Adolescent Medicine

Sports Medicine & Adolescent Medicine (CSG)
Joel Brenner, MD
David Smith, MD

Vaginitis

What is vaginitis?

Vaginitis refers to any inflammation or infection of the vagina. This is a common gynecological problem found in females of all ages, with most females having at least one form of vaginitis at some time during their lives. When the walls of the vagina become inflamed, because some irritant has disturbed the balance of the vaginal area, vaginitis can occur.

What causes vaginitis?

Bacteria, yeast, viruses, or chemicals in creams or sprays, can cause vaginitis. Sometimes, vaginitis occurs from organisms that are passed between sexual partners. In addition, the vaginal environment is influenced by a number of different factors including a female's health, her personal hygiene, medications, hormones (particularly estrogen), and the health of her sexual partner. A disturbance in any of these factors can trigger vaginitis.

What are the most common types of vaginitis?

The following are the most common types of vaginitis:

  • candida or "yeast" infection
  • bacterial vaginosis
  • trichomoniasis vaginitis
  • chlamydia
  • gonococcal vaginitis
  • viral vaginitis
  • noninfectious vaginitis

Each of these types of infection has a different cause and can present different symptoms, making diagnosis often complicated. In addition, more than one type of vaginitis may be present at the same time, with or without symptoms being present.

What is candida or "yeast" infections?

Yeast infections, as they are commonly called, are caused by one of the many species of fungus known as candida, which normally live in the vagina in small numbers. Candida can also be present in the mouth and digestive tract in both males and females.

Since yeast is normally present and well-balanced in the vagina, infection occurs when something in a female's system upsets this normal balance. For example, an antibiotic to treat another infection may upset this balance. In this case, the antibiotic kills the bacteria that normally protects and balances the yeast in the vagina. In turn, the yeast overgrows, causing an infection. Other factors that can cause this imbalance to occur include pregnancy, which changes hormone levels, and diabetes, which allows too much sugar in the urine and vagina.

What are the symptoms of a vaginal candida infection?

The following are the most common symptoms of a candida infection. However, each adolescent may experience symptoms differently. Symptoms may include:

  • a thick, white, cottage cheese-like vaginal discharge that is watery and usually odorless
  • itchiness and redness of the vulva and vagina

The symptoms of a vaginal candida infection may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Who is at risk for vaginal candida infections?

While any female can develop a yeast infection, the following females may be at an increased risk for the condition:

  • females who have had a recent course of antibiotics
  • females who are pregnant
  • females who have diabetes that is not well-controlled
  • females who are using an immunosuppressant medication
  • females who are using high-estrogen contraceptives
  • females who have a thyroid or endocrine disorder
  • females who are undergoing corticosteroid therapy, which slows the immune system

How is a vaginal candida infection diagnosed?

In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for vaginal candida infections often include a microscopic examination of the vaginal discharge.

Treatment for vaginal candida infections:

Specific treatment for candida will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment for candida may include:

  • anti-fungal, vaginal creams and suppositories
  • vaginal tablets
  • antibiotics

What is bacterial vaginosis?

While yeast infections are the most commonly discussed vaginal infection, bacterial vaginosis (BV) is actually the most common type of vaginitis in females of reproductive age. This infection is caused by a bacteria, not yeast. With a bacterial vaginosis infection, certain species of normal vaginal bacteria grow out of control and trigger inflammation. The cause of bacterial vaginosis is not known.

Q: I frequently experience vaginal discharge. Is this considered normal, or might something be wrong?

A: It is normal for all females to have some discharge from the vagina. Depending on the stage of the menstrual cycle, normal discharge is either thick and whitish, or slippery and clear. There is little odor and no itching or burning. Regular bathing and proper personal hygiene is important.

However, vaginal discharge changes can signal a vaginal, cervical, or sexually transmitted infection. These include changes in color, quantity, or texture of the fluid; an unpleasant odor; bleeding, spotting, or bloody discoloration; or itching and burning of the vagina or vulva.

What are the symptoms of bacterial vaginosis?

The following are the most common symptoms of bacterial vaginosis. However, each adolescent may experience symptoms differently. Symptoms may include:

  • a milky, thin discharge at times, or a heavy, gray discharge
  • "fishy" odor of discharge

The symptoms of bacterial vaginosis may resemble other conditions. Always consult your physician for a diagnosis.

Treatment for bacterial vaginosis:

Specific treatment for bacterial vaginosis will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Bacterial vaginosis is generally treated with oral antibiotics.

What is trichomoniasis?

Trichomoniasis, trichomonas, or "trich" as it is commonly called, is a sexually transmitted infection. It is caused by a one-celled parasite called Trichomonas vaginalis which passes between partners during sexual intercourse. Since most males do not present symptoms with trichomoniasis, the infection is often not diagnosed until the female develops symptoms of vaginitis.

What are the symptoms of trichomoniasis?

The following are the most common symptoms of trichomoniasis. However, each adolescent may experience symptoms differently. Symptoms may include:

  • a frothy, often musty-smelling, greenish-yellow discharge
  • itching in and around the vagina and vulva
  • burning during urination
  • discomfort in the lower abdomen
  • pain during intercourse

Some females with trichomoniasis are asymptomatic. The symptoms of trichomoniasis may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for trichomoniasis:

Specific treatment for trichomoniasis will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Both partners must be treated for trichomoniasis to avoid reinfection. Treatment generally involves taking oral antibiotics. If a female has more than one sexual partner, each partner (and any of their other partners) should also be treated.

What is chlamydia?

Chlamydia is the most commonly occurring sexually transmitted disease in the United States, although it often goes undiagnosed. If left untreated, chlamydia often leads to pelvic inflammatory disease (PID), which increases a female's risk of infertility, pelvic adhesions, chronic pelvic pain, and ectopic pregnancy.

Chlamydia, caused by the bacterium chlamydia trachomatis, exists in a number of different strains. This form of vaginitis is most commonly diagnosed in young women between the ages of 18 and 35 who have multiple sexual partners.

What are the symptoms of chlamydia?

Unfortunately, many females have no symptoms, thus prolonging diagnosis and treatment and possibly spreading the disease. The following are the most common symptoms of chlamydia. However, each adolescent may experience symptoms differently. Symptoms of chlamydia may include:

  • increased vaginal discharge
  • light bleeding, especially after intercourse
  • pain in the lower abdomen or pelvis
  • burning during urination
  • pus in the urine
  • redness and swelling of the urethra and labia

The symptoms of chlamydia may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for chlamydia:

Specific treatment for chlamydia will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Generally, treatment for chlamydia involves taking antibiotics.

What is gonococcal vaginitis?

Vaginitis can also be caused by the bacterium Neisseria gonorrhoeae (N. gonorrhoeae) - the same bacterium that causes the sexually transmitted disease known as gonorrhea.

What are the symptoms of gonococcal vaginitis?

In pre-pubertal children, the most common infection occurs in the genital tract, with vaginitis as the most common symptom. In adolescents who are sexually active, gonococcal infections may occur along with other types of vaginal infections, and are similar to gonococcal infections in adults. The following are the most common symptoms of a gonococcal infection. However, each adolescent may experience symptoms differently. Symptoms may include:

  • yellowish or bloody vaginal discharge (females) or yellowish white discharge from the penis (males)
  • painful or burning urination (males and females)
  • swollen or painful testicles (males)
  • vaginal bleeding during intercourse (females)
  • lower abdominal (pelvic) pain during intercourse (females)

The symptoms of a gonococcal infection may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for gonococcal vaginitis:

Specific treatment for a gonococcal infection will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

If left untreated, gonococcal infections can lead to serious conditions such as pelvic inflammatory disease (PID), which increases a female's risk of infertility, pelvic adhesions, chronic pelvic pain, and ectopic (tubal) pregnancy. Because of these risks, early treatment of the infection with antibiotics is essential. Treatment of sexual partners is also necessary to prevent reinfection and further spread of the disease.

What is viral vaginitis?

Viruses are a common cause of vaginitis, with most being spread through sexual contact. One type of virus that causes viral vaginitis is the herpes simplex virus (HSV, or simply herpes) whose primary symptom is pain in the genital area associated with lesions and sores. These sores are generally visible on the vulva, or vagina, but occasionally are inside the vagina and can only be found during a pelvic examination. Often stress or emotional situations can be a factor in triggering an outbreak of herpes.

Another source of viral vaginitis is the human papillomavirus (HPV), a virus that is also transmitted through sexual contact. This virus causes painful warts to grow on the vagina, rectum, vulva, or groin. However, visible warts are not always present, in which case, the virus is generally detected by a Pap test.

For years, research efforts have focused on developing a vaccine against HPV. Two HPV vaccines have been developed, and clinical trials of these vaccines have been successful. According to a study published in April, 2005, one of the vaccines was 89 percent effective in preventing infection by four particular strains of HPV and 100 percent effective in preventing cervical cancer, precancerous lesions, or genital warts. This vaccine was approved by the US Food and Drug Administration (FDA) in 2006. The other vaccine is to be submitted for regulatory approval in Europe in 2006.

What is noninfectious vaginitis?

Noninfectious vaginitis usually refers to vaginal irritation without an infection being present. Most often, this is caused by an allergic reaction to, or irritation from, vaginal sprays, douches, or spermicidal products. Noninfectious vaginitis may be also be caused by sensitivity to perfumed soaps, detergents, or fabric softeners.

What are the symptoms of noninfectious vaginitis?

The following are the most common symptoms of noninfectious vaginitis. However, each adolescent may experience symptoms differently. Symptoms may include:

  • vaginal itching
  • vaginal burning
  • vaginal discharge
  • pelvic pain (particularly during intercourse)

The symptoms of noninfectious vaginitis may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for noninfectious vaginitis:

Specific treatment for noninfectious vaginitis will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment for noninfectious vaginitis generally includes estrogen creams or oral tablets, which can restore lubrication and decrease soreness and irritation.

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Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Last reviewed on 10/4/2006