Tuesday, June 7, 2011

Vulvovaginitis - Vaginitis

Overview, Causes, & Risk Factors

Vaginitis is an inflammation of a woman's vagina. It can be caused by bacteria, fungus, viruses, parasites, hormonal changes, or chemicals.
What is going on in the body?
A healthy vagina has a balance of many bacteria and fungi. Normal vaginal discharge is clear, cloudy, or whitish. But the balance in the vaginal environment can be thrown off by many factors. Following are some of the common factors affecting the balance:
  • change in hormone levels

  • impaired health

  • normal aging

  • sexual activity

  • stress

  • What are the causes and risks of the condition?
    Candida albicans,\ \Candida tropicalis,\ \Candida glabrata,\ and \Candida parapsilosis.\ ',CAPTION,'Vaginal Yeast Infection');" onmouseout="return nd();">Vaginal yeast infections are a common cause of vaginitis. They are usually caused by an overgrowth of Candida albicans. This type of infection often produces an itchy, whitish vaginal discharge that may look like cottage cheese. Yeast infections are often seen after the woman has taken antibiotics for another infection. The antibiotics interfere with the normal balance of organisms in the vagina.
    Bacterial vaginosis occurs when several types of harmful bacteria that live in the vagina grow too fast. No one knows what causes the overgrowth of these bacteria. The harmful bacteria can replace protective bacteria. This makes the vagina less acidic. Half of the time, vaginosis causes no symptoms. Some women may have a grayish-white or yellowish-white discharge.
    Trichomonas vaginalis.\ ',CAPTION,'Trichomoniasis');" onmouseout="return nd();">Trichomoniasis is caused by a parasite. It spreads during sexual intercourse. There is a large amount of frothy vaginal discharge. The discharge is usually yellow-gray or green and has an unpleasant odor.
    Atrophic vaginitis is associated with low levels of estrogen. The vagina becomes less acidic. This allows harmful bacteria to nudge out healthy bacteria. The vagina is more susceptible to injury and infection. Some women with this condition have no symptoms. Others have vaginal dryness and burning. Usually this condition occurs after menopause. Sometimes it affects nursing mothers or girls before they reach puberty.
    Many factors can irritate the vagina or change its acidity, such as the following:
  • cervicitis, or inflammation of the cervix

  • chemicals in deodorants, powders, or soaps

  • chemicals in spermicides, condoms, and diaphragms

  • douches

  • an object left in the vagina, such as a forgotten tampon

  • sex toys

  • sexual intercourse

  • sexually transmitted diseases, or STDs

  • Other factors that increase a woman's risk for vaginitis include the following:
  • breastfeeding

  • clothing that holds heat and moisture, such as nylon panties

  • diabetes

  • hormone replacement therapy

  • immunodeficiency disorders, which weaken her response to infection

  • menopause

  • oral contraceptives

  • poor hygiene

  • pregnancy

  • stress


  • Symptoms & Signs

    What are the signs and symptoms of the condition?
    Many women have vaginitis without symptoms. Often, though, a woman will notice some of these symptoms:
  • abnormal vaginal bleeding

  • discomfort or burning during urination

  • dryness or discomfort during sexual intercourse

  • a foul or fishy vaginal odor, especially after intercourse

  • irritation and itching inside and outside the vagina

  • swelling or redness of the genital area

  • vaginal discharge that may be lumpy, frothy, or discolored


  • Diagnosis & Tests

    How is the condition diagnosed?
    The diagnosis of vaginitis begins with a medical history and physical exam. The healthcare provider will do a pelvic exam. The provider may also take the following steps.
  • Check the acidity of the vaginal discharge.

  • Order tests to rule out STDs or other diseases.

  • Perform a Pap smear.

  • Take a sample of discharge from the vagina.


  • Prevention & Expectations

    What can be done to prevent the condition?
    Vaginitis cannot always be prevented. Following these recommendations can lower a woman's risk for vaginitis.
  • Avoid douches and other chemicals in the vaginal area.

  • Consider hormone replacement therapy after menopause.

  • Control blood glucose, if she has diabetes.

  • Practice safer sex.

  • Wear loose-fitting, absorbent underwear.

  • Wipe front to back after using the toilet.

  • What are the long-term effects of the condition?
    If an infection is treated, long-term problems usually do not arise. Sometimes the cause of vaginitis cannot be cured. Severe STDs may cause chronic pain and infertility.
    What are the risks to others?
    If the vaginitis is caused by an STD, a woman can transmit the infection to a sexual partner.

    Treatment & Monitoring

    What are the treatments for the condition?
    Treatment options depend upon the cause of vaginitis. Therapy may include the following:
  • antibiotic medicines, such as ceftriaxone or clindamycin

  • antibiotic vaginal tablets or creams, such as metronidazole or triple sulfa

  • antifungal medicines, such as fluconazole

  • antifungal vaginal creams or tablets, such as miconazole or clotrimazole

  • hormone replacement therapy

  • sitz baths, which involve sitting in a few inches of warm water

  • soothing vaginal creams or ointments

  • What are the side effects of the treatments?
    Antibiotics and antifungal medicines may cause rash, stomach upset, or allergic reactions.
    What happens after treatment for the condition?
    Vaginitis may take a few days or more to disappear, depending on how long an infection has been present and the cause of the inflammation. If an STD has been diagnosed, the sexual partner or partners should be tested.
    How is the condition monitored?
    Any new or worsening symptoms should be reported to the healthcare provider.

    Attribution

    Author:Eva Martin, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:04/19/01
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:09/11/01