Vaginitis

Author: Dr Amanda Oakley, Dermatologist, Waikato Hospital, Hamilton New Zealand, 2009.

What is vaginitis?

Vaginitis is the term used to describe inflammatory conditions affecting the female vagina. It is sometimes called vaginal mucositis. Vaginitis may be associated with vulval (genital skin) conditions.

Vaginitis may result in vaginal soreness, itching, discharge, malodour, fissuring and bleeding. It may hurt to pass urine (dysuria). It may prevent sexual intercourse (apareunia) or result in painful or uncomfortable sexual intercourse (dyspareunia).

What are the causes of vaginitis?

Although most often due to infection, vaginitis may be due to one or more causes. These include:

Clues to some causes of vaginal discharge
Normal Thin to thick, clear or slightly white or yellow, minimal to profuse discharge
Retained tampon Increasingly foul-smelling, bloody discharge
Candidiasis Cottage cheese-like, thick discharge
Bacterial vaginosis Fishy, greyish discharge
Trichomoniasis Foul-smelling, thick discharge
Desquamative vaginitis Culture negative, bloody discharge
Erosive lichen planus Intense soreness, burning

Menstrual bleeding usually occurs for a few days at regular monthly intervals. Intermenstrual spotting can be quite normal. However, vaginal bleeding after established menopause may be serious and requires investigation as it may be an important sign of early cancer.

Vaginal dryness

Vaginal dryness is a common problem that significantly reduces women's enjoyment of sex. It is due to reduced vaginal natural lubrication.

Normal vaginal discharge is produced by mucus glands in the cervix and vagina, which mix with desquamating cells from the lining of the vagina. During arousal (orgasm), additional musk-smelling fluid is produced by the Bartholin glands at the entrance to vagina to reduce friction caused by penetration of a penis.

Lack of oestrogen due to menopause (atrophic vaginitis) or infancy reduces vaginal mucus production. This may cause atrophic vaginitis, resulting in postmenopausal dryness, burning and lack of sexual desire (decreased libido).

Vaginal dryness in premenopausal women may be caused by menstrual cycle hormonal fluctuations, pregnancy or Sjögren syndrome. Certain medications may dry up normal vaginal fluids, such as some oral contraceptive pills, depot progesterone injections, sedatives, heart pills, cold or allergy medicines.

Investigations

Vaginitis always requires thorough speculum examination of the vagina and cervix, as well as an examination of the abdomen, groin and genital skin (vulva). In some case examination under anaesthetic (EUA) is necessary, including hysteroscopy (examination of the inside of the womb).

Wet smear and high vaginal swabs should be taken for laboratory microscopy, culture and sensitivity. The results may be difficult to interpret as bacteria and yeasts may be found in the normal vaginal flora.

Additional tests may include midstream urine microscopy and culture.

Treatment

In general, the vagina does not need to be washed (douched), as it regularly cleans itself. Gently cleanse the outside skin with water. A non-soap cleanser may be used.

Water-based vaginal lubricant before and during sex, and/or a vaginal moisturiser inserted several times each week can make intercourse easier and less uncomfortable.

Treatment of vaginitis depends on the underlying cause. It may include:

Related information

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