Vaginitis: treatment, symptoms, signs, types of vaginitis

Vaginitis is an inflammation of the vaginal mucosa caused by disruption of the normal flora of the genital organs, the entry of pathogenic viruses and bacteria into it, as well as insufficient intimate hygiene or allergies to cosmetics and contraceptives. Acute vaginitis causes a list of unpleasant symptoms that impair quality of life and interfere with healthy sexual relationships. With a prolonged course of the inflammatory process in the vagina, with insufficient or incorrect treatment, vaginitis can develop into a chronic stage, which is fraught with serious complications for the woman’s reproductive system.

Causes and risk factors of the disease

In the clinic, a distinction is made between the concepts of “specific” and “nonspecific” inflammation of the vaginal mucosa. The first group occurs after certain bacteria enter the genital tract, causing a characteristic clinical picture and requiring a certain type of treatment. The most common specific vaginitis is caused by:

trichomonas;
gonococci;
mycoplasma;
ureaplasma;
fungi of the genus “Candida”;
chlamydia;
herpes and human papilloma viruses.

All these infections are included in the group of sexually transmitted diseases. Infection of the vagina occurs during sexual intercourse from an infected partner (clinically he may be healthy).

A nonspecific process occurs due to the activation of opportunistic vaginal flora, which is present in the genital tract of every woman without causing any clinical symptoms. This flora includes staphylococci, streptococci, Haemophilus influenzae, Escherichia coli and other bacteria. They can cause clinical vaginitis in certain conditions that are risk factors:

with mechanical damage to the vaginal mucosa (due to surgical interventions, childbirth, abortion);
uncontrolled use of antibiotics, suppressing the normal flora of the vagina;
insufficient blood supply to the vaginal mucosa, which is an age-related characteristic of the body (atrophic vaginitis);
hormonal imbalance in diseases of the ovaries, adrenal glands, menopause;
allergies to condoms, intimate gels and creams, tampons or suppositories;
failure to maintain personal hygiene.

general information

Vaginitis is an inflammation of the vagina that can lead to discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection. A decrease in estrogen levels after menopause can cause atrophic vaginitis and some skin disorders.

To better understand the essence of the problem, let’s define the medical terminology for this disease. In publications you can find different names for diseases of the lower reproductive tract that are similar in their causes and symptoms, which often leads to confusion. So…

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Vaginitis is an inflammatory process of the vaginal mucosa. Locally, this area is located in the area starting behind the hymen and ending at the cervix.

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Vulvitis is an inflammation of the external genital organs, their mucous membrane (labia, vestibule of the vagina, skin of the clitoris or hymen, and this also includes the external opening of the urethra). In 30% of cases in adolescence, the cause of vulvitis is Candida fungi (thrush), and in 15% the cause is a bacterial infection (the so-called gardnerellosis).

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Vulvovaginitis is a gynecological pathology in women, combining the causes and symptoms of vulvitis and vaginitis (specific or nonspecific).

Types of vaginitis:

Bacterial vaginosis, which is the result of a change from the normal bacteria found in your vagina to an overgrowth of other organisms;
Acute yeast vaginitis, which are usually caused by a naturally occurring fungus called Candida albicans;
Trichomonas vaginitis, which is caused by a parasite from a genus of protozoan microorganisms.

Treatment for vaginitis depends on the type of disease that your gynecologist diagnosed during the examination.

Symptoms of vaginitis

Signs and symptoms of vaginitis may include:

Change in color, odor, or amount of vaginal discharge;
Vaginal itching or irritation;
Pain during intercourse;
Painful urination;
Vaginal bleeding or spotting.

Acute vaginitis

If you have an unusual vaginal discharge that you haven't had before, its characteristics may indicate that you may have a sexually transmitted infection. Examples:

✔ Gardnerellosis . You may develop a greyish-white, foul-smelling discharge. The odor, often described as fishy, may be more obvious after regular vaginal intercourse. This most common cause of vaginitis is the result of a change in the amount of normal bacteria found in your vagina. Typically, these beneficial bacteria commonly found in the vagina (lactobacillus) outnumber other bacteria (anaerobes). If anaerobic bacteria become too numerous, they upset the balance, causing bacterial vaginosis.

This type of inflammation in the vagina is often associated with sexual intercourse, especially if you have multiple sexual partners or a new sexual partner, but it is also common or has happened to a woman who has had symptoms of acute vaginitis.

✔ Yeast infection. The main symptom is redness and itching, but you may have a white, thick discharge that resembles cottage cheese. Candidal vaginitis occurs when there is overgrowth of a fungal organism, usually C. albicans, in your vagina. Candida albicans also causes fungal infections in other moist areas of your body, such as the mouth (thrush), skin folds, and nail beds.

✔ Trichomonosis. Acute vaginitis in women, caused by the microbe Trichomonas, can produce a greenish-yellow, sometimes foamy discharge. This common genitourinary infection, transmitted through intimate intimacy of any kind, is caused by the microscopic single-celled parasite Trichomonas vaginalis. This microorganism is spread during sexual intercourse with a partner who has clinical signs or is a latent carrier. Acute vaginitis in girls and adolescents can be caused by this pathogen, acquired through household contact.

In men, the urinary tract is usually affected, but often does not cause any symptoms. In women, trichomoniasis usually affects the vagina and can cause symptoms. It also increases the risk of women contracting other sexually transmitted infections.

Nonspecific vaginitis

Vaginal sprays, scented soaps, scented cleansers, and spermicides may cause an allergic reaction or irritate the tissues of the vulva and vagina. Long-term inflammatory manifestations lead to chronic forms of nonspecific vaginitis. Foreign objects, such as a tissue or tampons left in the vagina, can also irritate the vaginal tissues, causing itching and an unpleasant odor from the intimate area.

In other words, nonspecific vaginitis in gynecology is a disease of an infectious-inflammatory nature that occurs against the background of a predominance of opportunistic flora formed in the vagina, mainly in adults, in women during pregnancy and in little girls. The emphasis is placed precisely on the absence of any specific, “specific” STI pathogen such as gonococcus, Trichomonas, etc.

A long course of taking antibiotics with broad antimicrobial action or self-medication with them at home leads to dysbiosis with the death of lactobacilli and a change in the pH of the vaginal environment from acidic to alkaline. These conditions are most favorable for the reproduction and growth of opportunistic microflora.

Atrophic vaginitis

Synonyms are “urinary menopause syndrome”, senile vaginitis and vaginal atrophy. A decrease in estrogen levels inevitably occurs during menopause and after menopause or surgical removal of the ovaries. This leads to a gradual thinning of the vaginal mucosa, sometimes leading to irritation, burning and dryness in the postmenopausal period.

Vaginitis in older women is associated with an atrophic nature and is predominantly nonspecific in nature and develops against the background of primary vaginal dysbiosis. This occurs as a result of a decrease in the production of lubrication by the vaginal glands, which directly depends on the level of estrogen. Such an environment is favorable for the proliferation of microorganisms of the opportunistic group, which are normally present in small quantities on the genitals.

Symptoms of atrophic vaginitis:

burning with itching outside inside the genitals,
itching when urinating, after washing with soap,
discomfort during sexual intercourse,
after sex there is “spotting” spotting on your underwear,
feeling that the vagina is “all dry”
the discharge has an unpleasant odor and contains patches of reddish or brown color,
decreased desire to have
During exercise, involuntary urination sometimes occurs.

Are there any symptoms of atrophic vaginitis?

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Causes of vaginitis

Factors that increase the risk of developing any type of vaginitis in women, regardless of their age, include:

Hormonal changes associated with pregnancy, birth control pills
Reduced ovarian function (chronic adnexitis, genital infantilism, fasting, menopause and menopause)
Sexual activity
Presence of a sexually transmitted infection
Medicines such as antibiotics and steroids
Use of spermicides for fertility regulation
Uncontrolled diabetes mellitus
Excessive hygiene products (bubble bath, vaginal spray or vaginal deodorant)
Douching without a doctor's prescription
Constant, prolonged wearing of wet, synthetic or tight-fitting clothing
Using an intrauterine device (IUD)

Diagnosis of vaginitis

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Prevention Tips

Good intimate hygiene can prevent some types of vaginitis and relieve symptoms before visiting your gynecologist:

Ignore baths, hydromassage water treatments with underwater massage.
Avoid irritants. These include scented tampons, pads, douches and scented soaps. After showering, rinse the soap from the external genital area and dry the area thoroughly to prevent irritation. Do not use harsh soaps that are antibacterial.
Avoid spreading fecal bacteria into the vagina.
Your vagina does not require any cleansing other than regular bathing. Repeated douching disrupts the beneficial bacteria found in the vagina and increases the risk of vaginal infection. Douching will not get rid of a vaginal infection if it is already present.
When having sex, especially with a new or unreliable partner, use a latex condom.
Treat cystitis promptly and fully and not cause inflammation of the appendages.
Wear cotton underwear.

Types of vaginitis

According to the duration of the inflammatory process, it is divided into several types:

acute vaginitis.
The inflammatory process develops quickly, more often after unprotected sexual intercourse; manifests itself with violent symptoms, but with a correctly prescribed treatment regimen, it is cured within two weeks;
subacute vaginitis
– develops against the background of acute inflammation, in the absence of treatment or an incorrectly selected antibiotic therapy regimen. Symptoms become less severe, but continue to occur for more than two weeks;
chronic vaginitis
diagnosed in cases where symptoms of inflammation persist for more than two months. It is also a consequence of improper treatment or, more often, the result of impaired immunity.

Gonorrheal vaginitis

Infectious vaginitis in women caused by gonococcus openly manifests itself in 50% of cases. In other women, the infection has a latent course. The incubation period ranges from 3 to 7 days, that is, the first symptoms after sexual contact with a partner may appear only after a week. The characteristic specific symptoms of the disease are as follows:

purulent vaginal discharge that is white-yellow or greenish in color;
severe pain, swelling and hyperemia of the mucous membrane. They are noticeable even without special examination;
frequent false urge to urinate, resulting from gonorrheal inflammation of the urethra.

This species is characterized by the frequent transition of the disease to a chronic form, which is associated with the resistance of bacteria to common antibiotics.

Symptoms of vaginitis depending on the pathogen

The main signs of vaginal inflammation are general discomfort in the genital area, which manifests itself in irritation, tingling and burning. High temperature, pain in the vagina and general weakness are not characteristic symptoms; their presence indicates the neglect of the process.

Symptoms of vaginitis vary depending on the causative agent of the disease:

bacterial is characterized by abundant purulent discharge of green or yellow color;
Trichomonas is characterized by foamy discharge with an unpleasant strong odor, the patient complains of pain in the lower abdomen, in the absence of treatment the temperature can rise to 39°C;
gonorrheal is manifested by pain, itching and mucous discharge mixed with pus or fragments of dead cells of the vaginal epithelium, and in an advanced form - with the presence of blood;
Candida is characterized by a curd-like discharge with a sour odor and severe itching;
atrophic vaginitis makes itself felt by unbearable itching, vaginal dryness, thinning of the vaginal epithelium, and frequent urination. Discharge is practically absent or may be bloody.

The most common type of inflammation is thrush. The disease does not go away on its own and requires complex treatment. For examination and diagnosis, you need to contact a gynecologist.

Trichomonas vaginitis

Sometimes the incubation period lasts up to one month. The absence of a regular sexual partner significantly complicates the search and elimination of the primary source of infection. The acute process is manifested by characteristic symptoms:

Vaginal discharge: foamy, yellow, gray or greenish in color. A specific sign of infection is the presence of gas bubbles in the secreted secretion;
the smell of discharge is sweetish and unpleasant;
a constant burning sensation that gets worse after urination or during sex.

This type of vaginitis can become chronic. The reason for this is the fact that the overwhelming number of trichomonas vaginitis is caused by a mixed infection, for which it is difficult to choose the optimal antibiotic therapy regimen.

Candidal vaginitis

Among women, this type of vaginitis is the most common. Acute fungal inflammation is characterized by white discharge of a cheesy nature and has a sour odor. Itching, pain and irritation intensify after sex and thermal procedures, sometimes becoming unbearably painful.

Despite the known cause of the disease and a wide range of antifungal drugs, the pathogen is still resistant to treatment; then the disease enters the chronic stage, manifesting itself as unexpressed symptoms that intensify after sexual intercourse or during menstruation.

Atrophic vaginitis

The irreversible aging process of a woman’s body also affects the health of her external genitalia. With the onset of menopause, blood circulation in the vaginal mucosa significantly worsens. The number of feeding vessels is significantly reduced, in contrast to which an abundant capillary network develops as a compensatory mechanism. This leads to a complex of clinical symptoms called “atrophic vaginitis.” Its manifestations:

decrease in vaginal secretion, manifested by pathological dryness of the genital tract and increased susceptibility to sexually transmitted infections;
bleeding after sexual relations caused by damage to thin-walled capillaries located close to the surface of the vaginal mucosa;
Dyspareunia is painful sexual intercourse caused by insufficient blood supply and deficiency of vaginal secretions.

Atrophic vaginitis has a slow, gradually progressive course. It is one of the signs marking the end of the reproductive period of a woman’s life.

How inflammation develops

The inner surface of the vagina is lined with epithelium - these are cells that protect the muscle wall and blood vessels from damage and participate in the formation of local immunity. The outer layers of the “coating” contain glycogen, which is the main nutrition and energy source for lactic acid bacteria. Microorganisms break down glycogen molecules. As a result of the reactions that occur, a slightly acidic environment is formed in the vagina, in which harmful bacteria cannot survive. Moreover, the number of lactobacilli in the normal microflora is so large that pathogens simply cannot gain a foothold on the mucous membrane and die.

The activity of lactic acid bacteria directly depends on the amount of glycogen in the cells of the mucous membrane. The substance is formed under the influence of sex hormones. Glycogen levels also depend on nutrition, the mental and emotional state of a woman, metabolism and a number of other factors. Any changes in hormonal levels or in the usual environment can disrupt the formation of glycogen. Lactobacilli do not receive sufficient nutrition and die, reducing the body's protective function. During this period, pathogens of vaginitis can easily gain a foothold on the mucous membrane and form a colony.

The infection settles in the female body, destroys epithelial cells, causes dilation of blood vessels, and increases the flow of leukocytes and phagocytes to the affected area. The mucous membrane swells. Gradually, the process spreads to the vulva (vulvovaginitis) and labia, affecting the muscular wall of the vagina. The breakdown products of epithelial cells irritate nerve endings and cause unpleasant symptoms. At the same time, increased secretion begins in the internal genital organs. Mucus should remove pathogens from the vagina - this is a natural defense mechanism against infection. If the walls of blood vessels are damaged, blood may become mixed with vaginal secretions.

Nonspecific vaginitis

Disturbance of the normal microflora of the vagina leads to the activation of opportunistic bacteria, which are present in the genital tract, but do not cause clinical symptoms. Features of this type of disease:

the onset of the disease is characterized by the presence of one of the predisposing factors: childbirth, abortion, surgery, hormonal changes, etc.;
vaginal discharge is liquid and watery, without pathological impurities or unpleasant odor. The latter can be added in cases of prolonged process, lack of treatment and insufficient hygiene;
Nonspecific vaginitis is not characterized by pain and impairment of general condition. It occurs in the form of a local inflammatory process.

Diagnostics

The clinical picture and clarification of the disease history significantly simplify the laboratory diagnosis of the disease. The main diagnostic task is to find the causative agent in order to prescribe specific treatment later. There are three main methods for determining microorganisms:

bacterioscopy – visualization of vaginal secretions under a multiple magnification microscope. The technique is widespread due to its practicality, ease of use and low cost. The disadvantage of the study is low specificity. In many cases, the method allows you to see microorganisms, but does not make it possible to accurately differentiate them;
a bacteriological method known to many as “seeding”. Vaginal secretions are placed in special conditions on a nutrient medium where microorganisms grow. The procedure has a fairly high specificity, but it often takes up to 7 days to complete. In conditions of progressive disease, such a long wait-and-see approach is unacceptable;
PCR is a highly informative diagnostic method that allows you to quickly identify the causative agent of the disease. Disadvantages - high cost. Conducting a blind study, simply identifying all the most common sexually transmitted infections, is not a cheap pleasure. The technique is justified by a competent approach, in which selective testing is carried out only for certain infections, justified by the clinical picture of the disease.

Treatment of vaginitis

Therapeutic tactics are determined by the gynecologist, based on the results of the clinical picture, objective examination and specific diagnostic methods.

From the point of view of selectivity, it is much easier to treat specific vaginitis, for which antibacterial, antifungal or antiviral agents are used, to which the pathogen is known to be sensitive.

The main means of treating specific vaginitis:

trichomoniasis - drugs that are effective against single-cell microorganisms are used (metronidazole, tinidazole, ornidazole). For an acute form of the disease, a 7-day course of treatment is sufficient, for a chronic form – a 10-day course. The drugs can be taken as tablets or, more commonly, vaginal suppositories;
gonococcal infection - use antibacterial drugs of the penicillin series, cephalosporins and fluoroquinolones (ceftriaxone, cefixime, penicillin, ofloxacin and others). The greatest effectiveness of treatment is observed with intravenous or intramuscular administration of drugs;
chlamydia and mycoplasma infection - antibiotics of the doxycycline group, fluoroquinolones and macrolides (erythromycin, josamycin, levofloxacin, moxifloxacin). The course of treatment for uncomplicated forms of the disease does not exceed 10 days. The route of drug administration is oral;
Candidiasis is effectively treated with antifungal drugs. In the acute form of the disease, fluconazole is prescribed at a dose of 150 mcg (1 tablet) once or two doses (200 mcg each) of itraconazole. Chronic and recurrent forms require a 7-day and sometimes two-week course of treatment.

A more difficult task is the treatment of nonspecific vaginitis, which should pursue the goals of exterminating pathogenic microorganisms and enriching the woman’s genital tract with benign bacteria. This often requires a long course of multicomponent therapy:

drugs effective against anaerobic bacteria (metronidazole, tinidazole, ornidazole);
antibiotics of the lincosamide group, covering a wide range of opportunistic microorganisms. Drugs such as clindamycin, dalacin and others can be prescribed in the form of tablets, suppositories and vaginal creams;
antiseptics. An important component of the treatment of nonspecific vaginitis is intimate hygiene using antiseptic drugs. Chlorhexidine and other antiseptics can be used as vaginal suppositories or douches;
vaginal suppositories containing “beneficial microorganisms”.

An additional component of the treatment of nonspecific vaginitis is the elimination of the “risk factor”. It includes vitamin therapy, correction of hormonal imbalances, taking antiallergic drugs, etc.

Therapy for vaginitis in a child

Treatment of vaginitis in girls begins with an examination by a pediatric gynecologist and collection of biological material for testing. After laboratory confirmation of vaginitis in a child, the doctor prescribes comprehensive treatment, which includes the following measures:

antibacterial therapy – aimed at destroying the microorganism that has become the causative agent of the inflammatory process;
symptomatic therapy - aimed at eliminating the symptoms of the disease and involves a variety of herbal baths and the use of drying drugs;
general strengthening of the immune system - very important for the child’s body to fully fight infections (vitamin complexes, immunomodulators);
therapy of concomitant diseases - involves influencing the foci of infection existing in the child’s body (dysbacteriosis, tonsillitis, sinusitis, purulent tonsillitis, bronchitis, etc.).

Vaginitis in girls, which is not treated properly, is fraught with serious consequences. Thus, in childhood, advanced vaginitis can lead to fusion of the child’s labia minora, and in adulthood – to infertility and anatomical abnormalities of the reproductive organs.

Preventing the development of vaginitis is much easier than treating the inflammatory process. Therefore, accustom your child to regular toileting of the genitals and hands, avoid taking antibiotics without a doctor’s prescription, buy loose underwear made from natural fabrics for the girl, and stop using sanitary pads every day.

Make an appointment with a gynecologist

Complications

From the vagina, the infection along the ascending path can reach the cervix, into the uterus itself and cause infection of the tubes and ovaries. Late detection, inadequate treatment and lack of measures to prevent relapse can result in complications. The most common complications include:

inflammation of the cervix, its inner lining and fallopian tubes. This group of complications is especially dangerous during pregnancy. Rising to the ovum, the infection can provoke miscarriage, premature birth, or due to infection of the amniotic fluid, severe pathology in the newborn. This complication can also cause postpartum endometritis, which, in severe cases, requires removal of the uterus;
urinary tract infection. The urethra in women has a short, wide lumen and opens at the vestibule of the vagina. These factors contribute to the fairly easy penetration of bacteria into the cavity of the bladder, ureters and kidneys, causing inflammation of these organs;
Severe cases of complicated vaginitis, if left untreated, result in bacteremia (“blood poisoning”) and a septic state. Mortality in such a situation exceeds the number of favorable outcomes of the disease.