As with any part of the body, the genitalia in females may experience symptoms due to irritation, injury, infection or various other causes. It is important to know the different terms for the external female genitalia as discussed under the parts of the vagina. Although the term vagina is used broadly to describe all the external genitalia, it is a specific part of the female reproductive system. The external genitalia includes the vulva and labia which is more commonly seen.
Therefore vaginal symptoms may include symptoms involving the vulva and labia. Some of the more common symptoms include redness, dryness, swelling and discharge. Abnormal vaginal bleeding, vaginal discharge and vaginal itching are discussed separately. Often more than one symptom occurs at the same time and this should be noted as it may indicate a possible cause.
Red Vagina and Vulva Redness
Redness of the vagina and vulva (involving both the labia majora and the labia minora) occurs most frequently in the case of an infection, which causes vulvovaginitis (inflammation of the vulva and vagina).
Causes of Vaginal Redness
The most common vaginal infections are :
- Bacterial vaginosis is a bacterial infection of the vagina, usually caused by an overgrowth of Gardnerella vaginalis (a type of bacteria which can normally be found in the vagina in small numbers).
- Candida vaginitis is a vaginal yeast (fungal) infection, caused most frequently by Candida albicans.
- Trichomoniasis is an infection with the protozoa, Trichomonas vaginalis, which is usually transmitted sexually. Red “strawberry spots” on the vaginal walls may sometimes be seen.
Other infections giving rise to symptoms of redness of the vagina, vulva and labia are :
- Genital herpes is caused by the herpes simplex virus and spread through sexual contact. Symptoms may be mild or severe.
- Genital warts (condyloma) are caused by the human papillomavirus (HPV) and are spread through sexual contact.
Other causes of redness of the vagina, vulva and labia may include:
- Foreign body – quite often a forgotten tampon.
- Irritation from urine or feces – risk factors may be incontinence or being bedridden. In infants, infrequent diaper changes and improper cleaning of the area after passing stool may also be a cause.
- Inadequate personal hygiene.
- Infestations – scabies, pubic lice, pinworm.
- Contact dermatitis – chemicals present in bubble baths, soap, perfumed toilet paper, deodorant tampons, powders, and sprays may irritate the vagina and vulva on contact.
- Allergy to semen, latex condoms or spermicide gels.
- One variety of invasive epidermoid cancer produces a characteristic velvety red lesion over the vulvar skin.
- Radiotherapy for cancer.
Dryness of the vagina is a result of the vagina not being effectively lubricated. Vaginal dryness can make sexual intercourse painful. There are many causes of vaginal dryness but it is most commonly encountered in women undergoing menopause, when it is known as menopausal atrophic vaginitis.
Symptoms of Vaginal Dryness
- Painful intercourse.
- Light bleeding during intercourse.
Causes of Vaginal Dryness
Decreased estrogen levels which occur during menopause, either normal menopause or following removal of the ovaries. During menopause the estrogen level drops and this results in making the vulvar and vaginal tissues thinner, drier and less elastic. Diminished vaginal secretions during menopause result in less lubrication of the vagina.
Decreased estrogen also reduces the acidic environment of the vagina, making it more susceptible to infections, causing vaginal itching. Prepubertal atrophic vaginitis, seen in girls before they reach puberty, may occur similarly due to lack of endogenous estrogen.
- Chronic vaginal infections – bacterial, fungal (candidiasis) or protozoal (trichomonal).
- Sexually transmitted diseases.
- Genital herpes.
- Vaginal warts.
- Sjogren’s syndrome is an autoimmune disease characterized by inflammation of the glands, mainly of the eyes and mouth, leading to extreme dryness of the mouth and eyes. Less commonly, the glands lining the vagina may become inflamed, causing vaginal dryness and itching, manifested as pain during intercourse and recurrent vaginal infections.
- Allergies to chemicals present in sprays, soap, bubble bath, toilet paper, deodorant tampons.
- Latex condoms or spermicide gels may cause irritation, leading to vulvar and vaginal itching.
- Inadequate personal hygiene.
- Frequent vaginal douching can cause vaginal dryness and itching.
- Certain medication such as antihistamines, antihypertensives, antidepressants and corticosteroids.
- Vulval intraepithelial neoplasia is a precancerous lesion of the vulva, affecting mainly older women. Itching may be the first sign.
Swelling of the vulva, labia is in most cases are due to an infection. Injury and allergic reactions are other frequent cases of swelling and itching. Often the swelling involves the vulva and labia when it is visibly evident but this is incorrectly referred to as vaginal swelling.
Causes of Vaginal Swelling
- Bacterial vaginosis is common in women, more so in those who are sexually active. However, it is not sexually transmitted and can be controlled effectively with proper antibiotic treatment.
- Vaginal candidiasis or a yeast infection of the vagina is also a common form of vaginal infection. The chances of co-existing diabetes is also a possibility. A vaginal yeast infection may recur even after adequate treatment.
- Trichomoniasis of the vagina occurs due to infection with Trichomonas vaginalis, which is usually transmitted through sexual intercourse.
- Vaginitis or vaginal inflammation can occur due to hormonal changes in the body, such as during menopause. It may also occur as a result of trauma, especially in young girls.
- Irritation due to wearing synthetic underwear, excessive tight jeans or wet swimwear for prolonged periods.
- An allergic reaction or contact dermatitis as a result of using tampons, sanitary pads, latex condoms or, spermicide gels used during intercourse or toilet paper.
- Micro-environmental changes (pH and naturally occurring microorganisms) within the vagina due to frequent vaginal douches and medication administered through the vagina.
- Sexually transmitted diseases (STDs).
- Injury to the vagina, vulva and/or labia.
- Erosive vulvovaginitis is the ulceration of the vulva and vagina.
- Sexual abuse in children should be kept in mind. Trichomonal vaginitis in children may suggest sexual abuse. Other symptoms such as vulvovaginal soreness, blood-tinged or foul-smelling discharge may also be present, along with non-specific medical complaints and behavioral changes.