Vaginal Infection

Vaginal infections are common conditions that affect many women throughout their lives, causing symptoms like unusual discharge, itching, burning, and discomfort. These infections can result from bacteria, yeast, parasites, or other factors that upset the natural balance in the vagina.

Table of contents

• What Is a Vaginal Infection?
• Types of Vaginal Infections
• Common Signs and Symptoms
• What Causes Vaginal Infections?
• How Doctors Diagnose Vaginal Infections
• Treatment Options
• Preventing Vaginal Infections
• When to See a Doctor

What Is a Vaginal Infection?

• Vagina
• Vulva

vaginitis, vulvovaginitis

A vaginal infection, also called vaginitis, happens when the vagina (the birth canal inside your body) becomes inflamed. This means the vagina might be swollen, itchy, or sore. You might also notice an unusual discharge (liquid) or an odd smell^[1]. Sometimes the vulva (the outside part of your genitals, including the labia and clitoris) is also affected. When both areas are inflamed, doctors call it vulvovaginitis^[1].

Vaginal infections are one of the most common reasons women visit their doctor, accounting for millions of visits each year^[6]. An estimated 75% of women will have at least one episode of a vaginal infection during their lives^[4]. Many women will experience two or more infections^[4].

Types of Vaginal Infections

There are several different types of vaginal infections, and each has different causes. The most common types include^[1][3]:

Bacterial vaginosis (BV) is the most frequent cause of vaginal infections, responsible for 40% to 50% of cases when a cause is identified^[14]. A healthy vagina contains a balance of many different kinds of bacteria and other tiny organisms. BV happens when one type of bacteria, usually Gardnerella vaginalis bacteria, grows too much and upsets this balance^[1]. This is not considered a typical infection but rather a change in the balance or overgrowth of the normal bacteria in the vagina^[6].

Yeast infections, also called vaginal candidiasis, account for 20% to 25% of vaginal infection cases^[14]. These infections occur when a type of fungus called Candida, typically Candida albicans, grows too much^[1][4]. Small amounts of this fungus normally live in your mouth, digestive system, and vagina without causing any problems. However, when the fungus multiplies out of control, it leads to an infection^[4].

Trichomoniasis is caused by a parasite spread during sex and accounts for 15% to 20% of vaginal infection cases^[14]. This infection causes a yellow-green, frothy discharge and can raise your risk of other sexually transmitted infections^[1].

Chlamydia is the most common sexually transmitted infection, especially among people ages 15-24 years who have multiple sex partners^[1].

Viral vaginitis is inflammation caused by a virus, such as the herpes simplex virus or human papillomavirus. Both spread through sexual contact and can cause painful sores or warts^[1].

Noninfectious vaginitis happens when something irritates your vagina. This accounts for 5% to 10% of vaginitis cases^[14]. It’s often caused by chemicals in soaps, douches, and other hygiene products. You might be allergic to these products, or your vagina might simply be sensitive to them^[1].

Vaginal atrophy occurs when you have low estrogen levels, usually after menopause or surgical removal of the ovaries. The hormonal changes can make the vagina dry, thin-skinned, and easily irritated^[1].

Common Signs and Symptoms

Vaginal infection symptoms can vary depending on the type of infection you have. However, symptoms alone cannot tell you which type of infection you have, so testing is important^[14].

Common signs of vaginal infections include^[3][8]:

• Change in the color, odor, or amount of discharge from your vagina
• Vaginal itching or irritation
• Pain during sex
• Painful urination
• Light vaginal bleeding or spotting
• Redness and swelling around your vulva and vagina

The characteristics of vaginal discharge can provide clues about the type of infection^[3]:

• Bacterial vaginosis typically causes a grayish-white, foul-smelling discharge. The odor is often described as a fishy smell that might be more noticeable after sex^[3].
• Yeast infections usually cause intense itching and may produce a thick white discharge that looks like cottage cheese^[3][4]. You might also notice small cuts or tiny cracks in the skin of your vulva^[4].
• Trichomoniasis often produces a greenish-yellow, sometimes frothy discharge with a fishy odor^[3].

It’s important to know that many women with bacterial vaginosis don’t experience any symptoms at all^[9]. Similarly, not all vaginal infections cause obvious symptoms.

What Causes Vaginal Infections?

Vaginal infections happen when something upsets the natural balance in your vagina. A healthy vagina normally maintains an acidic environment and contains protective bacteria called lactobacilli. When this balance is disrupted, infections can develop^[6].

Several factors can make infections more likely^[6]:

Reduced acidity in the vagina: The pH in the vagina is usually acidic. When this acidity decreases, the number of protective bacteria drops, and the number of bacteria that can cause inflammation increases. Menopause, semen, vaginal products, or infection can change the pH in the vagina^[6].

Taking antibiotics: Antibiotics that treat infections in your body also kill the good bacteria in your vagina. Without these good bacteria, yeast and harmful bacteria can grow too much, leading to an infection^[4][5].

Hormonal changes: Anything that disrupts or changes your hormones can upset the balance in your vagina. This includes being pregnant, using birth control pills, and normal changes during your menstrual cycle^[4]. Pregnancy causes hormonal shifts that can affect the balance of vaginal yeast and bacteria. For example, increased levels of estrogen create favorable conditions for yeast to grow^[5].

Weakened immune system: Having a disease that weakens your immune system can make you more susceptible to vaginal infections^[4].

Unmanaged diabetes: Yeast thrives on sugar. When diabetes is not well controlled, the extra sugar in your urine helps yeast grow and multiply. Unmanaged diabetes can also weaken your immune system^[4][5].

Other factors that increase your risk include^[4][6]:

• Staying in wet clothes or swimsuits
• Wearing tight, non-breathable clothing
• Using scented tampons, sprays, soaps, or deodorants
• Prolonged exposure to moisture, such as sitting in a bath or not changing menstrual or incontinence pads frequently
• Irritation or allergic reactions to soaps or other vaginal products

Sexual activity can also play a role. While most vaginal infections are not sexually transmitted infections, trichomoniasis spreads through sexual contact^[1]. Additionally, there is an increased risk of getting a yeast infection when you first become sexually active, and there has been a link between oral sex and yeast infections^[5].

How Doctors Diagnose Vaginal Infections

Diagnosing a vaginal infection requires more than just knowing your symptoms. Your doctor will use a combination of your medical history, physical examination, and testing to determine what type of infection you have^[14].

During your visit, your doctor may^[3][12]:

• Ask questions about your medical history, including any previous vaginal infections or sexually transmitted infections
• Perform a pelvic exam to look at your vagina for signs of infection and to check your pelvic organs
• Take a sample of vaginal discharge to examine under a microscope or send to a laboratory
• Test your vaginal pH using a pH strip placed in your vagina

For bacterial vaginosis, the diagnosis can be made using what doctors call Amsel criteria, although a test called a Gram stain is considered the diagnostic standard^[14]. The sample may be tested for “clue cells,” which are vaginal cells covered in bacteria and indicate bacterial vaginosis^[12]. A vaginal pH of 4.5 or higher is also a sign of bacterial vaginosis^[12].

For yeast infections, a doctor will examine a sample with a substance called potassium hydroxide under a microscope to look for yeast. If the diagnosis is unclear, your doctor may take a culture to identify the specific type of yeast^[1][4].

For trichomoniasis, newer laboratory tests that detect genetic material from the parasite are recommended for diagnosis in women with symptoms or those at high risk^[14].

It’s important not to try to diagnose yourself. Many women who think they have a yeast infection actually have a different condition^[1]. Self-diagnosis and treatment with over-the-counter medications can actually disrupt the balance of your vaginal bacteria and may lead to infections that resist treatment^[1].

Treatment Options

Treatment for vaginal infections depends on which type you have. Your doctor will recommend the appropriate medication based on your diagnosis.

Bacterial vaginosis treatment: Doctors typically prescribe antibiotics for bacterial vaginosis. The most common options include^[12][15]:

• Metronidazole taken by mouth, either as 400 mg or 500 mg twice daily for 7 days, or as a single 2-gram dose
• Metronidazole gel applied inside the vagina
• Clindamycin cream applied inside the vagina or taken by mouth as 300 mg twice daily for 7 days

If you take metronidazole, you should avoid drinking alcohol during treatment and for at least a full day afterward, as it can cause nausea or stomach pain^[12]. During pregnancy, metronidazole should ideally be avoided in the first trimester^[15].

Yeast infection treatment: Most vaginal yeast infections are treated with antifungal medications^[4]. These come in two forms:

• Topical medications include creams or suppositories that you insert into your vagina. Common options include miconazole, clotrimazole, and terconazole. These are used daily for up to seven days^[13]. Some topical medications are available over the counter, while others require a prescription.
• Oral medication is usually fluconazole 150 mg taken as a single dose by mouth^[4][13].

During pregnancy, only topical antifungal medications should be used; oral medications are not recommended^[13]. The creams and suppositories in these treatments are oil-based and may weaken latex condoms and diaphragms, so avoid sexual intercourse during treatment or use non-latex barriers^[13].

Trichomoniasis treatment: This infection is treated with antibiotics, typically^[15]:

• Metronidazole 2 grams as a single oral dose, or 400 mg to 500 mg twice daily for 7 days
• Tinidazole 2 grams as a single oral dose, or 500 mg twice daily for 5 days

It’s important that your sex partners also receive treatment to prevent reinfection^[1].

Noninfectious vaginitis treatment: Treatment should focus on identifying and removing the irritating substance. For vaginal atrophy, doctors may recommend hormonal or non-hormonal therapies^[14].

With proper treatment, most vaginal infections get better within a few days^[21]. Follow-up care is important to make sure the treatment worked. If your symptoms don’t improve after 2 days of treatment or if they return after you finish your medication, contact your doctor^[21].

Preventing Vaginal Infections

While you cannot prevent all vaginal infections, there are several steps you can take to reduce your risk^[22][23]:

Practice good hygiene: Keep your vaginal area clean using mild, unscented soap and water. Wash the vulva no more than once a day and let it air-dry^[21][22]. After using the bathroom, wipe from front to back to avoid spreading bacteria from the anus to the vagina^[6][22].

Choose the right clothing: Wear cotton underwear or underwear with a cotton crotch, as cotton keeps you cooler and drier than synthetic fabrics^[22]. Avoid tight pants and non-breathable clothing^[4]. Some women find it helpful to sleep without underwear^[21].

Stay dry: Change out of wet bathing suits and damp exercise clothes as soon as possible. Yeast thrives in warm, moist environments^[22][24]. Rinse off with water and change into dry clothes promptly after swimming or exercising^[24].

Avoid irritating products: Don’t use douches, powders, sprays, perfumes, or scented tampons in your vagina or on your vulva. These items can change the normal balance of organisms in your vagina^[21][22]. Use paraben-free, dye-free hypoallergenic soaps or even gentle cleansers meant for babies^[24].

Consider your diet: Eating yogurt with live bacterial cultures or taking probiotic supplements containing lactobacillus may help maintain a healthy vaginal balance^[18][24]. Reducing your intake of sugary foods and drinks may also help, as yeast feeds on sugar^[18][24]. However, make sure to choose yogurt without added sugar or sweeteners^[24].

Manage existing health conditions: If you have diabetes, work with your doctor to keep your blood sugar levels under control^[18]. If you need to take antibiotics, ask your doctor about also taking probiotics to help maintain your vaginal balance^[18].

Practice safe sex: Use barrier methods during sexual activity to reduce the risk of sexually transmitted infections. If you develop an infection, avoid sexual intercourse until you have completed treatment^[21].

When to See a Doctor

You should see a healthcare provider if you develop vaginal discomfort, especially if^[3][21]:

• You have a particularly unpleasant vaginal odor, discharge, or itching
• You’ve never had a vaginal infection before
• You have new or increased pain in your vagina or pelvis
• You have unexpected vaginal bleeding
• You develop a fever
• You are not getting better after 2 days of treatment
• Your symptoms come back after you finish your medicines

Seeing your healthcare provider can help establish the cause of your symptoms and ensure you receive the right treatment. This is especially important because many conditions can cause similar symptoms, and the treatment differs depending on what’s causing your discomfort^[3].

During pregnancy, vaginal infections require special attention. Untreated bacterial vaginosis during pregnancy can lead to health problems for your baby, including increased risk of premature birth and low birth weight^[1]. If you’re pregnant and notice any symptoms of a vaginal infection, contact your healthcare provider right away.