Vaginitis

Vaginitis is inflammation of the vagina, caused by a disruption in the normal bacteria in the vagina. Experts estimate that 40% of all types of vaginitis are caused by candida, a yeast-like fungus. When it multiplies in the vaginal tract, the disorder is called vulvovaginitis. Women often refer to it as a "yeast infection." About 75% of women get candida vaginitis at some time in their lives. Vaginal candida does not generally occur without estrogen. So premenarchal girls and postmenopausal women not on estrogen replacement almost never develop vaginal yeast.

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Signs and Symptoms

• Itching and burning in the vagina and vulva
• Vaginal discharge (small amounts are normal)
• Red, swollen, painful vaginal mucous membranes and external genitalia
• Satellite lesions (tender, red, pus-filled bumps, which can spread to the thighs and anus)
• Odor

What Causes It?

Candida is a yeast-like fungus that grows in the vagina. The following increase your chance of getting a yeast infection:

• Antibiotics.
• Pregnancy. From increased heat, moisture, and hormonal shifts.
• Diabetes.
• Corticosteroid use.
• Sexually transmitted diseases (STDs) .
• HIV infection.
• Birth control pills.
• Obesity.
• High sugar intake.
• Wearing panty hose, tight clothing, or non-cotton underwear.
• Menstruation. Women report recurrent episodes of vaginitis immediately before and after their periods.
• Stress.
• Toxic shock syndrome.

What to Expect at Your Doctor's Office

Your doctor will give you a pelvic examination and swab your vagina to check for candida. You may also have a Pap smear. Some women have chronic yeast infections. If this happens, your doctor may want to do additional tests.

Treatment Options

Treatment Plan

Doctors usually recommend topical treatments before oral medications. For chronic infections, your doctor may increase the dosage and length of treatment. If you have vaginitis, you can also help prevent infection.

• Avoid excessive exertion and sweating.
• Keep the vaginal area as dry as possible.
• Avoid sex until symptoms clear.
• Take showers instead of baths.
• Use unscented soap.
• Always wipe from front to back after bowel movements.
• Wear cotton underwear.
• Avoid pantyhose and tight fitting pants.

Drug Therapies

Topical and oral therapies are equally effective.

Topical therapies may initially cause burning from inflammation. These include:

• Polyenes (nystatin). One tablet, twice a day, for 2 weeks, placed high in the vagina with an applicator. This treatment is 70% to 80% effective and causes no side effects on other parts of the body.
• Azole derivatives such as imidazole (such as miconazole, butoconazole) and triazole (such as fluconazole, terconazole) --Vaginal cream, 1 to 5 days, also may be used externally. This treatment is 85% to 90% effective and causes no side effects on other parts of the body.

Oral therapies include:

• Fluconazole (difulcan). About 75% to 92% effective. 150 mg once. This is often considered the treatment of choice. It should not be used during pregnancy.
• Ketoconazole. About 83% effective. 400 mg/day for 5 days, or for 2 weeks with recurring infection. Oral nystatin helps reduce intestinal problems.

Complementary and Alternative Therapies

Alternative therapies may help treat acute and chronic vaginitis. Make sure to inform your doctor about any herbs and supplements you are taking. Experienced practitioners may recommend douches, suppositories, and topical treatments with ingredients such as vinegar, tea tree oil, yogurt, or boric acid. Discuss these treatments with your doctor, as scientific evidence to support their use is lacking.

Nutrition and Supplements

These nutritional tips may help reduce symptoms.

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your doctor may want to test you for food sensitivities.
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy is present), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat high-antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods (such as white breads, pastas, and sugar).
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy), or beans for protein.
• Use healthy oils, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in commercially baked goods like cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily. Containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil. To help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources. Fish oil supplements can increase the effects of certain blood-thinning medications.
• Vitamin C. As an antioxidant for immune support and to protect the vaginal lining.
• Zinc lozenge. When needed for immune support during vaginitis outbreak. DO NOT exceed 45 mg of zinc daily.
• Probiotic supplement (containing Lactobacillus acidophilus). For maintenance of gastrointestinal and immune health. Refrigerate your probiotic supplements for best results. People with seriously weakened immune systems should speak to their doctors before taking probiotics.
• Grapefruit seed extract (Citrus paradisi). For antibacterial, antifungal, and antiviral activity, and for immunity. Grapefruit seed extract can potentially interfere with a variety of medications.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 grams) herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. You may use tinctures alone or in combination as noted. Some herbs can interfere with medications. So talk to your doctor first before beginning an herbal therapy.

• Green tea (Camellia sinensis). Standardized extract, for antioxidant, anticancer and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa). For anticancer, immune and antibacterial or antifungal activity. Cat's claw can interact with many medications. Use caution if you have leukemia or an autoimmune disease as Cat's claw may worsen these conditions. Speak with your doctor.
• Milk thistle (Silybum marianum). Seed standardized extract, for detoxification support. Since milk thistle works on the liver, it can interact with a variety of medications. People with a history of hormone-related conditions, or who are at risk for such conditions, should speak to their doctors before using milk thistle.
• Garlic (Allium sativum). Standardized extract, for antifungal and immune activity. Garlic can have a blood thinning effect so talk to your doctor if you are taking blood-thinning medications. Garlic can interfere with many drugs, including drugs that treat HIV.

Homeopathy

Some of the most common remedies for vaginitis are listed below. Usually, the dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms get better.

• Calcarea carbonica. For intense itching with thick white or yellowish discharge that is worse before you start your period.
• Borax. For burning pains with egg white colored discharge.
• Sepia. For burning pains with milky white discharge and pressure in vaginal area, especially if you feel depressed and irritable.
• Graphites. For backache with thin white discharge that is worse in the morning and when walking.
• Arsenicum album. For when you have burning discharge.
• Tea tree oil. To help treat symptoms.
• Homeopathic combinations are available as creams to apply vaginally.

Acupuncture

Acupuncture may help improve immune function.

Following Up

To prevent recurrence of infection:

• Take showers instead of baths.
• Use unscented soap.
• Always wipe from front to back after bowel movements.
• Wear cotton underwear.
• Avoid pantyhose and tight-fitting pants.

Recurrent signs and symptoms of vaginitis may be an indication of herpes simplex virus 2 (HSV-2). See your doctor if you are suffering from recurrent infections.

Special Considerations

HIV acquisition is increased among women with vaginitis. So prompt and effective treatment is critical. Yeast infections occur twice as often during pregnancy due to hormone fluctuations. The vagina may also be affected by skin conditions, or dermatoses. Diagnosis and treatment of these conditions is difficult because of the poor visibility in the vagina, and a lack of appropriate medications that are safe for use in the vagina.

Supporting Research

ACOG. ACOG Practice Bulletin. Clinical management guidelines for obstetricians-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. 2006;107(5):1195-1206.

Black M, Ambros-Rudolph CM, Edwards L, Lynch PJ, eds. Obstetric and Gynecologic Dermatology. 3rd ed. Baltimore, MD: Elsevier Mosby; 2008.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-250.

Delia A, Morgante G, Rago G, Musacchio MC, Petraglia F, De Leo V. Effectiveness of oral administration of Lactobaccillus paracasei subsp. paracasei F19 in association with vaginal suppositories of Lactobacillus acidofilus in the treatment of vaginosis and in the prevention of recurrent vaginitis. Minerva Ginecol. 2006;58(3):227-231.

Edwards L. Dermatologic causes of vaginitis: a clinical review. Dermatol Clin. 2010;28(4):727-735.

Guo HY, Hu XM, Han DD, Wang ZP, Meng L. Lipid peroxidation and antioxidant status in vagina microenvironment of patients with several common vaginitis. Clin Exp Obstet Gynecol. 2013;40(3):331-426.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med. 2002;8(3):333-340.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

Holloway D. Nursing considerations in patients with vaginitis. Br J Nurs. 2010;19(16):1040-1046.

Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017.

LaValle JB, Krinsky DL, Hawkins EB, eds. Natural Therapeutics Pocket Guide. 2nd ed. Hudson, OH:LexiComp; 2002:452-454.

Mohamadi J, Havasian MR, Panahi J, Pakzad I. Antigungal drug resistance pattern of Candida. spp isolated from vaginitis in Ilam-Iran during 2013-2014. Bioinformation. 2015;11(4):203-206.

Nanda N, Michel RG, Kurdgelashvili G, Wendel KA. Trichomoniasis and its treatment. Expert Rev Anti Infect Ther. 2006;4(1):125-135.

Pereira N, Edlind TD, Schlievert PM, Nyirjesy P. Vaginal toxic shock reaction triggering desquamative inflammatory vaginitis. J Low genit Tract Dis. 2013;17(1):88-91.

Powell AM, Gracely E, Nyirjesy P. Non-albicans candida vulvovaginitis: treatment experience at a Tertiary Care Vaginitis Center. J Low genit Tract Dis. 2016;20(1):85-89.

Quan M. Vaginitis: diagnosis and management. Postgrad Med. 2010; 22(7):117-127.

Reid G, Burton J, Hammond JA, Bruce AW. Nucleic acid-based diagnosis of bacterial vaginosis and improved management using probiotic lactobacilli. J Med Food. 2004;7(2):223-228.

Ross SE, Carter B, Lambert S. Seroprevalence of herpes simplex virus-2 infection among women seeking medical care for signs and symptoms of vaginitis. Herpes. 2009;15(3):46-50.

Scnitzler P, Schon K, Reichling J. Antiviral activity of Australian tea tree oil and eucalyptus oil against herpes simplex virus in cell culture. Pharmazie. 2001;56(4):343-347.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Sufka KJ, Roach JT, Chambliss WG Jr, et al. Anxiolytic properties of botanical extracts in the chick social separation-stress procedure. Psychopharmacology (Berl). 2001;153(2):219-224.

Tempera G, Abbadessa G, Bonfiglio G, et al. Topical kanamycin: an effective therapeutic option in aerobic vaginitis. J Chemother. 2006;18(4):409-414.

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Review Date: 1/1/2017  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M Editorial team.

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