Doctor's Notes on Vaginal Infections (Vaginitis)
Vaginal infections are infections of the tissues of the vagina with viruses, bacteria, yeast, or parasites such as Trichomonas. Not all vaginal infections are considered to be sexually-transmitted diseases (STDs), but many STDs can cause vaginal infections, including herpesviruses, gonorrhea, and chlamydia. Candidiasis, or yeast infection, is another common type of vaginal infection.
Many signs and symptoms can accompany vaginal infections. In some cases, the infection may be silent and not produce symptoms. When symptoms do occur, they are related to the type of infection. Associated symptoms and signs include vaginal discharge, odor, redness, pain with urination, pain with sexual intercourse, and itching of the vaginal area. Herpesvirus infections can lead to the characteristic painful blister formation, and infections with human papillomavirus (HPV) cause genital warts.
Vaginal Infections (Vaginitis) Symptoms
Vaginal discharge, itching, and burning are common symptoms of the various forms of vaginitis. Although the symptoms of these infections can be very similar, there are some differences to look for in the color and smell of the discharge.
Some vaginal discharge is quite common and normal for women of childbearing age. Normally, cervical glands produce a clear mucous secretion that drains downward, mixing with bacteria, discarded vaginal cells, and Bartholin's gland secretions near the opening of the vagina. These substances may (depending on how much mucus there is) turn the mucus a whitish color, and the discharge turns yellowish when exposed to air. There are times during the menstrual cycle when the cervical glands produce more mucus than others, depending on the amount of estrogen produced. This is normal.
Sexual excitement and emotional stress have both been associated with an increase in normal physiologic vaginal discharge. This discharge is frequently clear, and watery in consistency.
If your vaginal discharge is abnormal in color such as green, has a foul smell, changes consistency, or is significantly increased or decreased in amount, you may be developing a form of vaginitis.
- Bacterial vaginosis (BV) causes an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fishy smell, especially after intercourse. The discharge is usually white or gray, and it can be thin. You may also have burning during urination or itching around the outside of the vagina, or both. Some women with bacterial vaginosis may have no symptoms.
- Yeast infections or candidiasis may cause a thick, whitish-gray "cottage cheese" type of vaginal discharge with accompanying itching. The itching may be intense. Painful urination and intercourse are also common. A vaginal discharge may not be present. Men with genital candidiasis may have an itchy rash on the penis. Most male partners of women with yeast infection do not experience any symptoms.
- Trichomoniasis results in a frothy vaginal discharge that may be yellow-green or gray. The infection may cause itching and irritation of the genitals, burning with urination (sometimes confused with a urinary tract infection), discomfort during intercourse, and a foul odor. Trichomoniasis is sexually-transmitted, and symptoms generally appear within 4-20 days after exposure. Men rarely have symptoms, but if they do, they may have a thin, whitish discharge from the penis accompanied by painful or difficult urination.
- Pain itself is not a frequent symptom of vaginal infections (except for the itching) and should prompt you to see your health care practitioner.
- If you have a condition called vulvodynia, you may have burning, stinging, irritation, or rawness of your genitalia. Vulvodynia is defined by symptoms, and there is frequently no infection or skin disease of the vulva or vagina. You may have intermittent pain, off and on. This is an unusual condition that requires further management with your health care practitioner.
Vaginal Infections (Vaginitis) Causes
Bacterial vaginosis (BV) is the most common cause of vaginitis. Bacterial vaginosis is caused by a change or imbalance in the types of the bacteria normally found in the vagina and causes an overgrowth of organisms such as Gardnerella vaginalis.
- Risk factors include pregnancy, intrauterine device (IUD) use, and frequent douching. It is associated with sexual activity, and possibly a new sexual partner or multiple sexual partners. Women who have never had sexual intercourse are rarely affected.
- You do not get bacterial vaginosis from toilet seats, bedding, or swimming pools.
- In the United States, as many as 25% of pregnant women have bacterial vaginosis. This varies by race and ethnicity from 6% in Asians and 9% in whites to 16% in Hispanics and 23% in African Americans.
Vaginal yeast infections are caused by a fungus, mainly by Candida albicans. This is also called candidiasis, genital candidiasis, or vulvovaginal candidiasis (VVC). Yeast infection can spread to other parts of the body including skin, mucous membranes, heart valves, esophagus, and other areas. In rare circumstances, it can cause life-threatening systemic infections mostly in people with weakened immune defenses (such as women who are pregnant and people who are HIV positive, have diabetes, or are taking steroids).
- A majority of adult women have had at least one genital yeast infection in their lifetime. Vaginal yeast infection is not considered a sexually transmitted disease, but some men will develop symptoms such as itching and penile rash following sexual contact with an infected partner.
- Yeast infections are caused by an overgrowth of normally growing fungi in the vagina that creates unpleasant symptoms. The yeast are normally kept under control by naturally occurring bacteria in the body. If the natural balance of microorganisms is disrupted, the yeast grow out of control. It is not clear how fungal infections originate, but they are not thought to be sexually transmitted. Infections tend to happen when an imbalance occurs, possibly caused by any of these events:
- Use of antibiotics: Antibiotics destroy protective bacteria in the vagina. These bacteria normally stop the candidal organisms from overgrowing. Yeast infection may occur after taking a course of antibiotics for another condition such as strep throat.
- Diabetes or pregnancy: Both diabetes and pregnancy make the vagina better suited for fungal growth. These conditions lower the glycogen store in certain vaginal cells. They may also raise the sugar content (and the pH) of the vagina and increase the risk of yeast infection.
- Birth control pills: Changes in the vaginal environment occur with increased hormonal levels from estrogen-containing birth control pills. This change creates an environment for the fungus to grow and cause symptoms.
- Hormonal changes such as ovulation, menopause, or pregnancy
- Steroid use
- Wearing underwear that is tight or non-cotton: This can increase temperature, moisture, and local irritation.
- Weakened immune system: HIV/AIDS, for example
- Use of douches, perfumed feminine hygiene sprays
- Scratches in the vagina (during insertion of a tampon or other objects)
- Trichomoniasis is a sexually transmitted disease (also called trich, pronounced "trick") caused by the parasite Trichomonas vaginalis. Trichomoniasis is primarily an infection of the urinary and genital tract. For women, the vagina is the most common site of infection. For men, the urethra is most commonly affected.
- Other causes of vaginal inflammation may be allergies to spermicides, vaginal hygiene products, and detergents and fabric softeners. Another type of sexually transmitted disease may be present. Older women may experience atrophic vaginitis (a thinning of the vaginal walls with menopause). Foreign objects such as a forgotten tampon or another foreign object may cause vaginal irritation.
It's not necessary to have sexual intercourse to get a sexually-transmitted disease (STD). The human papillomavirus (HPV) that causes genital warts can be transmitted by close skin-to-skin contact. Some types of HPVs cause cervical or anal cancer, and vaccines are available to protect against the most dangerous types. Other HPV types cause genital warts, which can be raised, flat, or cauliflower-shaped. HPV infection can occur in people who have no symptoms or visible warts.
- Genital warts can be big or small, flat or raised. They generally appear as a small bump or group of bumps in the genital region, and may be shaped like a cauliflower.
- A vaccine to prevent HPV is given in three shots. The second shot is given a month or two after the first shot. The third shot comes six months after the first shot.
- The Centers for Disease Control recommends boys and girls be vaccinated at ages 11 or 12.
- If they did not get the HPV vaccine as children, women can get the HPV vaccine through age 26. Men can get it through age 21. The CDC recommends HPV vaccination for men through age 26 for men who have sex with men or men with compromised immune systems, including HIV.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.