Vaginitis

Vagina is a part of the female reproductive system. The word vaginitis can be split as vagin(a) + itis, where ‘vagin’ means the vagina and ‘itis’ means inflammation or swelling. So, vaginitis is the swelling or inflammation of the vagina. It also causes irritation, burning or itching sensation in the vagina and the adjoining vulva along with an abnormal foul-odour vaginal discharge.

It mainly results due to changes in the normal pH of the vagina, which disturbs the normal microbes present on the thin membrane or lining (mucosa) of the vagina. The abnormal change in the vaginal pH may occur due to pathogenic microorganisms or adverse reaction to the intimate-care products. Vaginitis is a very common condition in women of reproductive age, especially those who are sexually active. In India, about 30 % of women with vaginitis have vaginal discharge.

Often, any type of vaginitis presents with common symptoms such as:

• Swelling
  Swelling of the vagina is the most common symptom of vaginitis. If there is involvement of the vulva, then vulvar swelling is also present.
• Dysuria
  Frequent urination or painful urination may be present in some women.
• Itching
  Intense itching in and around the vagina is common in vaginitis.
• Redness
  Redness surrounding the vulvar region is present.
• Abnormal discharge
  Abnormal vaginal discharge in all types of vaginitis can be a presenting complaint in women.
• Painful or uncomfortable intercourse
  Pain during sexual intercourse can also be a complaint of women with vaginitis.

Causes

Vaginal inflammation can be caused by any of the below-mentioned factors:

• Infection
  There is a vaginal invasion of harmful microorganisms like bacteria, fungi, or parasites due to unhygienic conditions like soiled undergarments and use of cloth during monthly periods. Sometimes overgrowth of normal flora, which is otherwise harmless, can occur in the case of a poor immunity state like HIV-AIDS, an imbalance of the pH of the vagina due to overcleaning, and after menopause where the reduced oestrogen levels increase the chances of infection with these commensal bacteria. Sometimes, it may be a mixed infection due to two or more pathogens. Symptoms are similar in most infections, but the colour of vaginal discharge differs. However, several times a vaginal discharge may be absent. 90 % of cases of vaginal discharge occur due to one of these three infections:
  • Candidiasis
    It is a type of fungal infection caused by the yeast Candida albicans. It is characterized by a white coloured vaginal discharge and white cotton-like growth inside the vagina.
  • Bacterial vaginosis
    Vaginitis caused by bacteria like E. coli and others is called bacterial vaginosis. It generally presents as a grey coloured vaginal discharge.
  • Trichomoniasis
    It is the vaginitis that is caused by the parasite Trichomonas vaginalis; hence the name. It generally presents as a yellowish-green coloured vaginal discharge.
• Hormonal imbalance
  In girls (before puberty) and post-menopausal women, there is a deficiency of the oestrogen hormone. This hormone is responsible for the production of glycogen, a food substrate for healthy bacteria like Lactobacillus, by the vaginal lining. Therefore, a lack of oestrogen secretion results in a reduced growth of healthy bacteria and a raised pH of the vaginal area causing vaginitis.
• Sexually transmitted diseases (STDs)
  Diseases transmitted from one person to the other during sexual activities are known as sexually transmitted diseases. These can be diseases of bacterial, fungal, and protozoal origin. Examples include gonorrhoea, chlamydia, herpes, syphilis, and HIV. These can spread to the female partner from the infected male partner and vice versa. The recurrence rate is high in such cases.
• Use of chemical-based products
  Sensitivity to creams, spermicidal jelly, condoms, intrauterine devices and other such contraceptive methods and ring pessary used in women with uterine prolapse or can lead to adverse reaction causing vaginal swelling and redness, which can further worsen due to an additional or superinfection.
• Medications
  Certain drugs like immunosuppressants used in cancer chemotherapy, after an organ transplant or rheumatoid arthritis, can cause vaginitis as a side-effect.

Risk factors

Women of childbearing age are at an increased risk of developing vaginitis. Other important risk factors for developing vaginitis are:

• Endocrine diseases
  Women with endocrine diseases such as diabetes and gestational diabetes (diabetes during pregnancy) are also at an increased risk of developing vaginitis. Diabetes increases the risk of vaginitis due to the presence of excess blood glucose and lowered immunity.
• Antibiotic therapy
  Antibiotics can kill the normal commensal bacteria; the non-pathogenic (harmless and symbiotic) bacteria that normally harbour the vagina. Also, these bacteria are protective and do not allow other pathogenic bacteria or fungi to grow in the vagina. If these normal bacteria are killed due to a long-term use of antibiotics, pathogenic fungi or bacteria can flourish, leading to vaginitis. (Read more: Precautions to take with antibiotics)
• Alcohol intake
  Consuming alcohol on a regular basis has been found to be a risk factor for bacterial vaginosis. (Read more: Alcohol side effects on body and benefits)

To prevent vaginitis, some important points that should be considered are as follows:

Hygiene

Cleanliness should be maintained by women of reproductive age by

• Taking proper care during periods by bathing and keeping the vaginal and surrounding area clean. (Read more: Period hygiene tips)
• Using sanitary pads or tampons instead of cloth during periods, as a cloth is not sterilised (bacteria-free) and can spread infection.
• Changing sanitary pads or tampons in every 3-6 hours during periods even if there is less bleeding.
• Washing your vulvar and adjoining area thoroughly with a pH balanced or mild soap and water only once in a day while taking shower. Overcleaning will cause irritation and swelling.
• Emptying your bladder before and after sexual intercourse to avoid infection with pathogens through the urinary tract. Both partners should wash their hands to prevent the spread of infection through touching.
• Using clean undergarments and changing them regularly.
• Ensuring that the partner also maintains hygiene to prevent sexually transmitted diseases. (Read more: Sex education and sexual health)

Cautious use of medical devices and products

• Proper knowledge of medical devices and products is important before use.
• Before using condoms, one should check for latex or lubricant (used in condom manufacturing) allergies in the female partner.
• Spermicidal jellies and creams can also cause vaginal redness, itching, and swelling. Hence, its advisable to test the products once prior to regular use and avoid using these products without a gynaecologist’s consultation.
• Always read the product information, precautions, and contraindications on the product label thoroughly.

Monogamous relationship

Most times, sexually transmitted diseases (STDs) are caused due to multiple sexual partners. Maintaining intimate relations with a single partner can help prevent STDs.

Maintaining vaginal pH

Use of harsh soaps should be avoided and mild soaps which will not affect the vaginal pH should be used instead. Use of specially formulated and clinically tested liquid soaps to wash the intimate area should be considered.

Diagnosis is generally made on the basis of clinical symptoms and signs. Further testing is required only if the cause remains unknown despite this, or if the treatment is not resolving the condition.

• Visual assessment of discharge
  Visual observation and examination by your doctor can confirm the diagnosis of vaginitis.
• Microscopic examination
  When the cause of vaginitis remains unknown, a sterile cotton swab is inserted into the vagina to collect a sample of the vaginal discharge. This sample is observed under the microscope to confirm the type of organism (whether bacteria, fungus or parasite).
• Culture
  If your doctor suspects a fungal infection but examination (clinically or microscopically) does not confirm the diagnosis, a culture of the microorganism in the lab is performed to let it grow on a substrate. Once sufficient growth is seen, it is examined under the microscope. (Read more: Fungal culture test)
• DNA probe testing
  It is a DNA-based study, which is equally effective as microscopic testing. It is helpful in confirming the diagnosis of complicated vaginitis that is not responding to treatment and other infections like Gonorrhoea, Chlamydia, Candida, Trichomonas, and more.

Never hesitate to share problems related to the reproductive system with your doctor. Most times, sexually transmitted diseases are found to be recurrent in couples who hesitate to consult the doctor for any discomfort or infection in the reproductive organs.

Some basic things to follow if you suffer from vaginitis are:

• Observation
  If you observe any of the above-mentioned symptoms, first note what change has caused these symptoms.
• Antibiotics
  When you are diagnosed with vaginitis due to an infection, local application of antimicrobials for particular infections is prescribed by your doctor in the form of creams or pessaries. Pessaries are vaginal tablets, which are placed inside the vagina using a device called a plunger. In recurrent cases, oral antimicrobials might be started.

In the case of sexually transmitted diseases, treatment of both partners with antibiotics is advised to stop recurrence or spread of infection.

Lifestyle management

Lifestyle changes play an important role in the treatment of vaginitis. These include:

• Avoid physical contact
  In case of vaginitis due to a sexually transmitted disease, avoid physical contact with your partner till you are completely cured of the infection, else it may spread to your partner. Simultaneous check-up and treatment of the partner are necessary to check if he has the infection too.
• Maintaining hygiene
  Keeping the intimate area clean will help to decrease infection faster and will avoid further risk of infection.
• Avoid allergens
  Use of allergic products should be avoided. Always check for sensitivity by using a small quantity of hair removing cream or any type of jelly on the inner side of your thigh before applying it to the intimate area. Check for irritation due to condom used by your partner, which can be due to sensitivity to lubricants in condoms. If vaginitis is due to any new cream or device you are using, immediately stop using it.

Prognosis

The outcome of vaginitis is very good as it is completely treatable but requires completion of treatment under doctor’s guidance and regular follow-up to avoid any recurrence. Also, in the case of STDs, treatment of both the partners is necessary to prevent recurrence.

Complications

• Recurrence
  Recurrence of infection is the most common complication of vaginitis seen in women suffering from sexually transmitted disease and those who do not complete their treatment.
• Mixed infection
  If there is a recurrence of bacterial infection, there is an increased risk of superinfection by Candida fungus, which becomes difficult to treat if not tested for both types of infections.