Vaginitis, also known as vulvovaginitis, is inflammation of the

vagina In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...

and

vulva In mammals, the vulva (: vulvas or vulvae) comprises mostly external, visible structures of the female sex organ, genitalia leading into the interior of the female reproductive tract. For humans, it includes the mons pubis, labia majora, lab ...

. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

. The three main causes are infections, specifically

bacterial vaginosis Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urina ...

, vaginal yeast infection, and

trichomoniasis Trichomoniasis (trich) is an infectious disease caused by the parasite ''Trichomonas vaginalis''. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms ca ...

. Other causes include

allergies Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

to substances such as spermicides or soaps or as a result of low

estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...

levels during breast-feeding or after

menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...

. More than one cause may exist at a time. The common causes vary by age. Prepubescent girls are often at risk for development of vulvovaginitis because of low amounts of estrogen and an underdeveloped labia minora. Diagnosis generally include examination, measuring the pH, and culturing the discharge. Other causes of symptoms such as inflammation of the cervix, pelvic inflammatory disease,

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

, foreign bodies, and skin conditions should be ruled out. Treatment depends on the underlying cause. Infections should be treated. Sitz baths may help with symptoms. Soaps and feminine hygiene products such as sprays should not be used. About a third of women have vaginitis at some point in time. Women of reproductive age are most often affected.

Signs and symptoms

A woman may have vaginal irritation, itching, or

burning Combustion, or burning, is a high-temperature exothermic redox chemical reaction between a fuel (the reductant) and an oxidant, usually atmospheric oxygen, that produces oxidized, often gaseous products, in a mixture termed as smoke. Combust ...

or may notice a foul-smelling or abnormal discharge that could appear green or yellow. The following signs or symptoms may indicate the presence of infection:"Trichomoniasis." Gale: Contemporary Women's Issues. HealthyWomen, Dec. 2010. Web. April 7, 2011. *Irritation or itching of the genital area *inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area *vaginal discharge *foul vaginal odor *pain/irritation with sexual intercourse

Complications

Vaginal infections left untreated can lead to further complications, especially for the pregnant woman. For bacterial vaginosis, these include "premature delivery, postpartum infections, clinically apparent and subclinical pelvic inflammatory disease, s well aspostsurgical complications (after abortion, hysterectomy, caesarian section), increased vulnerability to HIV infection and, possibly, infertility"."Bacterial Vaginosis." Gale: Contemporary Women's Issues. HealthyWomen, Dec. 2010. Web. April 7, 2011. Studies have also linked trichomoniasis with increased likelihood of acquiring HIV; theories include that "vaginitis increases the number of immune cells at the site of infection, and HIV then infects those immune cells." Other theories suggest that trichomoniasis increases the amount of HIV genital shedding, thereby increasing the risk of transmission to sexual partners. While the exact association between trichomoniasis infection and HIV genital shedding has not been consistently demonstrated, "there is good evidence that TV treatment reduces HIV genital shedding. Five studies were reported in the literature and, of these, four found a decrease in HIV genital shedding after TV treatment." Further, there are complications which lead to daily discomfort such as: * persistent discomfort * superficial skin infection (from scratching) * complications of the causative condition (such as gonorrhea and candida infection)

Causes

Infection

Vaginitis is often caused by an infection or the disruption of the healthy vaginal flora. The vaginal flora consists of those organisms which generally do not cause symptoms and is dominated mainly by '' Lactobacillus'' species. Disruption of the normal flora can cause a vaginal yeast infection. Vaginal yeast infection can affect women of all ages and is very common. The yeast '' Candida albicans'' is the most common cause of vaginitis. Specific forms of vaginal inflammation include the following types: Infectious vaginitis accounts for 90% of all cases in reproductive age women: * Candidiasis: vaginitis caused by proliferation of '' Candida albicans'', '' Candida tropicalis'', '' Candida krusei'' *

Bacterial vaginosis Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urina ...

: vaginitis caused by increased growth of '' Gardnerella'' (a bacterium). * Aerobic vaginitis Other less common infections are caused by gonorrhea, chlamydia, '' Mycoplasma'', herpes, '' Campylobacter'', improper hygiene, and some parasites, notably '' Trichomonas vaginalis''. Rare cases of amebic vaginitis have been reported, primarily in tropical, developing countries. Women who have

diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

develop infectious vaginitis more often than women who do not. Further, either a change in pH balance or introduction of foreign bacteria in the vagina can lead to infectious vaginitis. Physical factors that have been claimed to contribute to the development of infections include the following: constantly wet vulva due to tight clothing, chemicals coming in contact with the vagina via scented tampons, antibiotics, birth control pills, or a diet favoring refined sugar and yeast.

Hormonal

Hormonal vaginitis includes atrophic vaginitis usually found in

postmenopausal Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of the reproductive stage for the female human. It typically occurs between the ages of 45 and 55, although the exact timing can ...

women.

Irritation/allergy

Irritant vaginitis can be caused by allergies or reactions to vaginal sprays, douches, spermicides, soaps, detergents, or fabric softeners. It can also be caused by hot tubs, abrasion, tissue, tampons, or topical medications. Foreign body vaginitis (most common foreign bodies are retained tampons or condoms) may cause extremely malodorous vaginal discharges. Treatment consists of removal, for which ring forceps may be useful. Further treatment is generally not necessary.

Diagnosis

Diagnosis is typically suspected based on a women's symptoms. Diagnosis is made with

microscopy Microscopy is the technical field of using microscopes to view subjects too small to be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of microscopy: optical mic ...

(mostly by vaginal wet mount) and

culture Culture ( ) is a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...

of the discharge after a careful history and physical examination have been completed. The color, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. Determining the agent is especially important because women may have more than one infection, or have symptoms that overlap those of another infection, which dictates different treatment processes to cure the infection. For example, women often self-diagnose for yeast infections but due to the 89% misdiagnosis rate, self-diagnoses of vaginal infections are highly discouraged. Another type of vaginitis, called desquamative inflammatory vaginitis (DIV) also exists. The cause behind this type is still poorly understood. DIV corresponds to the severe forms of aerobic vaginitis. About 5 to 10% of women are affected by aerobic vaginitis. The International Statistical Classification of Diseases and Related Health Problems codes for the several causes of vaginitis are:

Prevention

Prevention of candidiasis, the most common type of vaginitis, includes using loose cotton underwear. The vaginal area should be washed with water. Perfumed soaps, shower gels, and vaginal deodorants should be avoided.NHS Choices, United Kingdom National Health Service
''Preventing vaginal thrush''
reviewed 2012-02-17, retrieved June 10, 2013 Douching is not recommended. The practice upsets the normal balance of yeast in the vagina and does more harm than good.Vaginal Health Organizatio
How to avoid getting a Vaginal Yeast Infection
July 10, 2010 Prevention of bacterial vaginosis includes healthy diets and behaviors as well as minimizing stress as all these factors can affect the pH balance of the vagina. Prevention of trichomoniasis revolves around avoiding other people's wet towels and hot tubs, and safe-sex procedures, such as condom use. Some women consume good bacteria in food with live culture, such as yogurt, sauerkraut and kimchi, or in probiotic supplements either to try to prevent candidiasis, or to reduce the likelihood of developing bacterial vaginitis following antibiotic treatment. There is no firm evidence to suggest that eating live yogurt or taking probiotic supplements will prevent candidiasis. Studies have suggested a possible clinical role for the use of standardized oral or vaginal probiotics in the treatment of bacterial vaginosis, either in addition to or in place of the typical antibiotic regimens. However, recent articles question their efficacy in preventing recurrence compared with other means, or conclude that there is insufficient evidence for or against recommending probiotics for the treatment of bacterial vaginosis.

Treatment

The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing

cortisone Cortisone is a pregnene (21-carbon) steroid hormone. It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug. Cortisol is converted by the action of the enzyme corticosteroid 11-beta-dehydrogenase ...

may also be used to relieve some of the irritation. If an allergic reaction is involved, an

antihistamine Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides ...

may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed. The following are typical treatments for trichomoniasis, bacterial vaginosis, and yeast infections: * Trichomoniasis: Oral treatment with either

metronidazole Metronidazole, sold under the brand name Flagyl and Metrogyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vagino ...

or tinidazole. "Sexual partner(s) should be treated simultaneously. Patients should be advised to avoid sexual intercourse for at least 1 week and until they and their partner(s) have completed treatment and follow-up." * Bacterial vaginosis: The most commonly used antibiotics are metronidazole, available in both pill and gel form, and clindamycin available in both pill and cream form. * Yeast infections: Local azole, in the form of ovula and cream. All agents appear to be equally effective. These anti-fungal medications, which are available in over the counter form, are generally used to treat yeast infections. Treatment may last anywhere between one, three, or seven days."Yeast Infections." Gale: Contemporary Women's Issues. HealthyWomen, Dec. 2010. Web. April 7, 2011.

Aerobic vaginitis

Treatment can include topical steroids to diminish the inflammation. Antibiotics to diminish the proportion of aerobic bacteria is still a matter of debate. The use of local antibiotics, preferably local non-absorbed and broad spectrum, covering enteric

gram-positive In bacteriology, gram-positive bacteria are bacteria that give a positive result in the Gram stain test, which is traditionally used to quickly classify bacteria into two broad categories according to their type of cell wall. The Gram stain is ...

and

gram-negative Gram-negative bacteria are bacteria that, unlike gram-positive bacteria, do not retain the crystal violet stain used in the Gram staining method of bacterial differentiation. Their defining characteristic is that their cell envelope consists ...

aerobes, can be an option. In some cases, systemic antibiotics can be helpful, such as amoxicillin/clavulanate or

moxifloxacin Moxifloxacin is an antibiotic, used to treat bacterial infections, including pneumonia, conjunctivitis, endocarditis, tuberculosis, and sinusitis. It can be given by mouth, by injection into a vein, and as an eye drop. Common side effec ...

. Vaginal rinsing with povidone iodine can provide relief of symptoms but does not provide long-term reduction of bacterial loads. Dequalinium chloride can also be an option for treatment.

Mixed infectious vaginitis

Mixed infectious vaginitis is a condition caused by multiple pathogens, leading to significant alterations in the vaginal environment, including a decrease in lactic acid bacteria, an increase in vaginal pH, and a reduction in local defenses. The term "mixed" refers to the involvement of multiple pathogens in causing the condition. The female vagina hosts a diverse array of over 50 different microorganisms that interact and coexist in a complex microecological environment. When the balance among these microorganisms is disrupted, it can lead to mixed infectious vaginitis, with the specific pathogens involved varying based on individual cases and environmental factors. This condition often results in distressing symptoms like vulvar itching, burning pain, and urethral irritation, and can be complicated by increasing drug resistance and recurrence rates, particularly in patients with ineffective treatment, long-term contraceptive use, or compromised sexual hygiene. Mixed infectious vaginitis is a condition characterized by the simultaneous infection of two or more types of pathogens, which may include Chlamydia, Mycoplasma, anaerobic bacteria, and aerobic bacteria. Additionally, this mixed infection can also involve yeast, further contributing to the complexity of the condition. An effective treatment option for mixed infectious vaginitis is a combination of clotrimazole and metronidazole.

In children

Vulvovaginitis in children may be "nonspecific", or caused by irritation with no known infectious cause, or infectious, caused by a pathogenic organism. Nonspecific vulvovaginitis may be triggered by fecal contamination, sexual abuse, chronic diseases, foreign bodies, nonestrogenized epithelium, chemical irritants,

eczema Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened ...

, seborrhea, or immunodeficiency. It is treated with topical steroids; antibiotics may be given in cases where itching has resulted in a secondary infection. Infectious vulvovaginitis can be caused by group A beta-hemolytic ''Streptococcus'' (7-20% of cases), ''

Haemophilus influenzae ''Haemophilus influenzae'' (formerly called Pfeiffer's bacillus or ''Bacillus influenzae'') is a Gram-negative, Motility, non-motile, Coccobacillus, coccobacillary, facultative anaerobic organism, facultatively anaerobic, Capnophile, capnophili ...

, Streptococcus pneumoniae,

Staphylococcus aureus ''Staphylococcus aureus'' is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often posi ...

, Shigella, Yersinia'', or common STI organisms ('' Neisseria gonorrhoeae,

Chlamydia trachomatis ''Chlamydia trachomatis'' () is a Gram-negative, Anaerobic organism, anaerobic bacterium responsible for Chlamydia infection, chlamydia and trachoma. ''C. trachomatis'' exists in two forms, an extracellular infectious elementary body (EB) and an ...

, Trichomonas vaginalis'',

herpes simplex virus Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) are two members of the Herpesviridae#Human herpesvirus types, human ''Herpesviridae'' family, a set of viruses that produce Viral disease, viral infections in the majority of humans. Both HSV-1 a ...

, and

human papillomavirus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and r ...

)''.'' Symptoms and treatment of infectious vulvovaginitis vary depending on the organism causing it. ''Shigella'' infections of the reproductive tract usually coexist with infectious of the gastrointestinal tract and cause mucous, purulent discharge. They are treated with trimethoprim-sulfamethoxazole. ''Streptococcus'' infections cause similar symptoms to nonspecific vulvovaginitis and are treated with amoxicillin. STI-associated vulvovaginitis may be caused by sexual abuse or vertical transmission, and are treated and diagnosed like adult infections.

References

{{Authority control Inflammations Inflammatory diseases of female pelvic organs Vagina Wikipedia medicine articles ready to translate