Vaginal infection: what is vaginitis?
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Vaginal infection: what is vaginitis?

Vaginitis is an inflammation of the vagina that is most often due to infection, but not always.

To know everything about this disease, consult our article below.

What is vaginitis?

Vaginitis is an inflammation of the vagina that is most often due to infection, but not always. It results in irritation, itching, or painful sensations in the vulva or vagina, as well as “abnormal” vaginal discharge. It is also called vulvovaginitis.

This condition is relatively common: 75% of women will be affected at least once in their lives. Vaginitis is said to be the most frequent reason for medical consultation in women.

The different types of vaginitis

Infectious vaginitis

The most common vaginitis is caused by microorganisms, such as bacteria, viruses, parasites, or yeast (yeast is a microscopic fungus).

Infectious vaginitis can be caused by a disturbance in the balance of the vaginal environment. The vagina is an environment where many protective microorganisms live, which constitute the vaginal flora (or Döderlein flora).

The good balance of this flora prevents the multiplication of harmful bacteria or yeasts and prevents infections. The vaginal environment has a relatively acidic pH. Changes in pH or flora, but also abnormal levels of glucose, glycogen, antibodies, and other compounds in vaginal secretions can throw the vaginal flora out of balance. Similarly, age, sexual intercourse, pregnancy, contraceptive pills, hygiene measures, or clothing habits can disrupt the flora.

This can lead to an abnormal overgrowth of bacteria or fungi already present in the vagina. Yeast vaginitis caused by different types of yeast in the Candida family (also called mycosis or vaginal candidiasis) and bacterial vaginosis caused by Gardnerella vaginalis bacteria are the most common.

They can also be caused by a sexually transmitted infection (STI). The introduction of the parasite Trichomonas vaginalis into the vagina during sexual intercourse with an infected partner. This type of vaginitis is called trichomoniasis and is called an STI.

Atrophic vaginitis (resulting in vaginal dryness)

This type of vaginitis is caused by a drop in estrogen levels after surgical removal of the ovaries or at menopause. There is then a thinning and less of the vaginal mucosa, which becomes more sensitive and irritates more easily.

Irritation vaginitis

Vaginal inflammation can be caused by irritating chemicals or allergic reactions caused by spermicides, douching, detergents, scented soaps, fabric softeners, latex condoms used without lubricant or with too little lubricant, or prolonged use of a tampon.

Note: This document will focus on infectious vaginitis, which accounts for about 90% of vaginitis cases.

Possible complications of vaginitis

In general, vaginitis does not cause complications. However, they can be a problem in pregnant women. Indeed, vaginitis caused by bacteria or the parasite Trichomonas vaginalis can cause premature deliveries.

Bacterial vaginitis and trichomoniasis also increase the risk of contracting human immunodeficiency virus (HIV) and other infections during unprotected sex with an infected partner.

In addition, some vaginitis may tend to recur. Thus, nearly half of women who have had vaginal candidiasis will have a second infection. In total, about 5% of women of childbearing age have more than 4 candidiasis infections per year. However, recurrent vaginitis can significantly alter the quality of life and have significant consequences on the sexual life of affected women. They are also more difficult to treat.

Vaginitis is manifested by pain and itching in the vagina, and often in the vulva.

Discover the complete list of symptoms in this article.

Symptoms of vaginitis

  • Pain and itching in the vagina, and often in the vulva;
  • A significant change in the smell, abundance, texture, and color of vaginal discharge can be a sign of infectious vaginitis. In the case of yeast infection, the discharge is often whitish, with a curdled milk appearance. When it comes to bacterial infections, they are rather gray or yellowish and smelly;
  • irritation or burning during urination and sexual intercourse
  • swelling and redness of the vulva
  • slight vaginal bleeding, in rare cases

Many women carrying the agent of infectious vaginitis have no symptoms.

For example, the parasite Trichomonas vaginalis can remain in the vagina for several years without causing symptoms.

Some people are at higher risk of developing vaginitis.

Also, risk factors favor the onset of the disease.

Discover them here.

People at risk of vaginitis

  • Women with diabetes whose disease is not well controlled (therefore experiencing hyperglycemic attacks) are more prone to yeast infections, yeast being fond of glucose.
  • Pregnant women. Yeast infections are 10 to 20 times more common during pregnancy. Bacterial vaginosis is also more common, affecting 15% to 20% of pregnant women.27 The main reason would be the increase in estrogen levels, pH, vaginal glycogen levels, and blood sugar levels in pregnant women.

Risk factors for vaginitis

Yeast vaginitis and bacterial vaginosis

  • Fatigue caused by lack of sleep, dieting, stress, medication, illness, or any other condition that weakens the immune system;
  • taking antibiotics, as they destroy the natural bacterial flora of the vagina. Corticosteroids may also stimulate the growth of Candida;
  • taking the contraceptive pill in some women;
  • wearing synthetic fabric underwear and tight clothing, which retains body heat and creates a moist environment conducive to the growth of Candida yeast;
  • consumption of foods high in sugar;
  • estrogen treatment;
  • regular use of douching for “hygienic” purposes (3 or more times per month) or the use of intimate antiseptic products;
  • wearing a copper IUD;
  • a new or many sexual partners (this is a hypothesis about bacterial vaginosis).

Trichomoniasis

Unprotected sex with an infected partner or multiple partners.

Summary

In order to prevent vaginitis, it is important to have good intimate hygiene, rinse well and dry the genital area properly.

Discover the complete list of preventive measures to put in place below.

Prevention of vaginitis

Basic preventive measures

  • Have good intimate hygiene, rinse well, and dry the genital area properly. Be careful, however, not to wash too frequently or use antiseptic products that weaken the mucosa;
  • wipe from front to back after bowel movements to prevent the spread of bacteria from the rectum to the vagina.
  • avoid the use of scented products (soaps, bubble baths, toilet paper, tampons, or panty liners);
  • Avoid using douching for hygienic purposes. Douching alters the natural balance of vaginal flora;
  • do not use vaginal deodorant;
  • regularly change tampons and sanitary napkins;
  • wear cotton underwear (avoid nylon and g-strings);
  • if possible, wash underwear with a little bleach in hot water to kill microorganisms;
  • sleep without underwear to let air circulate around the vulva;
  • avoid wearing tight pants and nylon tights;
  • avoid keeping a swimsuit wet;
  • have safe sex to prevent the risk of trichomoniasis and other sexually transmitted infections.

Measures to prevent a recurrence

Adopt good eating habits

The vaginal environment is a reflection of the general condition of the body. A balanced diet low in fat and processed foods is a good idea to prevent vaginal infections.

To promote the balance of the vaginal flora and stimulate immune function, it is also recommended to consume rich foods:

  • vitamin A and beta-carotene such as organ meats, liver, sweet potatoes, carrots, and spinach;
  • vitamin C such as red and green peppers, guava, kiwi, and citrus fruits;
  • zinc such as oysters, meats (beef, veal, lamb), chicken, legumes, and whole grains.

Especially for yeast infections, it is recommended to avoid consuming too much sugar, including sweet fruit juices.

Consume probiotics

The consumption of probiotics, in the form of yogurt, may be beneficial (see the section Complementary approaches). In addition, since regular consumption of kefir, tempeh, and sauerkraut help maintain the health of the intestinal flora, it could have the same effect on the vaginal flora.

Medical treatment of vaginitis is not always necessary.

Nevertheless, discover in this sheet the effective treatments if necessary.

How to treat vaginitis?

It is essential to consult a doctor if you think you have vaginitis in order to obtain a reliable diagnosis. Sometimes vaginal swabs are needed to find out the cause of the infection and make sure it is not just vaginal dryness.

It is also imperative to consult your doctor in case of symptoms of vaginitis accompanied by fever or unusual symptoms (vomiting, abdominal pain …), in case of pregnancy, risk of sexually transmitted infection, or multiple vaginal infections in recent months.

Conventional treatments treat 90% of vaginitis in less than 2 weeks, and sometimes in a few days if the risk factors are low.

Yeast vaginitis

In case of symptoms, it is treated with vaginal eggs or antifungal creams to be applied to the vagina at bedtime, even during menstruation. Women who have already been diagnosed with vaginitis and are familiar with its symptoms can purchase these drugs with or without a prescription, seeking the advice of the pharmacist. For example, miconazole (Monistat®), clotrimazole (Canesten®) and tioconazole (Gynecure®), Clotrimazole® (mycohydralin), Sertaconasole (Monazol®)…

Oral treatments are also available by prescription, such as nystatin (Mycostatin®) and fluconazole (Diflucan®). Sometimes yeast infections are recurrent, so it’s important to look for the underlying cause and avoid risk factors.

Note that yeast infections are not sexually transmitted infections. The sexual partner, however, can be treated, only if he has symptoms (in men, inflammation of the glans). When the infection is caused by a species of Candida rarer than Candida albicans (involved in 90% of cases), intravaginal treatment with boric acid is sometimes proposed.28.

Bacterial vaginosis

Tablets, gels, or creams containing antibiotics are prescribed to treat bacterial vaginosis. The most commonly used drug is metronidazole, administered orally or vaginally. Clindamycin can also be used. Refrain from alcohol during treatment with metronidazole and for 48 hours after treatment (alcohol may cause cramping, nausea, and vomiting).

If symptoms persist after treatment, it is necessary to consult a doctor again. No treatment is recommended for the male sexual partner. Treatment is imperative in case of pregnancy even in the absence of symptoms.

Trichomoniasis

Trichomoniasis should be treated with a single dose of the drug metronidazole, obtained with a doctor’s prescription. For this type of vaginitis, it is important that all sexual partners are treated simultaneously to avoid recurrences, regardless of the symptoms. Refrain from alcohol during treatment with metronidazole and for 48 hours after treatment (alcohol may cause cramping, nausea, and vomiting).

Metronidazole should not be given during the first trimester of pregnancy. The doctor will then offer clotrimazole as a cream or egg (intravaginally). In addition, some experts recommend that breastfeeding women stop breastfeeding for 24 hours after taking their dose of metronidazole.

Some additional tips

It is important to adhere to the dosage determined by the doctor, until the end of treatment, even if the symptoms have disappeared.

Tell your doctor if symptoms persist or recur 2 weeks after treatment.

Sexual intercourse should be avoided during treatment to avoid pain (and therefore subsequent sexual blockages), prevent re-infection, and reduce aggression to the vaginal mucosa. Otherwise, have sexual partners wear a condom as long as the sexual intercourse is not painful.

Some oil-based creams weaken latex condoms. Ask your doctor.

Tell your doctor if you are potentially pregnant.

In the case of vaginitis (vaginal infection), some complementary approaches allow it to be treated in a more natural way.

Check out the list here.

Complementary apprelatives to treat vaginitis

In prevention

Probiotics

The normal vaginal flora consists mainly of beneficial bacteria such as Lactobacillus acidophilus that counteract the proliferation of harmful microorganisms. Vaginal administration of these “good” bacteria, probiotics, could therefore be a way to prevent recurrent vaginal infections.31.

Vaginal administration of probiotics effectively fights bacterial vaginosis. Thus, a clinical trial conducted in 2010 with a hundred women prone to recurrent bacterial vaginosis showed that daily vaginal administration of probiotic capsules (Probaclac Vaginal®) reduced the rate of recurrence of infections by about 75% (for 11 months).

The capsules were administered for 2 weeks, with a one-week break between each treatment period. Unfortunately, in the case of yeast vaginitis, probiotics seem ineffective, whether administered orally or vaginally. For more details, consult the Probiotics sheet.

Remark. The absence of adverse effects on the fetus makes probiotics an interesting option for pregnant women.

In treatment

Boric acid

A few clinical trials have evaluated the effectiveness of boric acid in the form of vaginal capsules for treating yeast infections. Boric acid has disinfectant and antifungal properties.

One of the first trials to be published involved 108 patients with yeast vaginitis (Candida albicans). Treatment with capsules containing 600 mg boric acid was much more effective than treatment with nystatin (100,000 units per day), a conventional antifungal (92% cure rate versus 64%, 10 days after stopping treatment).4 After 30 days, 72% of women treated with boric acid had still not had a recurrence, compared with 50% of those treated with antifungal.

More recent trials support the usefulness of boric acid in treating yeast vaginitis, particularly in diabetic women (Candida glabrata vaginitis).

Contraindication: In the absence of data on the safety of boric acid in pregnant women, they should refrain from using this treatment.

Side effects: Boric acid may cause irritation and burning. Under no circumstances should it be applied to open wounds.

RemarksBoric acid capsules are obtained without a prescription at the pharmacy but must be manufactured by the pharmacist upon request. Some experts suggest reserving this treatment for women who have recurrent Candida vaginitis, and in whom conventional treatments are ineffective.

Melaleuca essential oil (Melaleuca alternifolia)

Multiple in vitro tests have established the germicidal action of this essential oil on several classic pathogens of the vaginal environment, including Trichomonas vaginalis and Candida albicans. However, human studies are not yet available to establish its efficacy and safety in treating vaginal infections.

In 1962, a gynecologist published the results of a series of case studies of 130 women whose vaginal infections were treated with melaleuca essential oil (douching with a 1% essential oil solution and vaginal tampons soaked in a 20% solution, kept in place for 24 hours).12 After comparing the results of these interventions to those obtained in a control group treated with suppositories containing a synthetic germicide, the author concluded that the 2 treatments were of similar efficacy.

The author of a case study reported that his patient, having refused conventional treatment with metronidazole, had successfully treated her bacterial vaginitis with tampons soaked in melaleuca essential oil. However, there are no large-scale clinical trials to confirm these observations.

Echinacea (Echinacea sp.)

Echinacea stimulates the immune system and reduces inflammation. For these reasons, it has been traditionally used in the treatment of vaginitis.

Goldenseal (Hydrastis canadensis)

Goldenseal is a natural antibiotic. It also has antiseptic and astringent properties, which is why it has been used traditionally to treat infectious vaginitis. The medicinal properties of goldenseal are attributed to the antibacterial and antifungal properties of its alkaloids such as berberine. Although clinical studies are lacking in humans, in vitro and animal studies have confirmed their properties.

Dosage: give yourself a vaginal douching, 3 to 4 times a day, with the following infusion: 6 g of dried roots and rhizomes for 150 ml of boiling water, infused for 5 to 10 minutes.

Contraindication: goldenseal is contraindicated during pregnancy, the alkaloids it contains can cause contractions in the uterus.

Slippery elm (Ulmus rubra or U. favra)

Slippery elm has traditionally been used to treat inflammation of mucous membranes, including those of the vagina. Its therapeutic properties are due, among other things, to the mucilage contained in large quantities in its inner bark17.

Dosage: Make a thick paste by mixing inner bark powder with boiling water. Let the paste thus obtained cool and apply it as a poultice on the vulvar region.

Vinegar

Vinegar is used for its antiseptic and refreshing properties.

Dosage: Add 3 cups of vinegar to the bath water and stay in the bath by spreading your legs so that the water enters the vagina. Or douch with the following solution: 15 ml (1 tbsp) table vinegar in 1 liter of water.

Douching

The common practice of douching for “hygienic” purposes (3 or more times per month) increases the risk of vaginitis, and complications can ensue. On the other hand, their short-term therapeutic use (with probiotics, melaleuca oil, goldenseal, or vinegar) can help cure vaginitis. Careful. Douching is contraindicated in case of irritation vaginitis.

Advice

“It is now easy to get over-the-counter medications to treat vaginitis, especially infectious fungal (yeast) vaginitis. So, when should you see your doctor?

I recommend it in the following situations: if it is a first vaginal infection, your doctor will be able to establish the cause and help you detect signs and symptoms; If you have multiple sexual partners or a new partner, you may have a sexually transmitted infection that requires specific treatment and if you have used an over-the-counter medication that does not seem to be working, you may have non-fungal vaginitis.

Finally, if you are pregnant or if you have pelvic pain or fever, I also advise you to consult your doctor.

Image Credit: Image by vectorjuice on Freepik

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