Vaginitis

Causes, incidence, and risk factors

Vulvovaginitis can affect women of all ages and is extremely common. It can be caused by bacteria, yeasts, viruses, and other parasites. Some sexually transmitted infections (STIs) can also cause vulvovaginitis, as can various chemicals found in bubble baths, soaps, and perfumes. Environmental factors such as poor hygiene and allergens may also cause this condition.

Candida albicans, which causes yeast infections, is one of the most common causes of vulvovaginitis in women of all ages. Antibiotic use can lead to yeast infections by killing the normal antifungal bacteria that live in the vagina. Yeast infections cause itching and a thick, white discharge, and other symptoms. If over the counter meds don’t work—please give us a call for an appointment to check out other causes and treatments.

Another cause of vulvovaginitis is bacterial vaginosis, an overgrowth of certain types of bacteria in the vagina. Bacterial vaginosis may cause a thin, grey vaginal discharge and a fishy odor.An STI called trichomonas vaginitis infection is another common cause. This infection leads to genital itching, a vaginal odor, and a heavy vaginal discharge, which may be yellow-grey or green in color.  These usually require an office visit and a prescribed medication.

Some other causes:   Bubble baths, soaps, vaginal contraceptives, feminine sprays, and perfumes can cause irritating itchy rashes in the genital area, while tight-fitting or nonabsorbent clothing sometimes cause heat rashes.Irritated tissue is more susceptible to infection than normal tissue, and many infection-causing organisms thrive in environments that are warm, damp, and dark. Not only can these factors contribute to the cause of vulvovaginitis, they frequently prolong the recovery period.

A lack of estrogen in postmenopausal women can result in vaginal dryness and thinning of vaginal and vulvar skin, which may also lead to or worsen genital itching and burning.

Some skin conditions can cause itching and chronic irritation of the vulvar area. Foreign bodies, such as lost tampons, can also cause vulvar irritation and itching and strong smelling discharge.

Nonspecific vulvovaginitis (where specific cause cannot be identified) can be seen in all age groups, but it occurs most commonly in young girls before puberty. Once puberty begins, the vagina becomes more acidic, which tends to help prevent infections.Nonspecific vulvovaginitis can occur in girls with poor genital hygiene and is characterized by a foul-smelling, brownish-green discharge and irritation of the labia and vaginal opening. This condition is often associated with an overgrowth of a type of bacteria that is typically found in the stool. These bacteria are sometimes spread from the rectum to the vaginal area by wiping from back to front after using the bathroom.Sexual abuse should be considered in children with unusual infections and recurrent episodes of unexplained vulvovaginitis. Neisseria gonorrhoeae, the organism that causes gonorrhea, produces gonococcal vulvovaginitis in young girls who have sexual exposure. Gonorrhea-related vaginitis is considered a sexually transmitted illness. If lab tests confirm this diagnosis, young girls should be evaluated for sexual abuse.

Signs and tests

If you have been diagnosed with a yeast infection in the past, you can try treatment with over-the-counter products. However, if your symptoms do not completely disappear in about a week, contact your health care provider. Many other infections have similar symptoms. The health care provider will perform a pelvic examination. This may show red, tender areas on the vulva or vagina.

A wet prep (microscopic evaluation of vaginal discharge) is usually done to identify a vaginal infection or overgrowth of yeast or bacteria. In some cases, a culture of the vaginal discharge may identify the organism causing the infection.

A biopsy of the irritated area on the vulva may be recommended if there are no signs of infection. Rarely vulvar itching can be a sign of vulvar dystrophy (abnormal cells),  warts or cancer.

Treatment depends on what is causing the infection. Treatment may include:

• Antibiotics taken by mouth or applied to the skin
• Antifungal cream
• Antibacterial cream
• Cortisone cream
• Antihistamine, if the irritation is due to an allergic reaction
• Estrogen cream, if the irritation and inflammation is due to low levels of estrogen.
• It is often helpful to allow more air to reach the genital area. You can do this by: Wearing cotton underwear (rather than nylon) or underwear that has a cotton lining in the crotch area. This increases air flow and decreases moisture. Removing underwear at bedtime.