What is Vaginitis?
Inflammation of the vagina is known as vaginitis. It is one of the most common conditions that affect women of all ages. Sometimes, vaginitis is accompanied by inflammation of the vulva, when it is then known as vulvovaginitis.
Infection of the vagina due to various organisms (usually yeast or bacteria) is the most common causes of vaginitis, but there are many non-infectious causes like trauma or allergic reactions which may be responsible. Excessive vaginal discharge, with a change in color and odor, associated with redness, swelling, irritation, and itching of the vagina are the usual symptoms. Treatment is determined by the cause of vaginitis as well as the accompanying symptoms.
The vagina is an elastic muscular canal, approximately 7.5 cm long, extending from the uterus and connecting the uterus and cervix to the outside of the body. The vaginal opening is enclosed by two thin folds of tissue known as the labia minora, which are bounded by two thicker folds of tissue called the labia majora.
The vulva is made up of the mons pubis (the mound of flesh covered by pubic hair), labia majora, labia minora, clitoris, and the Bartholin’s glands opening into the vestibulum vaginae.
The vagina is lined by mucus membrane. This soft inner lining of the vagina (epithelium) provides lubrication and sensation during intercourse. The Bartholin’s glands produce a mucoid secretion during periods of sexual excitement that help to lubricate the vagina. During periods, the menstrual blood flows out through the vagina, and during delivery, the baby comes out through the vagina.
Some amount of clear or whitish vaginal discharge, with or without a mild odor, is normal in most women of childbearing age. Normal vaginal discharge consists of exfoliated (dead and cast-off) vaginal skin cells, bacteria, and secretions from the vaginal and cervical glands. Vaginal secretion is necessary to keep the vagina lubricated. It also helps to keep the vagina clean by carrying away the dead vaginal cells. The vaginal discharge of a healthy woman may contain many types of bacteria, the most important being lactobacilli.
In normal circumstances, from puberty to menopause, the vaginal environment is kept acidic (pH 3.8 to 4.5) by the production of lactic acid by the cells in the vaginal epithelium. This favors the growth of lactobacilli, which also help to keep the environment acidic. This acidic environment discourages growth of harmful bacteria as well as preventing infection from travelling from the outside through the vulva and vagina into the cervix and uterus.
There are certain factors which tend to make the vagina alkaline, such as menstrual discharge, male ejaculate, vaginal douches, and infected cervical mucus. Under these circumstances, there is more chance of the vagina getting infected and producing vaginitis.
Lack of endogenous estrogen in prepubertal girls causes the vaginal epithelium to be very thin and deficient in glycogen. This increases the susceptibility of the vagina to bacterial infections. In postmenopausal women, the level of endogenous estrogen again falls, resulting in postmenopausal atrophy. This, along with decrease in vaginal pH, predisposes to vaginal infection and subsequent vaginitis.
Causes of Vaginitis
Vaginal infection is the most common cause of vaginitis. Pathogens responsible for infectious vaginitis includes :
- Bacterial infection – bacterial vaginosis is caused by an overgrowth of the bacteria Gardnerella vaginalis which is normally found in small numbers in the vagina. Pregnancy, contraceptive devices, multiple sexual partners, and vaginal douching are considered to be some of the risk factors of this type of infection.
- Fungal (yeast) infection – infection of the vagina may be caused by Candida albicans, a type of fungus normally present in the vagina without causing any symptoms. Any situation where there is an imbalance between the fungi and the normal bacterial flora of the vagina, causing excessive fungal proliferation, can lead to vaginal infection. Diabetes, pregnancy, contraceptives, steroids, antibiotics, and immunodeficiency states may be some of the risk factors.
- Trichomoniasis – the protozoa Trichomonas vaginalis may cause this sexually transmitted infection of the vagina, resulting in vaginitis.
- Sexually transmitted infections such as chlamydia and gonorrhea and sexually transmitted diseases such as genital warts and genital herpes. Read more on STD symptoms in women.
- Urinary tract infection.
- Pubic lice.
- Prepubertal atrophic vaginitis.
- Postmenopausal atrophic vaginitis.
- Oral contraceptives.
- Allergy to latex condom and spermicide gels.
- Semen allergy.
- Chemicals present in soaps, detergents, bubble baths, colored or perfumed toilet paper or tampons.
- Inadequate personal hygiene
- Vaginal douching.
- Wearing tight, non-absorbent underclothing.
- Forgotten tampon or a piece of toilet paper in the vagina.
- Retained condom.
- Other articles in the vagina.
- Sexual abuse, particularly in children.
- During sexual intercourse.
- Injury while inserting a tampon.
- Lichen planus.
Cancerous and Pre-cancerous Conditions
- Lichen sclerosus.
- Vaginal cancer.