Also indexed as: Atrophic Vaginitis, Bacterial Vaginosis, Gardnerella Infection, Hormone-Related Vaginitis, Irritant Vaginitis, Trichomoniasis, Vulvovaginitis
Vaginitis is inflammation of the vagina.
Vaginitis is responsible for an estimated 10% of all visits by women to their healthcare practitioners. The three general causes of vaginitis are hormonal imbalance, irritation, and infection. Hormone-related vaginitis includes the atrophic vaginitis generally found in postmenopausal or postpartum women and, occasionally, in young girls before puberty. Irritant vaginitis can result from allergies or irritating substances. Infectious vaginitis is most common in reproductive-age women and is generally caused by one of three types of infections: bacterial vaginosis (BV), candidiasis (yeast infection), or trichomoniasis. A healthcare professional should be consulted for the diagnosis and treatment of any vaginal infection.
Although it is a type of vaginitis, yeast infection is not discussed on this page. For specific information on yeast infections (i.e., vaginitis caused by Candida albicans), see the yeast infections article.
Checklist for Vaginitis
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Hormone-related vaginitis is marked by dryness, irritation, thinning of the vaginal mucous membranes and painful intercourse. Irritant vaginitis is characterised by itching and soreness. Infectious vaginitis also itches and typically includes vaginal discharge that varies in colour, consistency, and odour, depending upon the infectious organism. Discharge may range from scant to thick and white and may or may not be accompanied by a strong odour. Symptoms are often worse immediately after intercourse or the menstrual period.
Over the counter drugs are available to treat vaginitis caused by candida. They include clotrimazole (Gyne-Lotrimin®, Mycelex®), miconazole (Monistat®), and butoconazole (Femstat®). Irritant vaginitis can be treated either by removal of the offending irritant or with an antihistamine agent, such as diphenhydramine (Benadryl®).
Prescription drug therapy varies with the cause of the vaginitis. Hormone-related vaginitis is commonly treated with oestrogen replacement therapy, including conjugated oestrogens (Premarin®), estradiol (Estrace®), and ethinylestradiol (Estinyl®). Bacterial vaginosis and trichomoniasis are each commonly treated with metronidazole (Flagyl®).
Food allergies are believed to be a contributory factor in some cases of recurrent irritant vaginitis.
In a controlled trial, women with recurrent BV or vaginal candidiasis ate 5 ounces (150 grams) of yoghurt containing live Lactobacillus acidophilus daily.1 They had more than a 50% reduction in recurrences, while women who consumed pasteurisedyoghurt that did not contain the bacteria had only a slight reduction.
In another study, women who ingested 45 grams of soya flour per day showed an improvement in the oestrogen effect on their vaginal tissue.2 That observation suggests that supplementing with soya may be helpful for preventing or reversing atrophic vaginitis.
For irritant vaginitis, minimizing friction and reducing exposure to perfumes, chemicals, irritating lubricants, and spermicides can be beneficial.
Lactobacillus acidophilus is a strain of friendly bacteria that is an integral part of normal vaginal flora. Lactobacilli help maintain the vaginal microflora by preventing overgrowth of unfriendly bacteria and Candida. Lactobacilli produce lactic acid, which acts like a natural antibiotic. These friendly bacteria also compete with other organisms for the utilization of glucose. The production of lactic acid and hydrogen peroxide by lactobacilli also helps to maintain the acidic pH needed for healthy vaginal flora to thrive. Most of the research has used yoghurt containing live cultures of Lactobacillus acidophilus or the topical application of such yoghurt or Lactobacillus acidophilus into the vagina. The effective amount of acidophilus depends on the strain used, as well as on the concentration of viable organisms.
Vaginal application of a proprietary Lactobacillus acidophilus preparation may help nonspecific vaginitis. In one trial, 80% of women with nonspecific vaginitis who used the preparation were either cured or experienced marked improvement in symptoms.3 In another trial, women who were predisposed to vaginal Candida infection because they were HIV-positive received either Lactobacillus acidophilus vaginal suppositories, the antifungal drug, clotrimazole (e.g., Gyne-Lotrimin®), or placebo weekly for 21 months.4 Compared to those receiving placebo, women receiving Lactobacillus acidophilus suppositories had only half the risk of experiencing an episode of Candida vaginitis—a result almost as good as that achieved with clotrimazole. In a preliminary trial, women with vaginal Trichomonas infection received vaginal Lactobacillus acidophilus suppositories for one year.5 Over 90% of them were reported to be cured of their clinical symptoms in that time.
Some doctors recommend vitamin E (taken orally, topically, or vaginally) for certain types of vaginitis. Vitamin E as a suppository in the vagina or vitamin E oil can be used once or twice per day for 3 to 14 days to soothe the mucous membranes of the vagina and vulva. Some doctors recommend vaginal administration of vitamin A to improve the integrity of the vaginal tissue and to enhance the function of local immune cells. Vitamin A can be administered vaginally by inserting a vitamin A capsule or using a prepared vitamin A suppository. Vitamin A used this way can be irritating to local tissue, so it should not be used more than once per day for up to seven consecutive days.
Topically applied tea tree oil has been studied and used successfully as a topical treatment for Trichomonas, Candida albicans, and other vaginal infections.6 Tea tree oil must be diluted when used as a vaginal douche, and should only be used for this purpose under the supervision of a healthcare practitioner. Some physicians suggest using tea tree oil by mixing the full-strength oil with vitamin E oil in the proportion of 1/3 tea tree oil to 2/3 vitamin E oil. A tampon is saturated with this mixture or the mixture is put in a capsule to be inserted in the vagina each day for a maximum of six weeks.
Teas of goldenseal, barberry, and echinacea are also sometimes used to treat infectious vaginitis. Although all three plants are known to be antibacterial in the test tube, the effectiveness of these herbs against vaginal infections has not been tested in humans. The usual approach is to douche with one of these teas twice each day, using 1–2 tablespoons (15–30 grams) of herb per pint of water. One to two pints (500–1,000 ml) are usually enough for each douching session. Echinacea is also known to improve immune function in humans.7 In order to increase resistance against infection, many doctors recommend oral use of the tincture or alcohol-preserved fresh juice of echinacea (1 teaspoon (5 ml) three or more times per day)—during all types of infection—to improve resistance.
1. Shalev E, Battino S, Weiner E, et al. Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent Candidal vaginitis and bacterial vaginosis. Arch Fam Med 1996;5:593–6.
2. Wilcox G, Wahlqvist M, Burger H, et al. Oestrogenic effects of plant foods in postmenopausal women. BMJ 1990;301:905–6.
3. Karkut G. Effect of lactobacillus immunotherapy on genital infections in women. Geburtshilfe Frauenheilkd 1984;44:311–4 [in German].
4. Williams A, Yu C, Tashima K, et al. Weekly treatment for prophylaxis of Candida vaginitis. Presentation. 7th Conference on Retroviruses and Opportunistic infections. Foundation for Retrovirology and Human Health in collaboration with the (US) National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention. January 30–February 2, 2000.
5. Litschgi MS, Da Rugna D, Mladenovic D, Grcic R. Effectiveness of a lactobacillus vaccine on Trichomonas infections in women. Preliminary results. Fortschr Med 1980;98:1624–7 [in German.]
6. Pena E. Melaleuca alternifolia oil: Its use for trichomonal vaginitis and other vaginal infections. Obstet Gynecol 1962;19:793–5.
7. Melchart D, Linde K, Worku F, et al. Immunomodulation with Echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245–54.
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2005.