Vaginal Infections

Vaginitis" is a medical term used to describe various conditions that cause infection or inflammation of the vagina. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from a vaginal infection caused by organisms such as bacteria, yeast or viruses, as well as by irritations from chemicals in creams, sprays, or even clothing that is in contact with this area. In some cases, vaginitis results from organisms that are passed between sexual partners.
What Are the Symptoms of a Vaginal Infection?
The symptoms of vaginitis can vary depending on what is causing the infection. Some women have no symptoms at all. Some of the more common symptoms of vaginitis include:
Abnormal vaginal discharge with an unpleasant odor.
Burning during urination.
Itching around the outside of the vagina.
Discomfort during intercourse.
Is Vaginal Discharge Normal?
A woman's vagina normally produces a discharge that usually is described as clear or slightly cloudy, non-irritating, and odor-free. During the normal menstrual cycle, the amount and consistency of discharge can vary. At one time of the month there may be a small amount of a very thin or watery discharge; and at another time, a more extensive thicker discharge may appear. All of these descriptions could be considered normal.
A vaginal discharge that has an odor or that is irritating usually is considered an abnormal discharge. The irritation might be itching or burning, or both. The itching may be present at any time of the day, but it often is most bothersome at night. These symptoms often are made worse by sexual intercourse. It is important to see your doctor if there has been a change in the amount, color, or smell of the discharge.
What Are the Most Common Types of Vaginal Infections?
The 6 most common types of vaginal infections are:
Candida or "yeast" infections
Bacterial vaginosis
Trichomoniasis vaginitis
Chlamydia vaginitis
Viral vaginitis
Non-infectious vaginitis
Although each of these vaginal infections can have different symptoms, it is not always easy for a woman to figure out which type of vaginal infection she has. In fact, diagnosis can even be tricky for an experienced doctor. Part of the problem is that sometimes more than one type of infection can be present at the same time. And, an infection may even be present without any symptoms at all.
To help you better understand these 6 major causes of vaginitis, let's look briefly at each one of them and how they are treated.
What Is Candida or a Vaginal "Yeast" Infection?
Yeast infections of the vagina are what most women think of when they hear the term "vaginitis." Vaginal yeast infections are caused by one of the many species of fungus called Candida. Candida normally live in small numbers in the vagina, as well as in the mouth and digestive tract, of both men and women.
Yeast infections can produce a thick, white vaginal discharge with the consistency of cottage cheese although vaginal discharge may not always be present. Yeast infections usually cause the vagina and the vulva to be very itchy and red.

Are Vaginal Yeast Infections Transmitted by Sexual Intercourse?
Yeast infections are not usually transmitted through sexual intercourse and are not considered a sexually transmitted disease.
What Factors Increase Your Risk of Vaginal Yeast Infections?
A few things will increase your risk of contacting a yeast infection, including:
Recent treatment with antibiotics. For example, a woman may take an antibiotic to treat an infection, and the antibiotic kills her "friendly" bacteria that normally keep the yeast in balance. As a result, the yeast overgrows and causes the infection.
Uncontrolled diabetes. This allows for too much sugar in the urine and vagina.
Pregnancy which changes hormone levels
Other Factors Include:
Oral contraceptives (birth control pills)
Disorders affecting the immune system
Thyroid or endocrine disorders
Corticosteroid therapy
How Are Vaginal Yeast Infections Treated?
Yeast infections are most often treated with medicine that you put into your vagina. This medicine may be in cream or suppository form and many are available over-the-counter. Medicine in a pill form that you take by mouth is also available by prescription.
What Should I Do to Prevent Vaginal Yeast Infections?
To prevent yeast infections, you should:
Wear loose clothing made from natural fibers (cotton, linen, silk).
Avoid wearing tight pants.
Don't douche. (Douching can kill bacteria that control fungus.)
Limit the use of feminine deodorant.
Limit the use of deodorant tampons or pads to the times when you need them.
Change out of wet clothing, especially bathing suits, as soon as you can
Avoid frequent hot tub baths.
Wash underwear in hot water.
Eat a well-balanced diet.
Eat yogurt.
If you have diabetes, keep your blood sugar level as close to normal as possible.
If you get frequent yeast infections, tell your doctor. He or she may need to do certain tests to rule out other medical conditions.
What Is Bacterial Vaginosis?
Although "yeast" is the name most women think of when they think of vaginal infections, bacterial vaginosis (BV) is the most common type of vaginal infection in women of reproductive age. BV is caused by a combination of several bacteria. These bacteria seem to overgrow in much the same way as do Candida when the vaginal balance is upset. The exact reason for this overgrowth is not known.
Is Bacterial Vaginosis Transmitted by Sexual Intercourse?
BV is not transmitted through sexual intercourse but is more common in women who are sexually active. It is also not a serious health concern but can increase a woman's risk of developing other sexually transmitted diseases and can increase the risk of pelvic inflammatory disease (PID) following surgical procedures such as abortion and hysterectomy. Some studies have shown and increased risk of early labor and premature births in women who have the infection during pregnancy. More recent investigations do not support this relationship.

What Are the Symptoms of Bacterial Vaginosis?
Up to 50% of the women who have bacterial vaginosis do not have any symptoms. Most women learn they have the infection during their annual gynecologic exam. But if symptoms appear, they can include:
White or discolored discharge
Discharge that smells "fishy" that is often strongest agter sex
Pain during urination
Itchy and sore vagina
How Is Bacterial Vaginosis Diagnosed?
Your doctor can tell you if you have BV. He or she will examine you and will take a sample of fluid from your vagina. The fluid is viewed under a microscope. In most cases, your doctor can tell right away if you have BV.
What Is the Treatment for Bacterial Vaginosis?
Bacterial vaginosis can only be treated with medicines ordered by your doctor. Over-the-counter remedies will not cure BV. The most common medicines prescribed for BV are called metronidazole (Flagyl) and clindamycin (Cleocin). These medications may be taken as a pill or used as a vaginal cream or gel.
Should I Be Treated for Bacterial Vaginosis if I am Pregnant?
Maybe. But some medications for BV should not be taken during the first three months of pregnancy. Tell your doctor if you are pregnant. Also let your doctor know if you think that you might be pregnant. You and your doctor should discuss whether or not the infection should be treated.
How Can I Protect Myself From Bacterial Vaginosis?
Ways to prevent BV are not yet known. Female hygiene products like douches and deodorants will not cure the infection. These products may even make the infection worse.
What Vaginal Infections Are Transmitted Through Sexual Intercourse?
There are several vaginal infections that are transmitted through sexual contact. Trichomoniasis, caused by a tiny single-celled organism that infects the vagina, can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms.
Chlamydia is another sexually transmitted form of vaginitis. Unfortunately, most women with chlamydia infection do not have symptoms, which makes diagnosis difficult. A vaginal discharge is sometimes present, but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18-35 years) who have multiple sexual partners. If you fit this description, you should request screening for chlamydia during your annual checkup. If left untreated, chlamydia can cause damage to a woman's reproductive organs, and can make it difficult for a woman to become pregnant.
Several sexually transmitted viruses cause vaginitis, including the herpes simplex virus and the humanpapilloma virus (HPV). The primary symptom of herpes is pain associated with lesions or "sores." These sores usually are visible on the vulva or the vagina but occasionally are deep inside the vagina and can only be seen during a gynecologic exam.HPV, sometimes referred to as genital warts, can cause warts to grow in the vagina, rectum, vulva or groin. These warts, when visible, usually are white to gray in color, but they may be pink or purple. When warts are not visible, a Pap smear or a more specialized HPV test may be the only way to detect the virus.

What Are the Symptoms of Bacterial Vaginosis?
Up to 50% of the women who have bacterial vaginosis do not have any symptoms. Most women learn they have the infection during their annual gynecologic exam. But if symptoms appear, they can include:
White or discolored discharge
Discharge that smells "fishy" that is often strongest agter sex
Pain during urination
Itchy and sore vagina
How Is Bacterial Vaginosis Diagnosed?
Your doctor can tell you if you have BV. He or she will examine you and will take a sample of fluid from your vagina. The fluid is viewed under a microscope. In most cases, your doctor can tell right away if you have BV.
What Is the Treatment for Bacterial Vaginosis?
Bacterial vaginosis can only be treated with medicines ordered by your doctor. Over-the-counter remedies will not cure BV. The most common medicines prescribed for BV are called metronidazole (Flagyl) and clindamycin (Cleocin). These medications may be taken as a pill or used as a vaginal cream or gel.
Should I Be Treated for Bacterial Vaginosis if I am Pregnant?
Maybe. But some medications for BV should not be taken during the first three months of pregnancy. Tell your doctor if you are pregnant. Also let your doctor know if you think that you might be pregnant. You and your doctor should discuss whether or not the infection should be treated.
How Can I Protect Myself From Bacterial Vaginosis?
Ways to prevent BV are not yet known. Female hygiene products like douches and deodorants will not cure the infection. These products may even make the infection worse.
What Vaginal Infections Are Transmitted Through Sexual Intercourse?
There are several vaginal infections that are transmitted through sexual contact. Trichomoniasis, caused by a tiny single-celled organism that infects the vagina, can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms.
Chlamydia is another sexually transmitted form of vaginitis. Unfortunately, most women with chlamydia infection do not have symptoms, which makes diagnosis difficult. A vaginal discharge is sometimes present, but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18-35 years) who have multiple sexual partners. If you fit this description, you should request screening for chlamydia during your annual checkup. If left untreated, chlamydia can cause damage to a woman's reproductive organs, and can make it difficult for a woman to become pregnant.
Several sexually transmitted viruses cause vaginitis, including the herpes simplex virus and the humanpapilloma virus (HPV). The primary symptom of herpes is pain associated with lesions or "sores." These sores usually are visible on the vulva or the vagina but occasionally are deep inside the vagina and can only be seen during a gynecologic exam.HPV, sometimes referred to as genital warts, can cause warts to grow in the vagina, rectum, vulva or groin. These warts, when visible, usually are white to gray in color, but they may be pink or purple. When warts are not visible, a Pap smear or a more specialized HPV test may be the only way to detect the virus.

What Are the Symptoms of Bacterial Vaginosis?
Up to 50% of the women who have bacterial vaginosis do not have any symptoms. Most women learn they have the infection during their annual gynecologic exam. But if symptoms appear, they can include:
White or discolored discharge
Discharge that smells "fishy" that is often strongest agter sex
Pain during urination
Itchy and sore vagina
How Is Bacterial Vaginosis Diagnosed?
Your doctor can tell you if you have BV. He or she will examine you and will take a sample of fluid from your vagina. The fluid is viewed under a microscope. In most cases, your doctor can tell right away if you have BV.
What Is the Treatment for Bacterial Vaginosis?
Bacterial vaginosis can only be treated with medicines ordered by your doctor. Over-the-counter remedies will not cure BV. The most common medicines prescribed for BV are called metronidazole (Flagyl) and clindamycin (Cleocin). These medications may be taken as a pill or used as a vaginal cream or gel.
Should I Be Treated for Bacterial Vaginosis if I am Pregnant?
Maybe. But some medications for BV should not be taken during the first three months of pregnancy. Tell your doctor if you are pregnant. Also let your doctor know if you think that you might be pregnant. You and your doctor should discuss whether or not the infection should be treated.
How Can I Protect Myself From Bacterial Vaginosis?
Ways to prevent BV are not yet known. Female hygiene products like douches and deodorants will not cure the infection. These products may even make the infection worse.
What Vaginal Infections Are Transmitted Through Sexual Intercourse?
There are several vaginal infections that are transmitted through sexual contact. Trichomoniasis, caused by a tiny single-celled organism that infects the vagina, can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms.
Chlamydia is another sexually transmitted form of vaginitis. Unfortunately, most women with chlamydia infection do not have symptoms, which makes diagnosis difficult. A vaginal discharge is sometimes present, but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18-35 years) who have multiple sexual partners. If you fit this description, you should request screening for chlamydia during your annual checkup. If left untreated, chlamydia can cause damage to a woman's reproductive organs, and can make it difficult for a woman to become pregnant.
Several sexually transmitted viruses cause vaginitis, including the herpes simplex virus and the humanpapilloma virus (HPV). The primary symptom of herpes is pain associated with lesions or "sores." These sores usually are visible on the vulva or the vagina but occasionally are deep inside the vagina and can only be seen during a gynecologic exam.HPV, sometimes referred to as genital warts, can cause warts to grow in the vagina, rectum, vulva or groin. These warts, when visible, usually are white to gray in color, but they may be pink or purple. When warts are not visible, a Pap smear or a more specialized HPV test may be the only way to detect the virus.

Vaginal Discharge

Vaginal discharge is normal and varies during your menstrual cycle. Before ovulation (the release of the egg), there is A LOT of mucous produced, up to 30X more than after ovulation. It is also more watery and elastic during that phase of your cycle. You may want to wear panty liners during that time.

The things to be worried about include if the discharge has a yellow or green color, is clumpy like cottage cheese, or has a bad odor. If worried, see a doctor.


Different Types of Discharge
Is this normal?
Different Types of Discharge

White: Thick, white discharge is common at the beginning and end of your cycle. Normal white discharge is not accompanied by itching. If itching is present, thick white discharge can indicate a yeast infection.

Clear and stretchy: This is "fertile" mucous and means you are ovulating.

Clear and watery: This occurs at different times of your cycle and can be particularly heavy after exercising.

Yellow or Green: May indicate an infection, especially if thick or clumpy like cottage cheese or has a foul odor.

Brown: May happen right after periods, and is just "cleaning out" your vagina. Old blood looks brown.

Spotting Blood/Brown Discharge: This may occur when you are ovulating/mid-cycle. Sometimes early in pregnancy you may have spotting or a brownish discharge at the time your period would normally come. If you have spotting at the time of your normal period rather than your usual amount of flow, and you have had sex without using birth control, you should check a pregnancy test.

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Is this normal?
We receive many questions about vaginal discharge through our "Ask the Expert" section. Below physician assistant Steven Johnson, explains what is normal and when to see a health care provider.

One of the challenges to answering questions sent into a health care Web site is making sure that the person asking the question seeks the advice and care from her doctor when appropriate. There is often information NOT given that can really change the answer.

For instance:

How old are you (really)?
Are you on medications or do you take herbs or vitamins?

Do you have pain or itching?

Are you pregnant?

Do you have other health problems (like diabetes)?

An important question is sexual activity. Sometimes it isn't accurate to simply say yes or no. Symptoms can depend on the number of sexual partners, kind of sexual partners, birth control, birth control failure, kind of sex you are having and if abuse is involved. I think you can see, it can get pretty complicated to get all the information needed to give the best answer possible.

With that said, here is my best answer to the common question of vaginal discharge.

A normal vaginal discharge consists of about a teaspoon (4 ML) a day that is white or transparent, thick to thin, and odorless. This is formed by the normal bacteria and fluids the vaginal cells put off. The discharge can be more noticeable at different times of the month depending on ovulation, menstrual flow, sexual activity and birth control.

It is not uncommon for the normal discharge to be dark, brown or discolored a day or two following the menstrual period.

If you are having ANY of the symptoms below SEE YOUR HEALTH CARE PROVIDER.
Pain

Itching

Discomfort

Rash or sores alone or with a vaginal discharge



The female reproductive system consists of two ovaries, two fallopian tubes, the uterus, and the vagina. An ovary normally produces an egg (ovulation) about 11 to 17 days before the woman''s next menstrual period, or approximately once a month. The egg is released from the ovary into a fallopian tube and swept into the uterus by tiny hairlike cells (cilia) and muscle action.