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:

Note that bacterial vaginosis does not cause vaginitis; bacterial vaginosis causes non-inflammatory and malodorous vaginal discharge.

Clues to some causes of vaginal discharge

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 cervical or endometrial 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, and it can also be a sign of vaginitis.

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 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 for vaginitis

Vaginitis is evaluated by speculum examination of the vagina and cervix, as well as an examination of the abdomen, groin and genital skin (vulva). In some cases, examination under anaesthetic (EUA) is necessary, including hysteroscopy (examination of the inside of the womb). Other investigations may include:

  • Evaluation of vaginal pH
  • Wet mount and high vaginal swabs for microscopy, culture and sensitivity. 
  • Midstream urine microscopy and culture
  • Biopsy.

Wet mount

Microscopy of a wet smear evaluates epithelial cells and patterns of micro-organisms. The results may be difficult to interpret, as bacteria and yeasts may be found in the normal vaginal flora.

pH measurement

Measurement of pH can help determine the likelihood of a particular cause of vaginitis.

High pH (> 5) is associated with bacterial vaginosis, aerobic vaginitis, trichomoniasis, and non-infectious causes of vaginitis, such as:

Normal or acidic pH is associated with candida vulvovaginitis, Group A streptococcal vaginitis (rare), and normal microbiome. Symptoms may be due to vulval and external conditions, such as contact allergic or irritant dermatitis, seborrhoeic dermatitis, and flexural psoriasis.

Treatment of vaginitis

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

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.

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