Vaginitis

– Infection and inflammation of the vaginal mucosa, often extending secondarily to the vulva.

Causes and Incidence

Most vaginitis is caused by bacteria (Gardnerella vaginalis), protozoa (Trichomonas vaginalis), fungi (Candida sp.), and viruses (human papilloma virus). Other causes include mechanical forces (foreign objects, vigorous wiping or cleansing); irritating chemicals found in douches, deodorant sprays, laundry soaps, and bathwater additives; and sensitivity to spermicides, latex condoms, or latex diaphragms. Tight, nonporous, nonabsorbent underclothing or poor hygiene may foster growth of pathogens. Women exposed to diethylstilbestrol have vaginal adenosis, which can produce a vaginal discharge. Older, postmenopausal women have vaginal and mucosal atrophy, which predisposes them to infection. Vaginitis is a common disorder, and most women can expect to have at least one vaginal infection in their lifetime. All age groups are at risk. In the reproductive years, vaginitis is usually caused by infection. Premenopausal and postmenopausal causes are more often mechanical or chemical.

Disease Process

The causative agent sets up an infective or inflammatory process. Infective agents invade and grow in the warm, moist environment of the vagina, often aided by a decrease in acidity and an increase in the sugar level in the vaginal environment. Infective agents are often introduced by sexual activity (Trichomonas and Gardnerella spp., papilloma virus) or are part of the normal vaginal flora (Candida albicans) that overgrow when vaginal conditions are ripe, such as before menstruation and during pregnancy. Inflammation occurs with mechanical, chemical, or other sensitivity, often with an inadequately lubricated or a thinning vaginal mucosa.

Symptoms

The most common presenting sign is vaginal discharge with or without itching, odor, or pain.

Mechanical/chemical
Increase in clear, viscous discharge; burning; redness; itching.

Bacterial (Gardnerella)
Malodorous (fishy) white or grayish yellow discharge; itching, burning.

Protozoan (Trichomonas)
Copious frothy, bubbly, greenish gray, malodorous discharge; itching, dyspareunia; vulvar edema, hyperemia.

Viral (papilloma virus)
Vaginal or vulvar warts, discharge, odor; spotty bleeding.

Fungi (C. albicans)
Thick, cheesy white or yellow discharge; intense itching, redness.

Atrophic
Itching, dryness, redness, irritation, burning, spotty bleeding.

Potential Complications

Chronic vulvitis and vulvar dystrophies can occur and are most often seen after menopause.

Diagnostic Tests

The diagnosis is made by the history, a pelvic examination, and a wet smear or culture to identify the causative organisms. Pap smears and biopsies may be done to rule out cancer.

Treatments

Surgery
Laser therapy, cautery, or cryotherapy to remove warts.

Drugs
Topical or systemic antiinfective drugs to treat specific causative pathogen; treatment of sex partner for pathogens; estrogen supplements with atrophic vaginitis.

General
Removal of chemical, mechanical, or other sources of irritation; instruction about vaginal hygiene; use of loose underwear that breathes (i.e., cotton).