Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 1, 2016

The vagina maintains a specific balance of bacteria and pH balance. If the balance is destroyed, the vagina can become inflamed, resulting in vaginitis. Vaginitis is also called vulvovaginitis or vaginal infection, and it refers to any sort of inflammation, irritation, or infection of the vagina.


Definition & Facts

Depending on the cause of the vaginitis, it may be referred to as a yeast infection, bacterial vaginosis, trichomoniasis, or atrophic vaginitis. Women can often have multiple types of vaginitis at once. Vaginitis is incredibly common, and it can happen to any woman regardless of sexual activity. Up to 75 percent of adult women have had at least one yeast infection, while 30 percent of adult women have been affected by bacterial vaginosis.

Symptoms & Complaints

The symptoms of vaginitis can vary slightly depending on the specific type of vaginitis that a patient has, and even two women with the same type of vaginitis may not experience the same symptoms. However, in general, the primary symptom of vaginitis is unusual discharge that may be odd in color, smell, or quantity.

If a person has bacterial vaginosis, vaginal discharge tends to smell particularly foul and fish-like, and it may appear grayish. Women with yeast infections experience thick amounts of white, lumpy discharge that is often compared to the appearance of cottage cheese. Women who are affected by trichomoniasis can have discharge that seems frothy and greenish-yellow.

In addition to odd discharge, the vagina and vulva may appear red and inflamed, and these areas can be sensitive to touch. Certain types of vaginitis, particularly yeast infections, can cause extreme itching and burning sensations. Some women may experience discomfort or pain during intercourse or urination. Occasionally, vaginitis may interfere with menstruation, causing light spotting or bleeding throughout the month.


The types of vaginitis are categorized by their own unique causes. Bacterial vaginosis is caused by an imbalance in the bacteria of the vagina. Normally, the vagina has several types of beneficial Lactobacillus bacteria that help the vagina to remain healthy and combat harmful bacteria. However, a new sexual partner, douching, or mineral deficiencies can put the bacterial levels out of balance, allowing harmful Gardnerella bacteria to flourish, resulting in bacterial vaginosis.

A yeast infection is caused by overgrown fungal organisms within the vagina, and the most common cause is Candida albicans yeast. There are always trace amounts of Candida yeasts in the vagina, but high amounts of sugar, weakened immune system, irritation from foreign chemicals, large amounts of moisture, or imbalanced bacteria levels can cause the Candida to flourish.

The trichomoniasis form of vaginitis is actually caused by a parasite, the Trichomonas vaginalis, and this parasite is primarily spread through sexual intercourse. Atrophic vaginitis is inflammation caused by a thinning vaginal lining, which happens after menopause or hysterectomies. Though vaginitis is primarily caused by bacteria or fungal overgrowth, sometimes there is no precise cause. In these circumstances, the vagina and vulva may just be experiencing an allergic reaction to soaps, douches, spermicides, or clothing dyes.

Diagnosis & Tests

The first step to receiving a vaginitis diagnosis is a thorough medical history and physical examination. During this step, the doctor may be able to rule out any sexually transmitted infections that could cause similar symptoms, or further STI tests may be needed.

Vaginitis, especially the more common forms like yeast infections, can then often be diagnosed primarily by the symptoms and the appearance of the discharge. In some cases, women may have unusual symptoms or more than one type of vaginitis at the same time, so lab tests of the discharge may be used to confirm the diagnosis. A lab test can reveal the presence of excess Candida fungi, high levels of Gardnerella bacteria, or the presence of trichomonas parasites.

The pH levels of the vagina can also be tested to assist in diagnosis. Women with yeast infections have unusually low pH levels, while women with bacterial vaginosis or trichomoniasis have elevated pH levels.

Treatment & Therapy

Most forms of vaginitis are rather simple to treat, but the treatment will vary based on the type of vaginitis that a woman has. Bacterial vaginosis is normally treated with antibiotics that can be applied topically or ingested orally. The most common forms of antibiotics for treating this type of vaginitis are clindamycin and metronidazole.

Metronidazole is used alongside tinidazole to treat trichomoniasis. If a patient has trichomoniasis, it is important for any sex partners to also seek treatment and avoid having sex with each other for a week in order to avoid reinfecting each other. Yeast infections are primarily treated with over-the-counter antifungal creams or suppositories that can be inserted into the vagina, such as miconazole or clotrimazole. Oral antifungal medications like fluconazole may also be prescribed for serious cases.

If the vaginitis is due to hormonal fluctuations, estrogen can be used to treat it. For women with vaginitis that is not caused by an infection or hormone imbalance, it is necessary to find the irritant or allergen and discontinue use.

Prevention & Prophylaxis

There are several lifestyle changes that can prevent vaginitis from occurring. Living an overall healthy lifestyle and eating a low-sugar diet will help to maintain beneficial vaginal bacteria, and wearing cotton underwear prevents yeast from thriving in moist environments.

Avoid soaking in baths and hot tubs to further reduce Candida overgrowth. Spermicides, vaginal douches, scented soaps, scented tampons, and scented pads may all irritate the vagina or disrupt the beneficial microorganisms within the vagina, so these items should be avoided. Practicing safe sex including condom use as well as only having sex with partners that have been recently tested can prevent the spread of trichomoniasis.