A Women's Guide to Vaginal Infections
Vaginal infections are the most common women's health problem and have been increasingly linked to a growing array of serious health risks.
The 3M National Vaginitis Association provides information and educational materials on vaginitis to consumers and healthcare providers to help achieve greater awareness of vaginal infections and promote better communication between patients and their physicians. This site addresses the three most common vaginal infections: bacterial vaginosis (BV), candidiasis (yeast infection), and trichomoniasis (trich).
What Every Women Should Know
Vaginal infections, known medically as vaginitis, are the most frequent reason American women see their doctors -- accounting for more than 10 million office visits each year. Yet a recent Gallup survey found that very few have a thorough understanding of these common afflictions. While 95 per cent of women surveyed had heard about yeast infections, for example, only 36 per cent had ever heard of a more common vaginal infection called bacterial vaginosis (BV), which can lead to serious medical complications.* This condition is caused by bacteria rather than yeast.
Vaginitis can be caused by a variety of organisms or other factors, and each must be treated differently. A non-prescription remedy that works against yeast, for example, will not be effective against other causes of infection and using it may make an accurate diagnosis more difficult.
Moreover, while the symptoms described on this Web site are typical, the outward signs of vaginal infections may vary or even be absent. It is therefore essential to see your physician or other medical professional so the cause of your vaginal infection can be determined and the correct treatment can be prescribed. Sometimes the symptoms may be due to non-infectious causes. In these instances, seeking health care can result in cost savings because you may learn you don't need the over-the-counter treatments you may have been using.
While routine Pap smears and speculum examinations alone are unreliable for diagnosing vaginal infections, simple office testing procedures using pH paper and a microscope can be performed in less than three minutes to identify the correct form of vaginitis to treat. This is especially important because women in the past have often found vaginal infections difficult to get rid of. In addition, there is now growing evidence that links certain vaginal infections with increased health risks.
Greater awareness of the signs and symptoms of these widespread disorders will help you and your healthcare provider take the right steps toward ensuring your good health.
The vagina leads from the uterus to the vulva, the external genital area. Some vaginal discharge is normal and can vary with age and contraceptive methods and during the menstrual cycle. While symptoms described on this Web site are typical, the outward signs of vaginal infections may vary. A physician or health care provider can perform simple testing procedures to identify the correct form of vaginitis to treat.
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Bacterial Vaginosis
While many physicians once believed vaginal infections were largely harmless, mounting evidence indicates that certain types of vaginitis may lead to complications if left untreated. Bacterial vaginosis is the most common vaginal infection. The disease has been found in 12 to 25 per cent of women in routine clinic populations, 10 to 26 per cent of women in obstetrics clinics and 32 to 64 per cent of women in clinics for sexually transmitted diseases (STDs).
Most importantly, BV has been associated with pelvic inflammatory disease, which can result in infertility, as well as increased risk of endometritis, cervicitis, pregnancy complications, post-operative infections and other health problems. Some recent study data have also suggested that BV may be linked with cervical intraepithelial neoplasia.*
In a comprehensive study of 13,500 pregnant women sponsored by the National Institutes of Health, women with BV in the 23rd to 26th weeks of pregnancy were 40 per cent more likely to deliver a low birth-weight baby -- one that weighs under 5.5 pounds. Studies are now underway to determine whether treatment of BV during pregnancy can reduce complications. It is especially important to discuss vaginal symptoms with your healthcare provider if you are pregnant or considering pregnancy.*
Bacterial vaginosis is caused by an overgrowth of bacteria rather than yeast or other organisms. These are primarily anaerobic bacteria (requiring no oxygen) and an organism called Gardnerella, all of which can be found in low numbers in the healthy vagina. But in women with BV, the vaginal balance is disrupted so that these bacteria overgrow at the expense of protective bacteria known as lactobacilli. Lactobacilli excrete the natural disinfectant hydrogen peroxide to help maintain a healthy and normal balance of microorganisms in the vagina. Women who have been diagnosed with BV have been found to have up to 1,000 times more anaerobic bacteria than women without the disease.
The exact reasons behind this overgrowth are unknown. While bacterial vaginosis is especially common among patients attending STD clinics, some experts believe this may occur because BV might enhance the transmittal of STDs rather than because BV itself is transmitted by sexual contact. While sexual activity may increase the likelihood of developing BV, the condition has also been found in sexually inexperienced and monogamous women. A few studies have also correlated BV with increased douching, an increased number of sexual partners and the use of intrauterine devices.
The outward signs of BV may include an unpleasant vaginal odour in varying degrees and an excessive white or grey vaginal discharge with a milk-like consistency that can stain undergarments. Vaginal itching or burning is also sometimes present. Women often report that the odour is particularly embarrassing after sexual intercourse. When semen mixes with vaginal secretions, it lowers the acidity level to make the odour particularly strong. Odour may also be more apparent around the time of menses.
Other signs of BV can be determined only through an examination by a healthcare professional. These include a decreased vaginal acidity (a vaginal pH of more than 4.5 as measured with pH paper) and the presence of "clue" cells -- epithelial cells coated with bacteria, seen in a vaginal discharge sample when viewed under a microscope. Potassium hydroxide may also be added to a vaginal discharge sample to enhance and help detect any fishy or foul odour.
It has been estimated that up to 40 per cent of women with BV may experience no outward symptoms or discomfort at all, although this perception may be due to a lack of communication by patients. It can be embarrassing to tell your healthcare provider about vaginal odour or other symptoms, but open communication is critical to ensuring an accurate diagnosis. Because of the increased health risks associated with BV, a growing number of physicians advocate the use of simple office procedures to screen for this condition during routine gynecological examinations. However, treatment may not be offered unless your healthcare provider is alerted to the fact that vaginal symptoms are present.
The most commonly prescribed treatment for BV is antibiotics administered orally or intravaginally. They are targeted against anaerobic bacteria, yet do not destroy the lactobacilli that protect against yeast and pathogenic bacteria.
Products like douches or deodorant sprays that mask vaginal odour should not be used to treat BV. Although they may temporarily eliminate odour, they will not cure the condition. It is especially important not to douche or use a feminine hygiene spray for a few days before an appointment with your doctor. These products may actually hide important clues that can help your physician in diagnosing BV and may make the condition worse.
Unlike many of the medications now available to treat yeast infections, medications to treat BV are available only by prescription. Non-prescription medications should not be used in the treatment of BV and can also interfere with proper diagnosis.
Yeast Infections
While far more women have heard of yeast infection than other forms of vaginitis, it is actually the second most common type of vaginal infection. Nonetheless, yeast infection (sometimes called Candida infection) has been estimated to affect most women at least once during a lifetime. Awareness of yeast infection may be especially high because of widespread consumer advertising for non-prescription yeast medications, which now rank among the largest-selling products found in drugstores. Although yeast infections often cause intense discomfort, prompting most sufferers to seek treatment, they have not been associated with serious health risks.
Because the outward symptoms of yeast infection may be similar to those of other infections, women are urged to obtain a diagnosis from a health care professional prior to treating themselves with over-the-counter yeast remedies. These medications are generally effective against yeast but have no utility in the treatment of other forms of vaginitis that may have more serious health consequences.
Yeast infections are caused by one of the many types of fungus called Candida, popularly known as yeast. Candida and other organisms are found in small numbers in the normal vagina as well as in the mouth and digestive tract. However, when the delicate balance of organisms in the vagina is upset, the yeast may overgrow and cause an infection.
For example, when a woman takes certain antibiotics to treat a bacterial infection, they may also kill the lactobacilli that produce hydrogen peroxide to protect against yeast overgrowth. Other factors that may upset the balance and lead to yeast infection include pregnancy, obesity, diabetes, birth control pills, steroids, prolonged exposure to moisture and poor feminine hygiene.
Yeast infections may produce a white, cottage cheese-like discharge that has no odour, and the vagina and vulva will nearly always become itchy and sometimes red.
A healthcare professional can confirm a yeast infection by adding potassium hydroxide and viewing a vaginal discharge sample under a microscope to detect an overgrowth of yeast organisms.
Yeast infections are usually treated intravaginally with anti-yeast creams or suppositories. Drugs that act against yeast may also be prescribed in oral tablet form.
Popular intravaginal treatments are now available without a prescription. However, while such non-prescription anti-yeast products are effective against most common types of yeast, they should not be used unless a yeast infection has been diagnosed by a medical professional. These products do not work against other kinds of vaginal infections that may be more health-threatening and may hinder correct diagnosis.
Other topical treatments may also be used to control itching. These products, however, do not act against the yeast that causes the infection.
Trichomoniasis
Another common form of vaginitis is trichomoniasis. This type of infection is caused by a single-cell parasite known as a trichomonad. Unlike BV and yeast infection, it is usually transmitted through sexual intercourse, but in rare instances may be passed on by wet towels, washcloths and bathing suits. The infection often persists because the parasite rarely causes symptoms in men, so that reinfection of women by untreated men is common. Some women can be infected for months to years as the infection is passed back and forth between the woman and her sexual partner. For this reason, both sexual partners must be treated at the same time, even if they are in a monogamous relationship.
The outward signs of trichomoniasis are a yellow-grey-green, frothy vaginal discharge that may have a foul or fishy odour. Burning, itching, soreness and redness of the vagina may also occur. In addition, urination and intercourse may be painful, and the symptoms may worsen during menstruation. On the other hand, many women with this infection may not have any symptoms.
A medical professional can confirm trichomoniasis when the vaginal pH level is higher (less acid) than 4.5, potassium hydroxide intensifies the odour and the trichomonad parasite can be seen under the microscope. Occasionally a diagnosis may be made by Pap smear or culture. Trichomoniasis is normally treated by prescribing a specific antibiotic for both the woman and her partner.
Chlamydia
A common and primarily sexually transmitted infection of the cervix is caused by chlamydia. Although chlamydia is estimated to affect more than 4 million annually in the United States, most women and their sexual partners experience no symptoms. However, since chlamydia has been found to be a frequent cause of infertility, it is yet another reason some physicians believe women should be tested for infection of the reproductive system during their regular gynecological examination.
The most common symptoms of chlamydial infection include light bleeding, especially after intercourse, burning during urination and sometimes an increased vaginal discharge. It is detected by medical professionals through a culture examination of the cervical discharge. It is treated with antibiotics for both sexual partners.
Viruses may also be a source of vaginal infection. Herpes infections, which may be spread through sexual intimacy, result in lesions or sores on the vulva or vagina. Another viral infection is caused by the human papillomavirus, which causes warts in the vagina, rectum, vulva or groin, and can lead to cervical cancer. Genital warts are treated by a variety of measures, including topical medications or freezing.
Noninfectious Vaginitis
Some women may experience vaginal itching, burning, increased discharge or painful intercourse without having an infection. A noninfectious condition known as atrophic vaginitis is common following menopause or hysterectomy when the vagina becomes dry. It can be treated with oral or intravaginal estrogen replacement therapy.
Another noninfectious vaginitis can result from reactions or irritations from vaginal sprays, douches, spermicides, chemically treated sanitary napkins, cervical sponges and caps, tampons, soaps, detergents and fabric softeners. Such products should be avoided when vaginal irritation is present.
Prevention of Vaginal Infections
Because the key to successful treatment of vaginal infections is correct diagnosis, it is essential that you openly discuss your symptoms and other background that may help your healthcare provider make an accurate diagnosis. Pay close attention to which symptoms you have, what they are like and when they occur.
Then be sure to take all of the prescribed medication exactly as directed. Do not discontinue therapy just because the symptoms go away, since the cause of the infection may not be completely eliminated and the problem may therefore reappear. If symptoms persist or come back following treatment, see a medical professional again. A different treatment may be necessary.
Do not self-medicate with non-prescription anti-yeast products, unless you have recently been diagnosed with yeast infection and the exact same symptoms recur. Most vaginal infections are not caused by yeast. Moreover, anti-yeast products do not work against the kinds of infections that may be more serious and may make accurate diagnosis difficult. Only a medical professional can reliably diagnose the cause of vaginal infections and prescribe the proper therapy.
Douching should be avoided. Studies have found that douching may disrupt the delicate balance of natural organisms in the vagina, leading to infection from the overgrowth of bacteria or yeast, and may also spread harmful organisms into the upper reproductive tract. Once you have an infection, further douching can make it worse and hinder accurate diagnosis.
Since many infection-causing organisms thrive on moisture, remove a wet bathing suit immediately. Be sure to dry yourself thoroughly after showering or bathing. Also, avoid tight clothing, and use cotton undergarments to help absorb moisture.
Keep the vaginal area clean. To avoid spreading organisms from the anus to the vagina, wipe front to back after a bowel movement.
Do not use scented or chemically treated toilet paper or sanitary napkins, feminine deodorants, perfumes, spermicides, harsh soaps or detergents if the vaginal area is irritated, since they may cause the problem or make it worse.
Practice safe sex to avoid sexually transmitted infections. Use condoms and avoid medicated vaginal creams and other products containing mineral oil, since they may weaken latex condoms and diaphragms. Also thoroughly clean diaphragms, cervical caps and applicators of spermicides or medication after each use.
Most importantly, recognize that vaginal infections are common among women of all ages, regardless of whether they are sexually active -- and that they may pose increased health risks unless properly treated. If you experience vaginal symptoms, see a medical professional for diagnosis and effective therapy. And remember that your healthcare provider will be better able to help you if you openly discuss your concerns.
Glossary
Anaerobic bacteria: Bacteria that do not require oxygen, are found in the normal vagina.
Bacterial vaginosis (BV): A common type of vaginal infection is caused by an overabundance of bacteria found in the normal vagina, with a loss of protective lactobacilli.
Chlamydia: A common infection of the cervix caused by a sexually transmitted microorganism with this name.
Clue cell: Epithelial cells coated with bacteria, seen under a microscope, indicating BV.
Culture: A laboratory test is used to diagnose infections caused by microorganisms not found in the normal vagina. Microorganisms in a discharge sample are allowed to grow so they can easily be identified.
Lactobacilli: The predominant bacteria in the normal vagina, serve to provide natural protection against infection.
PH: A unit for measuring alkaline/acid levels. Normal vaginal pH is approximately 4.0. Elevated pH may indicate the presence of BV or trichomoniasis.
Trichomoniasis: A vaginal infection is caused by a one-cell parasite known as a trichomonad.
Vaginitis: An infection of the vagina.
Yeast infection: A common vaginal infection is caused by an overabundance of yeast found in the normal vagina.