Vaginitis: Symptoms, Types, Causes and Treatment

Vaginitis is one of the most common gynecological concerns, affecting women of all ages and backgrounds. The symptoms can be uncomfortable and disruptive, but understanding the various types, causes, and available treatments can empower women to take control of their vaginal health. This article provides a comprehensive overview of vaginitis, synthesizing the latest scientific evidence to guide both patients and healthcare providers.

Symptoms of Vaginitis

Vaginitis often announces itself with bothersome symptoms that can significantly affect daily life. Recognizing these symptoms early helps in seeking timely diagnosis and effective treatment. While the symptoms can overlap between different types of vaginitis, some subtle differences may guide initial suspicion and further testing.

Symptom	Description	Typical Presentation	Source(s)
Discharge	Abnormal increase or change in vaginal fluids	May be thin, thick, milky, or cottage cheese-like	2 3 5 6 8
Odor	Unusual or foul vaginal smell	Fishy (BV), musty, or absent (yeast)	2 3 6
Itching	Irritation or pruritus in vulva/vagina	Ranges from mild to severe	1 2 5 8
Burning	Sensation of burning in the vaginal area	May be constant or during urination	2 5
Irritation	General discomfort or inflammation	Redness, swelling, sore tissues	5 6
Pain	Pain during urination (dysuria) or sex (dyspareunia)	May occur with inflammation or infection	5 6 8

Table 1: Key Symptoms

Common Manifestations

The classic symptoms of vaginitis include abnormal vaginal discharge, odor, itching, irritation, and sometimes pain or burning sensations. However, these symptoms alone are not sufficient to accurately distinguish between the different types of vaginitis 1 2 4. For instance:

• Discharge may vary in color, consistency, and amount. Bacterial vaginosis (BV) often produces a thin, grayish-white discharge with a fishy odor, while candidiasis typically causes thick, white, "cottage cheese" discharge without a strong odor 2 3 6.
• Odor is a distinguishing feature. A strong fishy smell is characteristic of BV, whereas trichomoniasis may produce a musty or unpleasant odor, and yeast infections usually lack odor 2 3 6.
• Itching and Irritation are more pronounced in yeast infections and trichomoniasis, but can be present in any form of vaginitis 1 2 5.
• Pain or burning may be experienced during urination or intercourse, especially if there is significant inflammation 5 6 8.

Variability and Overlap

Symptoms can overlap significantly, making it difficult to diagnose based solely on clinical presentation 1 4. For example, both candidiasis and trichomoniasis can cause intense itching and discharge, while BV and trichomoniasis can both lead to a noticeable odor. Some women may have only mild symptoms or be asymptomatic, particularly with BV 2 10.

When to Seek Medical Attention

Persistent, severe, or recurrent symptoms warrant evaluation by a healthcare provider. Early diagnosis can help prevent complications and improve quality of life.

Types of Vaginitis

Vaginitis is not a single disease but a syndrome with multiple etiologies. Understanding the different types is crucial for targeted management and prevention of recurrence.

Type	Key Features	Prevalence/Population	Source(s)
Bacterial Vaginosis	Overgrowth of anaerobic bacteria	Most common (40-50%)	2 3 6 10
Vulvovaginal Candidiasis	Fungal (Candida species) infection	20-25% of cases	2 3 6 10
Trichomoniasis	Protozoal (Trichomonas vaginalis)	15-20% of cases	2 3 6 10
Atrophic Vaginitis	Estrogen deficiency	Postmenopausal women	3 6
Allergic/Irritant	Reaction to chemicals, douches, etc.	5-10% of cases	2 5 3
Aerobic/Cytolytic	Imbalance of other bacteria or lactobacilli	Up to 13% (aerobic)	7

Table 2: Types of Vaginitis

Bacterial Vaginosis

Bacterial vaginosis results from the replacement of normal lactobacilli with mainly anaerobic bacteria, such as Gardnerella vaginalis and Mycoplasma hominis. It is the leading cause of vaginal complaints in women of reproductive age. BV is not considered a classical sexually transmitted infection, but sexual activity and certain practices (e.g., douching) increase risk 2 3 6 13.

Vulvovaginal Candidiasis

This type is caused primarily by Candida albicans, but non-albicans species like C. glabrata and C. tropicalis are increasingly recognized, particularly in recurrent or complicated cases. It is characterized by inflammation of the vulva and vagina, often associated with thick, white discharge and marked itching 2 3 6 10.

Trichomoniasis

A sexually transmitted infection caused by the protozoan Trichomonas vaginalis. It accounts for up to 20% of vaginitis cases and can result in frothy, yellow-green discharge and significant irritation. Trichomoniasis increases the risk of acquiring or transmitting other sexually transmitted infections 2 3 6 10.

Atrophic Vaginitis

Also known as genitourinary syndrome of menopause, this form is due to estrogen deficiency, mainly affecting postmenopausal women. Symptoms include dryness, irritation, and dyspareunia, often without significant discharge 3 6.

Allergic and Irritant Vaginitis

Non-infectious types can result from exposure to chemicals (e.g., soaps, detergents), allergic reactions, or foreign bodies. These are less common but important to recognize, especially in women with recurrent or unexplained symptoms 2 5 3.

Other Forms: Aerobic and Cytolytic Vaginitis

Aerobic vaginitis is caused by an overgrowth of aerobic bacteria, such as Escherichia coli or Staphylococcus aureus, and cytolytic vaginosis involves an overgrowth of lactobacilli leading to excessive breakdown of vaginal epithelial cells. Though less common, these forms should be considered in persistent cases 7.

Causes of Vaginitis

The underlying causes of vaginitis are diverse, ranging from infections to hormonal changes and chemical exposures. Identifying the cause is key to choosing the correct treatment.

Cause	Mechanism or Trigger	Risk Factors	Source(s)
Microbial	Overgrowth/infection by bacteria, fungi, protozoa	Sexual activity, antibiotics, hygiene	2 3 6 13
Hormonal	Estrogen deficiency	Menopause, breastfeeding	3 6
Chemical	Irritation/allergic response	Soaps, douches, lubricants	2 5 3
Foreign Body	Physical irritation or infection	Forgotten tampon, objects	5
Immune/Host	Host response, immune suppression	Diabetes, immunosuppression	13 16

Table 3: Causes of Vaginitis

Infectious Causes

• Bacterial Vaginosis: Disruption of the normal vaginal flora, particularly loss of lactobacilli, allows anaerobic bacteria to proliferate 2 3 6 13. Factors contributing include sexual activity, new/multiple partners, and vaginal douching.
• Vulvovaginal Candidiasis: Overgrowth of Candida species, often after antibiotic use, hormonal changes (pregnancy, oral contraceptives), diabetes, or immunosuppression 2 3 6 11 16.
• Trichomoniasis: A sexually transmitted infection spread through unprotected sex; risk is higher in women with multiple partners 2 3 6.

Non-Infectious Causes

• Atrophic (Hormonal) Vaginitis: Reduced estrogen leads to thinning of the vaginal epithelium and loss of protective flora, increasing susceptibility to irritation and infection 3 6.
• Allergic/Irritant Vaginitis: Contact with chemicals, such as soaps, detergents, spermicides, or latex, can provoke inflammation 2 5 3.
• Foreign Bodies: Retained tampons, condoms, or other objects can cause local inflammation and secondary infection 5.

Host and Environmental Factors

• Immune System: Women with diabetes or compromised immunity are more prone to recurrent or severe vaginitis 13 16.
• Diet and Microbiota: Diet and probiotic use may influence the composition of the vaginal microbiome, potentially reducing risk 13 16.
• Hygiene Practices: Overzealous cleaning, douching, or use of fragranced products can disrupt the natural vaginal environment 5 13.

Treatment of Vaginitis

Effective treatment of vaginitis depends on identifying the underlying cause. Most cases can be managed successfully with targeted therapy, but recurrence is common, and prevention strategies are increasingly emphasized.

Treatment	Indication/Type	Notes/Outcomes	Source(s)
Antibiotics	BV, trichomoniasis	Metronidazole, clindamycin	2 3 6 8
Antifungals	Candidiasis	Fluconazole, topical azoles	2 3 6
Hormone Therapy	Atrophic vaginitis	Topical/systemic estrogen	3 6
Partner Therapy	Trichomoniasis	Treat partners to prevent recurrence	2 3 8
Probiotics	Adjunctive/preventive	May restore flora, reduce recurrence	13 14 16
Avoid Irritants	Non-infectious	Discontinue offending agents	2 5 3
Other/Novel	Natural remedies, e.g., tamanu oil	Early evidence, supportive care	15

Table 4: Treatment Options

Standard Medical Therapies

Bacterial Vaginosis

• Antibiotics: Oral or topical metronidazole and clindamycin are first-line treatments, with similar efficacy 2 3 6.
• Newer Diagnostic Tests: Molecular tests can accurately identify BV, improving treatment selection 12.
• Partner Therapy: Not generally recommended unless recurrent or complicated 8.

Vulvovaginal Candidiasis

• Antifungals: Oral fluconazole or topical azoles are effective; topical azoles are preferred during pregnancy 2 3 6.
• Culture and Sensitivity: Needed for recurrent or non-albicans cases 2 6.
• Partner Therapy: Not usually required unless infection is recurrent and partners are symptomatic 8.

Trichomoniasis

• Antiprotozoals: Single-dose oral metronidazole or tinidazole is standard; both patient and sexual partners must be treated to prevent reinfection 2 3 6 8.
• Lab Diagnosis: Nucleic acid amplification tests are recommended for accurate diagnosis 2.

Atrophic Vaginitis

• Estrogen Therapy: Topical or systemic estrogen effectively relieves symptoms by restoring mucosal health 3 6.

Non-infectious Vaginitis

• Eliminate Irritants: Discontinue exposure to offending chemicals or foreign bodies 2 5 3.
• Steroid/Antibiotic Creams: May be used for inflammatory forms, under medical supervision 2.

Adjunctive and Preventive Approaches

Probiotics and Diet

• Probiotics: Supplementation with Lactobacillus strains can help restore and maintain healthy vaginal microbiota, reduce recurrence, and improve cure rates in BV and candidiasis 13 14 16.
• Diet: Healthy eating patterns may support vaginal and gut microbiome balance, though more research is needed 16.

Natural Remedies

• Tamanu Oil: Early studies suggest potential benefits in healing and anti-inflammatory effects but more data is needed before routine use 15.

Diagnosis and Follow-Up

Accurate diagnosis is essential for effective treatment. Wet mount microscopy, pH testing, and molecular assays are valuable tools 1 3 12. Self-collected swabs can be as accurate as clinician-collected in molecular testing, expanding access to care 12. Recurrence is common, so follow-up and prevention strategies are important.

Conclusion

Vaginitis remains a prevalent and impactful condition, but with proper knowledge and evidence-based approaches, it can be managed effectively. Here are the main points to remember:

• Symptoms: Include discharge, odor, itching, irritation, burning, and pain—often overlapping between types.
• Types: The most common are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, with atrophic and allergic/irritant forms also significant.
• Causes: Range from infectious (bacteria, fungi, protozoa) to hormonal changes, chemical exposures, and immune factors.
• Treatment: Targeted therapy (antibiotics, antifungals, hormones), removal of irritants, and adjunctive probiotic or dietary interventions are effective; accurate diagnosis is key.

By staying informed and attentive to symptoms, women can work with healthcare providers to achieve rapid relief and long-term vaginal health.