.
c) Candida vulvovaginitis: As the name suggests, this type of vaginal inflammation is caused by an infection with the yeast, candida. Almost 20-25% of all vaginitis is candida vulvovaginitis which is not considered as an STD.
Candida lives normally on the skin, mouth, gut and vagina without causing any problems. When the normal ecology of the vagina is somehow disrupted or there are issues with your immunity or hormones, you get prone to vaginal yeast infection where there is an excessive growth of candida. It occurs more frequently and in a more severe form in people who have a weakened immune system. Being pregnant, having diabetes, using antibiotics over long term and use of corticosteroid medicines puts you at higher risk for this condition.
When you have four or more episodes of candida vaginitis in a year, it is known as recurrent vulvovaginal candidiasis (RVVC) or chronic candida infection. There are a number of factors which can make you susceptible to RVVC which includes behavioural factors apart from infection with resistant types of candida (for example, Candida glabrata), inadequate treatment, diabetes, lower glucose tolerance, recent antibiotic use, estrogen use, and immunosuppressive therapy. Behavioural factors include practice of douching, contraceptive practices like use of diaphragm, spermicides, or intrauterine devices. However in many cases there may not be an obvious reason.
Itching of the vulva is the most common symptom of candida vulvovaginitis. You may have a thick, white, curd-like vaginal discharge. There usually is redness, irritation and you may have painful urination and sexual intercourse. In severe cases, there may be swelling and fissure formation. As the symptoms may be very similar to other genital infections, it is important to get a proper diagnosis in order to get the correct treatment.
Physical examination and symptom study alone are not sufficient to diagnose this condition due to similarity with other genital infections. Microscopic examination of the discharge which reveals abnormally large numbers of yeast cells and filaments is diagnostic of candida vulvovaginitis. A negative KOH whiff test will make sure that the infection is not bacterial.
You can prevent this condition by doing the following:
- Maintain good hygiene (of course without douching as douching is not good for the natural ecosystem of the vagina)
- Wear cotton underpants – always. This will ensure proper aeration of the genital area and not let sweat accumulate in the area. Candida is a fungus and likes to grow in moist, warm areas and you want to avoid this
- Eat a healthy, balanced diet and include enough sunshine in your daily routine. This will help boost your immune system in general and reduce your risk of developing these infections
- If you are prone to RVVC, CDC suggests that taking oral or intra-vaginal probiotics may help prevent frequent infections.
The most commonly prescribed treatment for candida vulvovaginitis is antifungal antibiotics. However there are a few issues with this:
- Some types of candida are increasingly becoming resistant to antifungal agents like fluconazole and echinocandins as is showed by data collected by CDC
- Long term usage of antifungal creams may also make candida resistant to their effect
- There is evidence from a large study in 1999 by Spanish and Dutch scientists – Rodriguez and colleagues – that azole drugs like fluconazole when taken orally can cause acute liver injury. So, apart from causing side-effects like nausea diarrhoea etc., these drugs can actually harm you.
What then are your options then, if not the pharmaceutical antifungal agents? The best would be to use natural antifungal agents. Mondello and colleagues from Italy showed in 2006 that a component of tea-tree oil is effective even against candida that was resistant to azole antifungal agents. A tea-tree oil based cream will be effective against candida without causing the problem of resistance. Coconut oil has antifungal properties, so including it in your diet as well as its use in external application can be useful. You can read more about the antifungal effects of coconut oil here. You can also use various natural baths to help ease the itching and pain. You can read more in details on these baths here. Canxida is a good oral alternative as it provides many benefits against candida without any serious side-effects. For best results canxida should be combined with a good well-balanced candida diet and lifestyle changes.
If left untreated, symptoms which can cause significant discomfort can persist. There is also a risk of passing the infection to your sexual partner.
Finally, here is a table that provides you an overview of the different types of vaginitis, the symptoms and diagnosis as compared to normal.
|Normal||Candida vulvovaginitis||Bacterial vaginosis||Trichomonas vaginitis||Atrophic vaginitis||Irritant vaginitis|
|Discharge||None or mild; clear to white||Thick; white; curd-like||Thin; milky white; adhering to vaginal walls; foul smelling (fishy)||Frothy; grey or yellow-green; foul smelling|
|None; vaginal dryness instead||Increased discharge|
|Vaginal pH||4.0-4.5||4.0-4.5||Higher than 4.5||5.0-6.0||Higher than 6.0||4.0-4.5|
|Painful sexual intercourse||No||Yes||No||Yes||Yes||Maybe|
|KOH Whiff test||Negative||Negative||Positive||Often Positive||Negative||Negative|
Some frequently asked questions I get over youtube, skype consultations and through email regarding inflammation.
How do you know for sure you have vaginitis?
Many people live with vaginitis without knowing that they have vaginitis as they have no bothersome symptoms. When you do have symptoms that bother you like the ones described above, you know that you have vaginitis of some type. You can only confirm what kind of vaginitis it is by visiting your health care provider and getting some tests done.
What is the difference between vaginitis vs vaginosis?
Vaginosis is an infection of the vagina by an organism whereas vaginitis is the inflammation caused by an infection of the vagina or due to other reasons like allergy, irritation due to chemicals or dryness of vagina due to ageing and decrease in estrogen levels.
Inflammation is the body’s response to an injury or infection in order to remove the cause. It is a protective response that our body produces and it generally leads to redness, itching, swelling and pain. If the inflammation continues for a long time (which means that our body is failing at removing the threat that started the inflammation in the first place), it starts harming our own cells. Thus, although inflammation is a protective mechanism, prolonged inflammation is harmful to our body.
What OTC options are available?
There are three types of OTC options available. Pharmaceutical azole antifungal creams, anti-itch products and other alternative therapies. The azole creams are meant only for treating candida infection and should never be used for other infections. We have already discussed the disadvantages of using these products in the article.
Anti-itch products contain benzocaine which is a local anesthetics, or external pain-killers like resorcinol, or corticosteroids that reduce itching. These products only relieve minor itching and cannot remove the infection. These creams may sometimes acts as an irritant in some women and worsen their condition.
Corticosteroid creams only suppress the inflammation for a short while after which usually the symptoms return with a vengeance. Long-term use of these is also harmful and use in sensitive areas such as genitals will have higher risk of unwanted side-effects.
As described in the article, other creams with natural contents like tea-tree oil may be useful for candida infections. Suppositories with cranberry extract can be useful against BV. Suppositories and oral tablets with lactobacilli can help against both BV and candida vaginitis as described by Van Kessel and colleagues from USA in 2003 in a literature review. A 2013 study by the Egyptian scientist Ibrahim found comparable effects of metronidazole and commercially available garlic tablets against trichomonas infections and thus found garlic to be a viable alternative to the pharmaceutical antibiotic.
What supplements are good?
You can try Canxida range of products for your viginitis. Canxida products help you fight microbial and parasitic infections and also provide you nutritive support and support for your immune system and thus act in a more holistic manner. Canxida cream is natural cream with antifungal agents which can be used for vaginal yeast infections. Additionally, if you find out that you are deficient in Vitamin D, it will be useful to include Vitamin D supplements as this will improve your immunity and may even help treat the vaginitis.
Can you experience it or have it during pregnancy? (vaginitis during pregnancy)
Yes, vaginitis can occur especially during pregnancy. This is because during pregnancy there are many hormonal changes which can affect your microbial ecosystem in the vagina and make you more susceptible to vaginal infections. Also, during pregnancy your body is undergoing a lot of stress and the immune system does not perform the best leading to higher susceptibility to infections.
What are some good home remedies?
First of all it is important to have a good well-balanced diet that also provides you all the micronutrients that we need for good overall health. The start of any treatment should always be combined with proper nutrition and giving up unhealthy lifestyle. Good nutrition and exercise helps boost the immune system and ensures proper functioning of all systems of our body.
Apart from this, you can try some home remedies for easing the itch and burning sensation that vaginitis/vulvovaginitis may give you. These include good baths with natural ingredients like apple cider vinegar, Aveeno oatmeal, lemon etc.– refer to our comprehensive article on baths here. You may also use a teaspoon of turmeric dissolved in a glass of milk as turmeric is a good antimicrobial agent. Ginger and turmeric both have anti-inflammatory properties and may be useful to consume these to ease your itching and burning.
Can you get it after having sex?
Yes, you can get different kinds of vaginitis after having sex if your partner is infected. This is especially true for bacterial and trichomonas vaginitis and other STDs that cause vaginitis. Rarely, you may also get candida vaginitis from an infected sexual partner.
Is genital warts inflammation same or different?
Genital warts are caused by Human papilloma Virus (HPV) and could be the reason of vaginitis. These are small, skin coloured or pink growths on the labia, at vaginal opening or in and around anus. These are generally asymptomatic, but rarely there may be itching or burning or tenderness in the genital area. If your inflammation is HPV related, you will need to be treated differently.
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Is candidal vulvovaginitis a yeast infection?
Yes, it is.
Is vulvovaginitis STD?
No, candida vulvovaginitis is not considered STD although it can sometimes (rarely) be transmitted through sexual intercourse. Rarely, one can transmit candida to one’s sexual partner and they can transmit it to another person they have sexual intercourse with. Similarly, rarely an infected woman can cause vulvovaginitis in her same-sex partner.
Is vulvovaginitis serious?
It depends how bad is your case. It is always a good idea to consult with your doctor.
Is vulvovaginitis contagious?
No, it is not and cannot be spread just by contact.