Sooner or later, we’re all bound to deal with vaginal irritation. Although the vagina is a very low-maintenance body part, it’s not immune to what life throws at it. Several things can cause irritation and inflammation in the vagina (referred to as vaginitis), ranging from bacterial infections to hormonal fluctuations. 

Keep reading to learn more about the most common causes of vaginitis and how to treat it. 

What is vaginitis?

"Vaginitis" is like an umbrella term for different things that can make your vagina inflamed or irritated, such as vaginal infections, vaginal atrophy, or a reaction caused by feminine hygiene products.

When both your vagina and outer genitalia are irritated, it's called vulvovaginitis. But for now, let's just focus on what causes vaginal infection. It's important to tell them apart because different things affect your vulva and vagina. Knowing the difference makes it easier to figure out and treat whatever is bothering you.

Vaginitis symptoms  

Symptoms can differ depending on the specific type of vaginitis you have. Some types may not cause any symptoms at all, and it's also possible to have multiple types of vaginitis at the same time. However, some signs and symptoms can occur across the board. 

The most common symptoms of vaginitis include: 

  • Vaginal itching 
  • Unusual vaginal discharge
  • Vaginal discomfort, especially during sexual intercourse or when inserting tampons 
  • A burning sensation when you pee.
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What causes vaginitis?

Several things can cause vaginitis, including vaginal infections, sexually transmitted infections (STIs), hormonal fluctuations, and chemical irritants. Below are the most common causes of vaginitis. 

Yeast infections

Yeast infections, also known as vaginal candidiasis, are a common condition caused by an overgrowth of a naturally occurring fungus called Candida — typically, Candida albicans. This fungus is normally present in small amounts in the vagina but sometimes certain things mess with this balance, causing the yeast to overgrow and leading to a yeast infection.

Too much Candida can cause vaginal irritation. Your body's response to the extra yeast includes inflammation, which leads to swelling, redness, and itching. The yeast also makes enzymes and toxins that can harm the delicate tissues of the vaginal lining. Plus, the infection can change the pH balance of the vagina, making it a better environment for more yeast to grow and causing even more irritation.

Yeast infection symptoms can be mild to severe and might include:

  • Vaginal itching and irritation
  • Redness and swelling
  • Thick, white, cottage cheese-like vaginal discharge
  • Burning when you pee or have sex
  • General soreness and pain in the vaginal area 

Cytolytic vaginosis

Cytolytic vaginosis, also known as Lactobacillus overgrowth syndrome, is a condition where there's an overgrowth of lactobacilli in the vagina. These bacteria are usually helpful in maintaining the vagina's acidic pH and preventing infections. However, when there's too much of them, it can cause symptoms that are often mistaken for other vaginal infections, like yeast infections or bacterial vaginosis.

Cytolytic vaginosis can lead to irritation because the excessive lactobacilli produce large amounts of lactic acid, which significantly lowers the vaginal pH. This acidic environment can irritate the vaginal tissues, causing discomfort and inflammation. It can also affect the balance of other microorganisms in the vagina and damage the vaginal lining, making the irritation worse.

The symptoms of cytolytic vaginosis can be similar to those of other vaginal conditions, making diagnosis challenging. Common symptoms include:

  • Vaginal itching and discomfort
  • Excessive, thick, white, or creamy vaginal discharge that can resemble a yeast infection
  • Pain and burning when you urinate or have sex

Bacterial vaginosis

Bacterial vaginosis (BV) is a common vaginal infection characterized by an imbalance in the normal bacteria in the vagina. Normally, the vagina contains a balance of beneficial bacteria, predominantly Lactobacilli, which help the vaginal pH acidic and prevent the overgrowth of harmful bacteria. In bacterial vaginosis, there is a decrease in Lactobacilli and an overgrowth of anaerobic bacteria such as Gardnerella and Prevotella.

Although the exact cause isn't fully understood, several factors can contribute to the development of bacterial vaginosis. Anything that can upset the balance of vaginal flora can lead to bacterial vaginosis. Some of the most common risk factors include:

Bacterial vaginosis causes vaginitis through several mechanisms. Firstly, the overgrowth of anaerobic bacteria disrupts the vaginal pH balance, making it slightly less acidic. This change in pH can irritate the vaginal tissues, resulting in inflammation. 

Secondly, these anaerobic bacteria produce amines like putrescine and cadaverine, which can further irritate the vaginal mucosa and lead to the characteristic fishy odor associated with bacterial vaginosis.

Bacterial vaginosis may not always cause symptoms, but when present, the most common symptom is thin, grayish-white vaginal discharge with a fishy odor, especially noticeable after sex. Bacterial vaginosis doesn't typically cause vaginal itching or irritation, but it's not out of the question. 

Aerobic vaginitis 

Aerobic vaginitis is a vaginal condition caused by an overgrowth of aerobic bacteria, which thrive in the presence of oxygen. Unlike bacterial vaginosis, which is caused by an overgrowth of anaerobic bacteria, aerobic vaginitis is characterized by inflammation and the presence of harmful bacteria such as E. coli, Staphylococcus aureus, and Enterococcus faecalis. 

These bacteria can disrupt the normal vaginal flora and lead to uncomfortable symptoms. The exact cause of aerobic vaginitis isn't well understood, but it may be linked to factors such as hormonal changes, immune system issues, and the use of certain medications or hygiene products.

Aerobic vaginitis can cause vaginal irritation due to the inflammatory response triggered by the overgrowth of aerobic bacteria. These bacteria produce toxins and enzymes that damage the vaginal lining, leading to symptoms such as redness, swelling, and pain. 

The inflammation also disrupts the natural balance of the vaginal microbiome, reducing the presence of beneficial Lactobacilli and allowing harmful bacteria to take over. This imbalance and the resulting inflammation cause significant discomfort and irritation.

The symptoms of aerobic vaginitis can be similar to those of other infections, so it's important to seek an accurate diagnosis. Common symptoms include:

Sexually transmitted infections

Certain sexually transmitted infections (STIs) like chlamydia, gonorrhea, and trichomoniasis can cause vaginal irritation. When these infections invade the vaginal tissues, the body’s immune system responds by sending white blood cells to fight off the infection, leading to redness, swelling, and irritation. The immune response can also cause sensations of itching, burning, and discomfort.

Most of the time, sexually transmitted infections don't cause any noticeable symptoms, but when they do, signs of a sexually transmitted infection include:

  • Vaginal itching and irritation
  • Abnormal vaginal discharge that may look watery, frothy, or clumpy and have a bad smell
  • Burning when you pee
  • Discomfort or pain during sex
  • Bleeding between periods. 

Vaginal dryness

Vaginal dryness happens when there isn't enough natural lubrication in the vaginal area, which can lead to discomfort during everyday activities like exercise and sex. While it can affect women of all ages, it's more common during and after menopause due to hormonal changes. It can also happen during periods of hormone deficiency and diminishing levels of estrogen including postpartum lactation, infertility treatments, and cancer treatments.

It can cause irritation for several reasons:

  • Lack of lubrication: Your vagina needs natural moisture to stay healthy and comfortable. Without enough lubrication, the delicate tissues of the vagina can become irritated and inflamed, leading to discomfort during activities like sex and even everyday movement.
  • Thinning of vaginal tissues: Changes in estrogen levels can cause the vaginal tissues to become thinner and less elastic, making them more prone to irritation and injury.
  • Changes in pH balance: Estrogen helps maintain the acidic environment of the vagina, which is important for keeping harmful bacteria at bay. When estrogen levels drop, the pH balance can shift, making the vagina more susceptible to infections.

The symptoms can include:

  • Vaginal itching and soreness
  • Discomfort during sex
  • A feeling of tightness in the vagina
  • Spotting or slight bleeding after intercourse. 

Chemical irritants

Some hygiene products may contain chemicals that can cause vaginal irritation. Vaginal tissue is pretty sensitive and it may react to certain substances, leading to irritation and inflammation.

Products like intimate soaps, body washes, feminine hygiene items (like douches and deodorants), and scented sanitary pads or tampons often contain chemicals and fragrances that can be irritating. These products might upset the natural pH balance of the vagina or cause allergic reactions. 

Additionally, some spermicides and lubricants (often found in condoms, too) could also contain chemicals that might irritate the vaginal tissues. For example, Nonoxynol-9, a common spermicide, can potentially cause irritation and increase your risk of infections with frequent use.

How to treat vaginitis 

Dealing with vaginitis can be really frustrating, but getting an accurate diagnosis from your healthcare provider is the first step to effective management. Research shows that most of us aren’t that great at self-diagnosing, so it can be tricky to distinguish between different infections.

If diagnosed with a bacterial infection (including some types of STIs), your provider may prescribe antibiotics such as metronidazole or clindamycin. These antibiotics can come in the form of gels, creams inserted into the vagina, or oral pills. 

For vaginal yeast infections, most cases can be treated with over-the-counter antifungal medications. That said, it's important to confirm the diagnosis first to avoid worsening symptoms with the wrong medication. Your provider might also prescribe an oral antifungal if necessary.

Trichomoniasis, caused by a parasite, typically requires oral antibiotics such as metronidazole or tinidazole to eliminate the infection. It's important for recent sexual partners to also receive treatment to prevent re-infection. Non-infectious causes of vaginitis, like irritation from new soaps, detergents, or fabric softeners, require identifying and discontinuing the irritant.

For genitourinary syndrome of menopause (atrophic vaginitis) or other similar hormone deficiency syndromes (where low estrogen levels contribute to symptoms), prescription estrogen therapy can help. This can be in the form of vaginal creams, tablets, or rings inserted into the vagina, which restore moisture and improve vaginal health. Alternatively, your doctor might recommend a vaginal moisturizer like Evvy’s Hyaluronic Acid Suppositories, vaginal dehydroepiandrosterone (DHEA), or ospemifene (an oral medication used to treat vaginal dryness and painful sex caused by menopause).

Can you prevent vaginitis? 

There are a few things you can do to reduce your chances of getting vaginitis: 

  • Practice safe sex by using a barrier method like condoms or dental dams.
  • Choose a microbiome-friendly lubricant (without spermicide, glycerin, or flavors).
  • Don't use feminine hygiene products with harsh ingredients, such as vaginal sprays or detergents. All you need to clean your vulva is warm water and mild, unscented soap.
  • Avoid douching, as it disrupts the natural balance of vaginal bacteria and can actually mask existing infections.
  • Wipe from front to back to prevent spreading bacteria from the anus to the vagina. Also, ensure that any objects entering the vagina, including sex toys or fingers, are clean to avoid introducing harmful bacteria.
  • If you're approaching menopause or have low estrogen levels, discuss with your healthcare provider the benefits of using a vaginal estrogen cream to maintain vaginal health and lubrication.
  • Stay proactive with your health by scheduling regular OBGYN exams, including pap smears as recommended.
  • Get an STI test at least once a year, or more often if you have several sex partners.

FAQ

How long does vaginitis last?

Vaginitis can vary in how long it sticks around depending on what's causing it and how you treat it. Usually, with the right treatment, like antibiotics for bacterial vaginosis or antifungal creams for a yeast infection, you can start feeling better within a week. If you leave it untreated or if it's more complicated, though, it might last longer. In the case of hormone deficiency syndromes that cause vaginitis, for example, the condition might be chronic and progressive and need continuous management. Sometimes, vaginitis can come back, especially if there are underlying factors at play.

What does vaginitis look like?

Vaginitis can show up in a few different ways, but it usually involves some unpleasant symptoms. You might notice abnormal discharge that could be thin, thick, or have a different color than usual — like gray, green, or yellow. Sometimes, there's an odor, too, which can vary from fishy to rotten. You may also have an itchy vagina or feel sore, and you could have some redness or swelling down there. Basically, if things don't seem normal and you're feeling uncomfortable, it might be a good idea to chat with your healthcare provider to figure out what's going on and get the right treatment.