Genital Infection Female

Genital infections in women are very common conditions that affect the vagina and surrounding areas, causing symptoms like itching, discharge, and discomfort. Understanding these infections can help you recognize when to seek care and how to prevent future problems.

Table of contents

• What are female genital infections?
• Common types of vaginal infections
• Signs and symptoms
• Causes and risk factors
• How infections are diagnosed
• Treatment options
• Prevention strategies
• Infections during pregnancy

What are female genital infections?

Female genital infections are conditions that cause inflammation or infection of the vagina and the external genital area called the vulva (the outer part of the female genitals, including the labia and clitoris). When both areas are affected together, this is called vulvovaginitis^[1].

These infections are extremely common. Most women will experience at least one episode during their lives, making vaginal infections one of the most common reasons women visit their doctors^[1][3]. Up to 3 in 4 women will have a yeast infection at least once, and about half will have two or more^[3].

Vaginal infections can result from an overgrowth of organisms that normally live in the vagina, like bacteria or yeast. They can also be caused by organisms spread through sexual contact, or by irritation from chemicals in products like soaps or sprays^[4].

Common types of vaginal infections

The most common types of vaginal infections include bacterial vaginosis, yeast infections, and trichomoniasis^[4].

Bacterial vaginosis is the most frequent cause, accounting for 40% to 50% of cases when a cause is identified. This condition happens when there is an imbalance of the bacteria naturally found in the vagina. Normally, a healthy vagina maintains a balance of many different kinds of bacteria, yeast, and other microbes. When this balance is upset and one type of bacteria grows too much—usually a bacteria called Gardnerella vaginalis—bacterial vaginosis develops. It can cause a grayish-white discharge with a strong fishy smell, especially after sex^[1][4][8].

Yeast infections, also called vaginal candidiasis, account for 20% to 25% of vaginal infections. These are caused by an overgrowth of a fungus called Candida, usually Candida albicans. Small amounts of this fungus normally live in your mouth, digestive system, and vagina without causing problems. However, when the balance is disrupted, Candida can multiply out of control. The main symptom is itching, along with thick white discharge that looks like cottage cheese^[1][3][4].

Trichomoniasis causes 15% to 20% of vaginal infections. This infection is caused by a parasite called Trichomonas vaginalis and is spread through sexual contact. It can cause a greenish-yellow, sometimes frothy discharge^[1][4].

Other types of vaginal infections include viral vaginitis caused by viruses like herpes simplex or human papillomavirus, which can cause painful sores or warts^[1]. Noninfectious vaginitis occurs when chemicals in soaps, douches, and other hygiene products irritate the vagina^[1][4].

Signs and symptoms

Vaginal infections can cause various symptoms, though some women may not have any symptoms at all^[4]. Common signs include changes in vaginal discharge (color, odor, or amount), vaginal itching or irritation, pain during sex, painful urination, and light vaginal bleeding or spotting^[4].

For yeast infections, typical symptoms include itching or burning in or around the vagina, thick white discharge that resembles cottage cheese, redness and swelling around the vulva and vagina, small cuts or tiny cracks in the skin of the vulva, burning when urinating, and pain during sex^[3][10].

Bacterial vaginosis may cause a grayish-white discharge with a foul smell often described as fishy, which might be more noticeable after sexual intercourse^[4].

Trichomoniasis can produce a greenish-yellow, sometimes frothy discharge, along with vaginal itching or irritation^[4].

It’s important to know that symptoms alone cannot reliably distinguish between different types of vaginal infections. The symptoms of various infections often overlap, making proper diagnosis by a healthcare provider essential^[1][4].

Causes and risk factors

Vaginal infections develop when the normal balance of organisms in the vagina is disrupted. A healthy vagina is usually acidic, which helps control the growth of bacteria and yeast. When this acidity is reduced or the balance changes, infection can occur^[7].

Several factors can increase your risk of developing vaginal infections. Taking antibiotics is a common trigger because antibiotics kill both good and bad bacteria in your body. Without the good bacteria to maintain balance, yeast can overgrow, leading to a yeast infection^[3][10].

Hormonal changes during pregnancy, from using birth control pills, or during normal menstrual cycles can disrupt the balance of Candida in the vagina. Being pregnant increases the risk of yeast infections due to hormonal shifts^[3][10].

Having a weakened immune system or unmanaged diabetes makes you more susceptible to yeast infections. In diabetes, extra sugar in your urine helps yeast grow and multiply^[3][10].

Sexual activity can introduce new bacteria and change the vaginal environment, though yeast infections are not considered sexually transmitted infections^[3][10]. However, bacterial vaginosis and trichomoniasis can be associated with sexual activity. Bacterial vaginosis most often occurs in sexually active women, and factors like douching, not using condoms, and having new or multiple sex partners can upset the normal bacterial balance^[8].

Other risk factors include staying in wet clothes or swimsuits for prolonged periods, wearing tight or non-breathable clothing, and using scented tampons, sprays, soaps, or deodorants^[3][10].

How infections are diagnosed

Because symptoms alone cannot reliably identify the specific cause of a vaginal infection, proper diagnosis requires a healthcare provider’s evaluation. Self-diagnosis is not recommended, as it can lead to incorrect treatment and delays in proper care^[1][4].

Your doctor will typically start by asking about your medical history, including any previous vaginal infections or sexually transmitted infections^[4]. A pelvic exam will be performed to look at your vagina for signs of infection and to feel your pelvic organs^[4].

To confirm the diagnosis, your healthcare provider may take a sample of vaginal discharge for testing. This sample can be examined under a microscope or sent to a laboratory. For yeast infections, the test looks for budding yeasts, hyphae, or pseudohyphae. For bacterial vaginosis, the test checks for “clue cells”—vaginal cells covered in bacteria—and measures the vaginal pH level. A vaginal pH of 4.5 or higher suggests bacterial vaginosis^[3][4].

For trichomoniasis, newer laboratory tests that detect the organism’s genetic material are recommended for symptomatic or high-risk women^[8].

The combination of your symptoms and the test results will tell your healthcare provider what type of infection you have and how to treat it most effectively^[3][10].

Treatment options

Treatment depends on the specific type of vaginal infection you have^[1][4].

For bacterial vaginosis, doctors may prescribe metronidazole (Flagyl), which comes as a pill or topical gel, or clindamycin (Cleocin), available as a cream that you insert into the vagina. Oral metronidazole can be taken as a 400 mg or 500 mg tablet twice daily for 7 days, or as a single 2-gram dose. It’s important to avoid alcohol while using metronidazole and for a full day afterward, as it can cause nausea or stomach pain^[11][13].

Yeast infections are treated with antifungal medications, which work by fighting yeast overgrowth in your body. These medications can be either oral or topical. Topical treatments include creams and suppositories (small objects inserted into the vagina) used daily for up to seven days. Examples include miconazole (Monistat) and clotrimazole vaginal tablets. Oral treatment typically involves a single dose of fluconazole (Diflucan) taken by mouth. In non-pregnant women, oral and vaginal treatment options have similar effectiveness^{[3][10][13][14]}.

Trichomoniasis is treated with oral metronidazole or tinidazole. The medication can be given as a single 2-gram dose or as 400 mg to 500 mg twice daily for 7 days. It’s important that sexual partners are also treated to prevent reinfection^[13].

For noninfectious vaginitis caused by chemical irritation, treatment focuses on identifying and avoiding the irritating substance. If the cause is low estrogen levels after menopause (atrophic vaginitis), hormonal and non-hormonal therapies may help^[1].

It’s crucial to take all the medicine your provider prescribes, even if your symptoms go away before you finish the medication. This helps ensure the infection is fully treated and reduces the risk of it returning^[8].

Prevention strategies

While it’s not always possible to prevent vaginal infections, several lifestyle practices can help reduce your risk^[1].

Good hygiene is essential. Keep your vaginal area clean by washing daily with warm water and mild, unscented soap. Use your fingers instead of a washcloth, and avoid washing inside your vagina, as the vagina naturally cleans itself. Excessive washing or using chemicals can be irritating^[1]. Always wipe from front to back after using the toilet to prevent bacteria from spreading from the anus to the vagina^[7].

Avoid products that can disrupt your vaginal balance. Do not douche, as it can upset the natural bacterial environment in your vagina and cause infections or irritation. Skip feminine washes, scented soaps, vaginal sprays, douches, and other products marketed for vaginal hygiene, as they can throw off your natural pH balance^[1][7].

Choose appropriate clothing. Wear loose-fitting clothes and cotton underwear, which keeps your genital area dry and allows it to breathe better. Cotton is preferable to synthetic materials because it keeps you cooler and drier. Avoid wearing tight pants or thong underwear. Change out of wet bathing suits and damp exercise clothes as soon as possible, since yeast thrives in warm, moist environments^[3][10].

Sexual health practices can also help. For bacterial vaginosis prevention, consider limiting your number of sex partners and using condoms correctly every time you have sex. If you’re sexually active and get recurrent yeast infections, avoid sexual contact until you see a doctor, as you could pass the infection to your partner^[8].

If you’re taking antibiotics, consider taking probiotics at the same time. Probiotics can help maintain the balance of good bacteria in your body. Some women find that consuming yogurt with live bacterial cultures or taking probiotic supplements helps prevent yeast infections^[1].

Infections during pregnancy

Vaginal infections are more common after menopause and during pregnancy due to hormonal changes. When you’re pregnant, your hormone levels change, which can lead to yeast infections, bacterial vaginosis, and other forms of vaginitis^[1].

It’s especially important to treat vaginitis during pregnancy because these infections can cause health problems for your baby. If you’re pregnant and have bacterial vaginosis, your baby is more likely to be born early (premature) or at a low birth weight. Low birth weight means having a baby that weighs less than 5.5 pounds at birth^[8].

Treating bacterial vaginosis during pregnancy is very important and can improve symptoms. However, research shows that antibiotic treatment of bacterial vaginosis in pregnancy does not reduce the risk of preterm birth, even in women with a history of preterm labor in previous pregnancies^[16].

During pregnancy, treatment options may be limited. In the first trimester, metronidazole should ideally be avoided. Only topical azole medications (not oral fluconazole) are recommended for treating yeast infections during pregnancy^[13][15].

If you experience any symptoms of a vaginal infection while pregnant, contact your healthcare provider promptly for proper evaluation and treatment.