Vaginitis

Not to be confused with Vaginismus.

Vaginitis
Classification and external resources
ICD-10	N76.0-N76.1
ICD-9	616.1
DiseasesDB	14017
eMedicine	med/3369 med/2358 emerg/631 emerg/639
MeSH	D014627

Vaginitis is an inflammation of the vagina. It can result in discharge, itching and pain, and is often associated with an irritation or infection of the vulva. It is usually due to infection.

Symptoms

A woman with this condition may have itching or burning and may notice a discharge. In general, these are symptoms of vaginitis:

• irritation and/or itching of the genital area
• inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area
• vaginal discharge
• foul vaginal odor
• discomfort or burning when urinating
• pain/irritation with sexual intercourse

Causes

Vulvovaginitis can affect women of all ages and is very common. Specific forms of vaginitis are:

Infection

Infectious vaginitis accounts for 90% of all cases in reproductive age women and is represented by the triad:

• Candidiasis: vaginitis caused by Candida albicans (a yeast).
• Bacterial vaginosis: vaginitis caused by Gardnerella (a bacterium).
• Trichomoniasis: vaginitis caused by Trichomonas vaginalis (a parasitic protozoan).

Other less common infections are caused by gonorrhea, chlamydia, mycoplasma, herpes, campylobacter, improper hygiene, and some parasites.

Vaginal infection are often (varies between countries between 20 to 40% of vaginal infections) a mix of various etiologies, which present challenging cases for treatment. Indeed, when only one cause is treated, the other pathogens can gain in resistance and induce relapses and recurrences. The key factor is therefore to get a precise diagnosis and treat with broad spectrum anti-infective (often also inducing adverse effects).

Pre-pubescent girls may also have infectious vaginitis, although the causes are different than those for women:

• Bacterial vaginosis: vaginitis caused by Streptococcus spp..
• Improper hygiene, which may introduce bacteria or other irritants from the anal region to the vaginal area.

The pH balance in adolescent girls' bodies is not conducive to the growth of Candida albicans, so they are unlikely to contract a yeast infection.

Hormonal

Hormonal vaginitis includes atrophic vaginitis usually found in postmenopausal or postpartum women. Sometimes it can occur in young girls before puberty. In these situations the estrogen support of the vagina is poor.

Irritation/allergy

Irritant vaginitis can be caused by allergies to condoms, spermicides, soaps, perfumes, douches, lubricants and semen. It can also be caused by hot tubs, abrasion, tissue, tampons or topical medications.

Foreign body

Foreign Body Vaginitis: Foreign bodies (most commonly retained tampons or condoms) cause extremely malodorous vaginal discharges. Treatment consists of removal, for which ring forceps may be useful. Further treatment is generally not necessary.

Role of STDs

Sexually Transmitted Diseases (STDs) can be a cause of vaginal discharge. Chlamydia and gonorrhea testing should be done whenever a sexually active individual complains of vaginal discharge even when the cervix appears normal.

Diabetes

Women who have diabetes develop infectious vaginitis more often than women who do not.

Diagnosis

Diagnosis is made with microscopy (mostly by vaginal wet mount) and culture of the discharge after a careful history and physical examination have been completed. The color, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. The International Statistical Classification of Diseases and Related Health Problems codes for the several causes of vaginitis are:

Condition	Description	pH
Candida vaginitis (B37.3)	Commonly referred to as a yeast infection, Candidiasis is a fungal infection that usually causes a watery, white, cottage cheese like vaginal discharges. The discharge is irritating to the vagina and the surrounding skin.	low (4.0-4.5)
Atrophic vaginitis (or Senile vaginitis) (N95.2)	usually causes scant vaginal discharge with no odour, dry vagina and painful intercourse. These symptoms are usually due to decreased hormones usually occurring during and after menopause.
Bacterial vaginitis (B96.3).	Gardnerella usually causes a discharge with a fish-like odour. It is associated with itching and irritation, but not pain during intercourse.	elevated
Trichomonas vaginalis (A59.0)	can cause a profuse discharge with a fish-like odour, pain upon urination, painful intercourse, and inflammation of the external genitals.	elevated (5.0-6.0)
Herpes (A60.0)	usually occurs as water blisters on the genital region, about one week after infection. There is tenderness, swollen glands, and fever. The water blisters are extremely painful and heal in about three weeks. However, herpes is usually an external infection and does not fall under the category of vaginitis.

Complications

• persistent discomfort
• superficial skin infection (from scratching)
• complications of the causative condition (such as gonorrhea and candida infection)

Treatment

The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed.

Often, after an anti-infective treatment, the vaginal flora (aka Döderlein flora) is disturbed. The cause is the reduced density of live flora (physiological barrier against pathogens) and the reduction of the vaginal epithelium (physical barrier against pathogens). As a result, post antiinfective treatment also requests the strengthening of the natural vaginal flora, which is done with local administration of lactobacillus and potentially low dose of hormone (e.g. estriol) to increase the proliferation of the epithelial cells.

See also

• List of cutaneous conditions

Further reading

• Jaquiery A, Stylianopoulos A, Hogg G, Grover S (1999). "Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract". Arch. Dis. Child. 81 (1): 64–7. doi:10.1136/adc.81.1.64. PMC 1717979 Freely accessible. PMID 10373139. CS1 maint: Multiple names: authors list (link)
• Brook I (2002). "Microbiology and management of polymicrobial female genital tract infections in adolescents". J Pediatr Adolesc Gynecol. 15 (4): 217–26. doi:10.1016/S1083-3188(02)00159-6. PMID 12459228. 
• Joesoef MR, Schmid GP, Hillier SL (1999). "Bacterial vaginosis: review of treatment options and potential clinical indications for therapy". Clin. Infect. Dis. 28 Suppl 1: S57–65. doi:10.1086/514725. PMID 10028110. CS1 maint: Multiple names: authors list (link)
• Ozkinay E; et al. (2005). "The effectiveness of live lactobacilli in combination with low dose estriol to restore the vaginal flora after treatment of vaginal infections". IBJOG. 112 (2): 234–240; quiz 440–1. doi:10.1111/j.1471-0528.2004.00329.x. PMID 15663590. CS1 maint: Explicit use of et al. (link)
• Reed BD, Slattery ML, French TK (1989). "The association between dietary intake and reported history of Candida vulvovaginitis". J Fam Pract. 29 (5): 509–15. PMID 2553850. CS1 maint: Multiple names: authors list (link)
• Rodgers CA, Beardall AJ (1999). "Recurrent vulvovaginal candidiasis: why does it occur?". Int J STD AIDS. 10 (7): 435–9; quiz 440–1. doi:10.1258/0956462991914429. PMID 10454177. 

See also

• Atrophic vaginitis
• Vulvovaginal health

ar:التهاب المهبل tr:Vajinit