Vaginal discharge? Vaginal irritation? Odor? What to do? Vaginal infections are exceedingly common. In fact, they are so common that the majority of women will experience at least one in her lifetime. Vaginitis complaints are responsible for roughly 10% of doctor visits each year, amounting to nearly $10 million in annual costs.
Outlined below are the major causes of vaginal infections, associated complications, and how they are identified and treated.
The majority of vaginitis cases in women of childbearing age can be attributed to bacterial vaginosis (BV), yeast vaginitis, and trichomoniasis.
Bacterial vaginosis (BV) is the most common cause of infectious vaginitis, and is characterized by white, thin discharge with a fishy odor, and elevated vaginal pH that is often attributed to an imbalance of normal vaginal bacteria. Some women note symptoms are worse after intercourse or menses, while others experience no symptoms at all. It is important to treat symptomatic BV because this disruption in vaginal flora has been shown to increase risk for acquiring and transmitting sexually transmitted infections (STIs). Additionally, BV can lead to poor pregnancy outcomes. Your provider can diagnose this condition after doing a pelvic exam and collecting a sample of vaginal fluid. Conventional treatment primarily includes oral or vaginal antibiotics. Natural agents such as boric acid suppositories, vitamin C suppositories, and very specific species of probiotics may be sufficient in some cases or may augment conventional treatment in other cases. Unfortunately, BV recurs in as many as 58% of women who were previously treated and experienced resolution. For these cases we can look to other factors that may influence the existence of BV like biofilms that can harbor bacteria, preventing adequate exposure to antibiotics. Additionally, douching, low vitamin D status, smoking, diet, and stress may play a role in development and recurrence of BV.
Yeast vaginitis is also known as vulvovaginal candidiasis (VVC) and can cause symptoms of itching, burning, pain with intercourse, red and inflamed tissue, along with a yellow-white “cottage cheese” discharge. The most common culprits are Candida albicans (80–90 % of symptomatic cases), Candida glabrata (2–5 %), and Candida krusei (1-2 %). VVC is one of the most common vaginal infections – responsible for 40-50 % of all vaginal infections. About 75% of reproductive aged women will experience at least one episode of VVC. Unfortunately, up to 50% of these women will develop a second infection of VVC and up to 5% will become recurrent cases. Conventional treatment includes oral or local antifungal and restoration of the vaginal microbiota. In addition to conventional treatments, Naturopathic physicians may use botanical/nutraceutical antifungal agents to re-establish normal vaginal flora, as well as address gastrointestinal function and flora and many other risk factors for development and recurrence of VVC, namely, diet, lifestyle, and co-morbid conditions.
Trichamoniasis symptoms can range from none at all to including a thin, foamy, yellow-green discharge, vaginal itching, burning sensation or odor, pain with urination, lower abdominal pain, and irregular spotting especially after penetrative intercourse. Your doctor will do a pelvic exam and in addition to the discharge, may see red spots on your cervix, a presentation that is referred to as “strawberry cervix,” although this finding is rare. During the examination, your provider will likely take a sample of the discharge for testing and will likely note an elevated vaginal pH greater than 5. If trichamoniasis is confirmed, you will be prescribed an antibiotic to treat the infection. And since trichamoniasis is a sexually transmitted infection (STI), it warrants testing and treatment of your sexual partner as well.
Aerobic vaginitis (AV) is caused by aerobic bacteria, for example: Staphylococci, Streptococci, E. coli, E. faecalis, to name a few. Symptoms include vaginal redness, inflammation, and burning with a persistent green, yellow, gray discharge, and elevated vaginal pH. Your provider will test a sample of the discharge and if aerobic bacteria are confirmed, treat with antibiotics that are specific to the pathogenic bacteria and steroids for inflammation. A naturopathic approach can include the use of the antibiotics along with vaginal ecology restoration with select species of probiotics along with supporting overall immune health.
Mixed vaginitis can include a combination of the bacteria responsible for causing bacterial vaginosis and/or aerobic vaginitis and/or yeast vaginitis. Symptoms can include a yellow-green discharge, and a burning sensation, redness, and inflammation of the vulva/vagina. Examination and laboratory evaluation of vaginal discharge is very important so that targeted treatment may be used to eradicate the problematic bacteria. Restoration of healthy normal vaginal bacteria is also important as well as addressing any potential lifestyle factors that could have led to the infection.
Cytolytic vaginitis is a controversial condition where the abundant growth of lactobacilli results in the breakdown of vaginal epithelial cells. Symptoms mimic those of yeast vaginitis: vaginal/vulvar itching, burning, pain with intercourse and urination, and may be accompanied with a discharge. Treatment may include a sodium bicarbonate vaginal rinse as well as stress management and blood sugar control.
Chlamydia and gonorrhea are the most common bacterial causes of sexually transmitted infections. In women there are rarely symptoms indicating either infection, however, some women experience yellow vaginal discharge, urinary urgency or frequency, pain with urination, bleeding between periods, or pain with sex. Routine STI testing is highly recommended as once an infection is identified, targeted treatment can be administered to you and your partner. Left untreated, both gonorrheal and chlamydial infections can cause pelvic inflammatory disease (PID), ectopic pregnancy, chronic pelvic pain, and infertility and other severe complications. Other sexually transmitted infections like herpes simplex virus (HSV) and syphilis may also cause an abnormal vaginal discharge.
As you can see, there are numerous types of vaginal infections that can present similarly. As such, it is important that you see your provider so that proper assessment and possibly testing be performed in order to get you the most appropriate treatment. If you are experiencing any of these symptoms contact your provider for an office visit.