Vaginitis has several causes. In women of child-bearing years, it may be due to infection with one of a few common organisms. Chemical substances such as douches and foams can also cause irritation and discharge. In women who are past menopause, the vaginal walls are thin and easily irritated, causing vaginitis. Vaginitis is usually a benign condition. By this we mean there is usually no serious harm to the uterus, cervix, vagina or to the body as a whole. There are times, however, when a vaginal discharge is not from vaginitis but is caused by an infection of the uterus (pelvic inflammatory disease) or cervix. This is less common but more serious and needs immediate medical attention.
Often the only way for a doctor to identify the cause of a discharge is by taking a careful history of the problem, inspecting the discharge and affected areas and performing tests to sample the germs growing in the area.
Some vaginal discharges are normal. They may be due to an increase in a woman’s normal secretions and not require any treatment. This may happen at different times during the menstrual cycle or when a woman is on the birth control pill.
Candida (yeast) is a common germ and exists normally everywhere, including the vagina. The trouble occurs when vaginal conditions change, such as when a woman takes antibiotics or the birth control pill or becomes pregnant. The yeast may multiply enough to cause a thick white discharge (often said to be like cottage cheese). This discharge causes intense irritation and itching. Diabetes can also result in an overgrowth of yeast, as can tight clothing, douches, perfumed soaps and bubble baths.
Bacterial Vaginosis (Gardnerella) is a common cause of vaginal discharge. Unlike yeast, there is no irritation or itching. This bacteria causes a thin, bad-smelling discharge that may have a fishy odor. As with yeast, Gardnerella is not treated unless it causes symptoms. Aside from producing a foul-smelling discharge, it is usually harmless. An exception is in pregnancy where this infection can cause premature rupture of the membranes and early labour.
Trichomonas is the third most common cause of vaginitis in women in the child-bearing years. It is often passed through sexual intercourse and causes many symptoms including burning, spotting and discharge. The extent of these symptoms depends on how much the lining of the vagina is irritated.
Vaginitis in women after menopause may occur when the amount of estrogen (the main female hormone) in the blood drops, causing a thinning of the vaginal lining. The lining of the vagina becomes inflamed because the tissues are not as thick or strong as they had been.
When a woman visits her doctor complaining of vaginal discharge, irritation or bad smell, she is asked about her general health and habits, the nature of any discharge, and medications she is taking or has recently finished. The doctor examines the vulva (skin just outside the vagina), vagina and cervix, giving special attention to signs of inflammation and discharge.
A sample of the discharge is sent to the lab to identify the germs that might be causing the problem. Another sample may be examined right in the doctor’s office. Often the doctor has a good idea of the cause before learning it from the lab and can start treatment right at the time of examination if the symptoms are distressing to the woman.
Yeast and Gardnerella cause little harm and, unless the symptoms are troublesome, there is no need to treat them. Trichomonas is usually treated to prevent possible development into an intense vaginitis and to prevent its spread through sexual intercourse.
When treatment is needed, the type used depends on the cause. A vaginal suppository or cream is used for yeast. Gardnerella and Trichomonas both respond to a pill called metronidazole (Flagyl) taken by mouth two or three times a day for a week. The sexual partner may be asked to take the medication to prevent recurrences. Since Flagyl should not be taken in pregnancy, another type of antibiotic is used for pregnant women.
Some women have vaginal infections which recur despite treatment. This is particularly so for yeast infections, which can be difficult to manage. Avoiding douches, perfumed soaps and sanitary napkins, tight clothing and bubble baths can help. However, this may not be enough. These women may be given supplies of creams or suppositories to treat themselves as soon as symptoms appear. Another option is self-treatment a few days before each menstrual period, since this is a common time for yeast infection to recur. A doctor may prescribe medication in pill form to clear the yeast from the rest of the body, particularly the bowel. A recent development is a single dose tablet, DiflucanTM, which is very effective.
For women after menopause, vaginitis may cause a sore vagina and painful intercourse. There may be a discharge and spotting. Doctors treat these women with creams or tablets containing estrogen. Symptoms usually settle easily with this regimen. Since there are situations where estrogens cannot be used, every woman with this problem should discuss her treatment with her doctor.
Vaginitis is a common condition. In many cases, it does not need treatment, but it can be annoying and frustrating. A woman should see her doctor about any unusual vaginal discharge in case the problem is not vaginitis but an infection of the cervix or uterus which needs immediate attention.