What is vaginitis?
In the case of vaginitis, the protective vaginal flora is out of balance. Normally, the vagina is well protected from the outside against pathogens by the labia minora and labia majora as well as the pubic hair. Inside, it is lined with a multi-layered tissue: the epithelium. This protects against mechanical stimuli, for example during sexual intercourse. The inside of the vagina itself is colonized by lactic acid bacteria such as Döderlein and lactobacteria. These create an acidic environment with a low pH value inside the vagina, which makes it difficult for pathogens to colonize.
Vaginitis: causes and risk factors
Two factors play an important role in the development of vaginitis: a disturbed vaginal environment and certain pathogens. Experts distinguish between two causes of inflammation:
- Primary vaginitis: Primary vaginitis occurs when large numbers of germs penetrate from outside and damage the intact vaginal flora.
- Secondary vaginitis: We speak of secondary vaginitis when the vaginal environment is already disturbed and inflammation develops as a result. This also includes inflammation caused by a lack of oestrogen, which mainly occurs in older women or girls before puberty.
What unbalances the vaginal environment?
There are many risk factors that can unbalance the vaginal environment and make it easier for pathogens to enter. These include:
- Antibiotics (they impair the natural bacterial colonization of the vagina)
- Excessive hygiene (with alkaline soaps)
- Estrogen deficiency
- Vaginal douches
- Chemicals
- heavy menstrual bleeding (counteracts the acidic vaginal environment)
- High number of sexual partners
- mechanical influences such as
- Tampons
- Vaginal diaphragm
- Spiral
- Foreign body in the vagina (forgotten tampon or pessary)
- Diabetes mellitus (diabetes)
- Obesity
- Tumors
- Corticosteroids
- Cancer drugs
Which pathogens cause vaginitis?
Vaginitis can be triggered by numerous pathogens:
- Bacteria:
- Gardnerella vaginalis
- Chlamydia
- Staphylococci
- Streptococci
- Escherichia coli
- Enterobacteriaceae
- Mycoplasma
- Gonococci
- Parasites:
- Mushrooms:
- Sprout or yeast fungi (Candida albicans)
- Viruses:
- Worms
How is vaginitis transmitted?
Some potential pathogens are part of the normal vaginal flora. Only in large numbers do they cause vaginitis. Other pathogens enter the vagina from outside, for example during sexual intercourse. Vaginitis can also be transmitted via shared underwear or towels.
Which vaginitis occurs most frequently?
The most common is a bacterial vaginal infection (bacterial vaginosis). The infection causes the acidic environment of the vaginal flora to become unbalanced. The number of “good” lactic acid bacteria decreases. This allows bacteria that are not normally found in the vagina to colonize and multiply. Bacterial vaginosis is caused by numerous bacteria, including gardnerella. As a result, the pH value shifts to an alkaline environment (> 4.5 pH).
Causes of vaginitis in girls
The vaginal environment in girls is neutral (pH7). It is only with the increasing influence of the female sex hormone oestrogen that a constant acidity of the vaginal secretion (pH 4-4.5) develops in the vagina. This is why the natural protective mechanism of the vagina does not yet work in young girls. As a result, pathogens can multiply more easily in the vagina and cause vaginitis. Bacterial vaginitis in children is often caused by smear infections, for example by Escherichia coli from the anal area. Other causes are urinary tract infections or foreign bodies in the vagina. In girls, it is not uncommon for the external primary sexual organs to be affected as well as the vagina (= vulvovaginitis infantum).
Causes of vaginitis in menopausal women
The body produces fewer hormones in women during and after the menopause. This has an influence on the vaginal flora. The lactic acid bacteria in the vagina can no longer multiply sufficiently and bacteria (for example from the intestinal flora) can spread more easily. The risk of vaginitis increases. In addition, the lack of oestrogen causes the tissue layer in the vagina to become thinner and it is less supplied with blood. The technical term for vaginal inflammation caused by a lack of oestrogen is atrophic colpitis or colpitis senilis.
Symptoms: Recognizing vaginitis
If the sensitive vaginal flora is disturbed, this weakens the vagina’s natural protective mechanism. As a result, pathogens can colonize and multiply more easily. A typical sign of vaginitis is vaginal discharge, known as vaginal fluoride. Depending on which pathogen is responsible for the inflammation, further symptoms may occur. Common signs of vaginitis are:
- Discharge from the vagina
- Pain during sexual intercourse
- Burning pain (independent of mechanical irritation)
- Blisters (for genital herpes)
- Itching in the vagina (especially with fungal infections)
- Discomfort when urinating
- Bleeding
Vaginitis can spread from the vaginal entrance to the external primary sexual organs (vulvovaginitis). It does not always have to be accompanied by symptoms. Some women show no symptoms despite being infected.
Typical sign of vaginitis: vaginal discharge
Vaginitis causes the vagina to secrete more fluid. This often smells unpleasant. The discharge can take various forms: watery, mucousy, purulent, foamy, crumbly or even bloody. The nature of the discharge indicates which pathogen is responsible for the inflammation:
- Mixed infection: In many cases, several bacteria cause the inflammation. A yellow-greenish discharge is typical of a mixed infection.
- Infection with Gardnerella vaginalis bacteria: This bacterial vaginosis is caused by Gardnerella vaginalis bacteria, among others. It is characterized by an unpleasant, fishy smell with a thin discharge.
- Fungal infection: In the case of a fungal infection with Candida albicans, the discharge is white and odorless.
Vaginitis – diagnosis with us
Consult a gynecologist if you:
- suffer from increased (foul-smelling) discharge that does not disappear even after several days,
- symptoms such as itching, pain or bleeding in the vaginal area,
- the complaints increase.
Vaginitis: How is the pathogen determined?
To determine which pathogens are responsible for the vaginal inflammation, we take a swab from the vagina. The samples are then examined under the microscope and the pH value of the vaginal environment is determined. We can send the swabs to a microbiology laboratory for special questions.
Searching for clues: Which factors favor an infection?
To prevent vaginitis from recurring, we will talk to you about the factors that promote inflammation and how you can prevent further inflammation as part of your medical history. Favorable factors are, for example
- Excessive or inadequate hygiene,
- Oestrogen deficiency or
- previous therapy with antibiotics.
We will also identify or rule out other diseases that promote vaginal infections. These include cervical diseases, diabetes or carcinoma.
Vaginitis: prevention, early detection, prognosis
There is no one hundred percent protection against vaginal infections. However, you can take simple measures to protect yourself from pathogens:
- Use condoms during sexual intercourse.
- Always wipe your buttocks from front to back after a bowel movement. This will prevent bacteria from the stool entering the vagina.
- Clean your intimate area thoroughly, but do not overdo it. Poor hygiene increases the risk of vaginitis, as do frequent washing with soap, long bubble baths, intimate sprays or vaginal douches.
Vaginitis: course and prognosis
Vaginitis that is treated consistently usually heals without any problems.
How long the inflammation lasts depends, among other things, on this,
- which pathogen you have been infected with,
- how severe the inflammation is and
- how quickly you start a suitable therapy.
Vaginitis lasts a few days if treated promptly.
Be careful with vaginitis during pregnancy
Vaginitis during pregnancy carries various risks: Possible (rare) consequences are premature labor, premature rupture of the membranes or premature birth. It is also possible for the expectant mother to infect the baby with the pathogen during birth. Pathogens such as herpes viruses, gonococci or the bacterium Chlamydia trachomatis can cause infections such as conjunctivitis in babies. In some cases, it is necessary to consider whether a caesarean section is appropriate.
Vaginitis: Tailor treatment to the pathogen
The treatment of colpitis depends on the pathogen that caused the inflammation. Depending on the type of germ, treatment is either systemic or local.