Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection. Reduced estrogen levels after menopause and some skin disorders can also cause vaginitis.
The most common types of vaginitis are:
- Bacterial vaginosis, which results from a change of the normal bacteria found in your vagina to overgrowth of other organisms
- Yeast infections, which are usually caused by a naturally occurring fungus called Candida albicans
- Trichomoniasis, which is caused by a parasite and is commonly transmitted by sexual intercourse
Treatment depends on the type of vaginitis you have.
Vaginitis signs and symptoms can include:
- Change in color, odor or amount of discharge from your vagina
- Vaginal itching or irritation
- Pain during intercourse
- Painful urination
- Light vaginal bleeding or spotting
If you have vaginal discharge, which many women don’t, the characteristics of the discharge might indicate the type of vaginitis you have. Examples include:
- Bacterial vaginosis. You might develop a grayish-white, foul-smelling discharge. The odor, often described as a fishy odor, might be more obvious after sexual intercourse.
- Yeast infection. The main symptom is itching, but you might have a white, thick discharge that resembles cottage cheese.
- Trichomoniasis. An infection called trichomoniasis (trik-o-moe-NIE-uh-sis) can cause a greenish-yellow, sometimes frothy discharge.
To diagnose vaginitis, your doctor is likely to:
- Review your medical history. This includes your history of vaginal or sexually transmitted infections.
- Perform a pelvic exam. During the pelvic exam, your doctor may use an instrument (speculum) to look inside your vagina for inflammation and abnormal discharge.
- Collect a sample for lab testing. Your doctor might collect a sample of cervical or vaginal discharge for lab testing to confirm what kind of vaginitis you have.
- Perform pH testing. Your doctor might test your vaginal pH by applying a pH test stick or pH paper to the wall of your vagina. An elevated pH can indicate either bacterial vaginosis or trichomoniasis. However, pH testing alone is not a reliable diagnostic test.
A variety of organisms and conditions can cause vaginitis, so treatment targets the specific cause:
- Bacterial vaginosis. For this type of vaginitis, your doctor may prescribe metronidazole (Flagyl) tablets that you take by mouth or metronidazole (MetroGel) gel or clindamycin (Cleocin) cream that you apply to your vagina. You’ll need to get tested and be given a prescription for these medications.
- Yeast infections. Yeast infections usually are treated with an over-the-counter antifungal cream or suppository, such as miconazole (Monistat 1), clotrimazole (Gyne-Lotrimin), butoconazole (Femstat 3) or tioconazole (Vagistat-1). Yeast infections may also be treated with a prescription oral antifungal medication, such as fluconazole (Diflucan). The advantages of over-the-counter treatment are convenience, cost and not waiting to see your doctor. However, you might have something other than a yeast infection. Using the wrong medicine may delay an accurate diagnosis and proper treatment.
- Trichomoniasis. Your doctor may prescribe metronidazole (Flagyl) or tinidazole (Tindamax) tablets.
- Genitourinary syndrome of menopause (vaginal atrophy). Estrogen — in the form of vaginal creams, tablets or rings — can effectively treat this condition. This treatment is available by prescription from your doctor, after other risk factors and possible complications are reviewed.
- Noninfectious vaginitis. To treat this type of vaginitis, you need to pinpoint the source of the irritation and avoid it. Possible sources include new soap, laundry detergent, sanitary napkins or tampons