How to Treat Vaginitis

Experts say vaginitis may be caused by a bacterial infection, yeast infection, or sexually-transmitted infection (STI), and the best treatment for you will depend on the cause.^{[1]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source} Vaginitis is inflammation in your vagina, which often causes discharge, itching, pain, and odor. Vaginitis is fairly common and may be caused by something as simple as taking antibiotics or using certain personal care products. Research suggests that untreated vaginitis may increase your risk of getting a sexually-transmitted disease and may trigger pre-term labor in pregnant people, so it's important to get treatment from your doctor.^{[2]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source}

Part 1

Part 1 of 4:

Understanding Bacterial Vaginosis

1
Diagnose vaginitis. The best way to figure out what kind of vaginitis you have is to see a doctor. If you experience any abnormal discharge or vulvar symptoms, they should be checked by a physician.^{[3]XTrustworthy SourceAmerican Academy of Family PhysiciansOrganization devoted to improving the health of patients, families, and communitiesGo to source}
- You should also see the doctor if you’re sexually active and could have an STI, the discharge is malodorous, you have atrophic symptoms and are of perimenopausal or menopausal age, or if you have a sexual partner, either male or female, with trichomoniasis.
- When you go to the doctor, she will perform a pelvic exam to examine the vaginal vault and the vulva to check for inflammation and swelling and obtain a sample of discharge for examination. She will also examine your cervix to determine if there is any discharge coming from the cervix itself, indicating a cervicitis, which can be a STI such as chlamydia or gonorrhea. She may take swabs from the cervix or have you submit a urine specimen to double check for these STIs.^{[4]XResearch sourceHainer, Barry L. and Maria V. Gibson, Vaginitis: Diagnosis and Treatment American Family Physician 20ll , April 1, 83, (7)}
2
Learn about bacterial vaginosis (BV). BV is a disturbance of the natural balance of the vagina. It occurs when the bacterial flora become disrupted and the pH of your vaginal flora is higher than normal.^{[5]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source}
- This often develops in those who use douches, have multiple sexual partners, and who smoke.^{[6]XResearch sourceHainer, Barry L. and Maria V. Gibson, Vaginitis: Diagnosis and Treatment American Family Physician 20ll , April 1, 83, (7)}
3
Notice the symptoms of BV. There is one main symptom of BV. You will have a white, milky discharge that has a fishy odor.^{[7]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source} The best way to diagnosis BV is through a test done by your doctor.^{[8]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source} She will take a sample of the discharge for microscopic examination in the office. Under microscopic exam, there is the presence of Clue cells, which are bacteria-coated cells.
- She might also perform a whiff test, which is where she will check for the characteristic fishy smell.^{[9]XResearch sourceHainer, Barry L. and Maria V. Gibson, Vaginitis: Diagnosis and Treatment American Family Physician 20ll , April 1, 83, (7)}
4
Take medication for treatment. Once you have been positively diagnosed with BV, you will receive treatment for it from your doctor. Treatment typically consists of oral metronidazole tablets such as Flagyl. You should take a 500 mg tablet twice daily for one week. You can also use Flagyl Gel, which is a topical treatment. You use one applicator of gel a day at bedtime for one week.^{[10]XTrustworthy SourceCenters for Disease Control and PreventionMain public health institute for the US, run by the Dept. of Health and Human ServicesGo to source}
- A similar but newer antibiotic, tinidazole, or Tindamax, may also be prescribed. You take one 2 mg pill once a day for a week.^{[11]XResearch sourceHainer, Barry L. and Maria V. Gibson, Vaginitis: Diagnosis and Treatment American Family Physician 20ll , April 1, 83, (7)}
5
Try natural remedies to prevent recurrent BV. There are multiple natural remedies that you can try for BV. You can take probiotics to restore the natural balance of bacteria in the vaginal flora. These can come in the form of an oral probiotic you take twice a day for one week to intra-vaginal dosing for 30 days. Research has shown that the use of a lactobacillus supplement by those who have recurrent BV along with antibiotic therapy helps manage the disease.^{[12]XResearch sourceJeanne Pierre Menard, Antibacterial treatment of bacterial vaginosis: current and emerging therapies, Int J Womens Health, 2011, 3: 295–305}
- You can also try eating yogurt with a probiotic every day. You should also avoid douching. Your natural vaginal secretions are intended to keep the vagina cleansed and it needs nothing more than external cleansing with soap and water to be cleaned properly.

Part 2

Part 2 of 4:

Understanding Yeast Infections

1
Learn about yeast infections. A yeast infection, or vulvovaginitis candidiasis, is a very common condition. Over 50% of women will experience it once during their lifetime, though only 5% will have repeat infections. A yeast infection often develops when or shortly after you take a course of antibiotics, which disrupts your body’s natural lactobacillus count in the vagina.^{[13]XTrustworthy SourceFamilyDoctor.orgFamily-focused medical advice site run by the American Academy of Family DoctorsGo to source}
- The symptoms include complaints of a thick, cottage cheese-like discharge. This is accompanied by an itchy and irritated sensation around the vulva and vagina. This can make those areas irritated and sensitive.
- Some people may get recurrent episodes, which are described as four or more infections per year. However, this is rare.^{[14]XResearch sourceRingdahl, Erika N. Treatment of Recurrent Vulvovaginal Candidiasis, Am Fam Physician, 2000 Jun 1. 61(11): 3306-3312}
You can generally tell if you have a yeast infection at home. If you notice the symptoms, you can do a visual exam to see if you fit all the criteria of a yeast infection. On visual exam, you should see the inflamed labia and vulva. You should also notice the obvious discharge, which will be thick and white or yellow along the vaginal vault.^{[15]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source} There should be no odor.
3
Look out for repeat fungal infections. If you have three or more yeast infections per year that are unrelated to antibiotic therapy, you should take note and seek a medical diagnosis. This is important as taking repeated courses of the antifungal therapy for yeast infections can cause systemic toxicity. You should also be vigilant because there could be an underlying cause of the infections, such as, diabetes or immunosuppression from HIV.^{[16]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source}
- Try not to over self-diagnose. If you simply tell your doctor you have a yeast infection without proper examination, your family provider might call in a prescription in an attempt to be helpful. This may not be helpful because you could have a more insidious disease, such as an STI.^{[17]XResearch sourceHainer, Barry L. and Maria V. Gibson, Vaginitis: Diagnosis and Treatment American Family Physician 20ll , April 1, 83, (7)}
4
Treat a yeast infection. You can use either oral or topical treatment for a yeast infection. The medicine is an antifungal agent that fights the yeast causing the infection. You can use a 150 mg oral dose of diflucan once.^{[18]XTrustworthy SourceNational Health Service (UK)Public healthcare system of the UKGo to source} You can also use the topical creams diflucan or clotrimazole, which are available over the counter in most drugstores. Topical creams are the most popular treatment because they can be purchased without a prescription.^{[19]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source}
- Most of the topical medications have similar medical safety and efficacy. You can get different variations that differ in the number of times you need to apply them. You can get a cream or cream suppository that you only use once, but you can also get creams that you need to use for up to a week.
- If you think you might have trouble remembering to apply a nightly cream, the single dose oral therapy might be better for you. However, in general, this method will be more expensive and may require a prescription.^{[20]XResearch sourceHainer, Barry L. and Maria V. Gibson, Vaginitis: Diagnosis and Treatment American Family Physician 20ll , April 1, 83, (7)}

Part 3

Part 3 of 4:

Understanding Trichomoniasis

1
Learn about trichomoniasis. Often called trich, trichomoniasis is a type of vaginitis that is caused by a protozoa or parasite. It affects up to five million people in the US each year. This organism is a small parasite with a tail. In men, if trich is untreated, it can lead to chronic prostatitis. The symptoms of trichomoniasis include an itchy, green, and possibly frothy discharge with a fishy odor.^{[21]XTrustworthy SourceNational Health Service (UK)Public healthcare system of the UKGo to source}
- This disease is sexually transmitted, so if you think you have it, you should let your sexual partner know so both partners can be tested and treated before resuming intercourse. If one of you is diagnosed then both of you need treatment.
2
Diagnose trich. Traditionally, the diagnosis for trich is done in a doctor’s office. A wet prep is done by placing vaginal secretions under the microscope with a drop of saline solution. This will cause the parasite under the microscope to swim across the field and be identified.^{[22]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source}
- There can be doctor discrepancy. Because of this, your doctor may also perform more standardized testing, such as a PCR assay to determine exactly what disease you have. You may also be given a pap smear as well.
- If this is not treated in pregnant people, there can be complications when giving birth such as low birth weight and prematurity due to a premature rupture of membranes (PROM).^{[23]XResearch source Wendall, Karen A. and Kimberly Workowski, Trichomoniasis: Challenges to Appropriate Management Clinical Infectious Disease, Supplement 3, S123- S129}
3
Treat trich. As with BV, trich can be treated with oral medication such as Flagyl. The usual dose is 2 grams taken once orally. You should avoid alcohol while taking Flagyl. Your partner should also take Flagyl at the same time. While you are taking the medication, intercourse should be avoided until both partners have completed treatment.^{[24]XTrustworthy SourceNational Health Service (UK)Public healthcare system of the UKGo to source}
- Some studies recommend the use of Tindamax for trich as well. If prescribed, you will only have to take one 2 mg dose. This medication has a cure rate between 86-100%.^{[25]XResearch source Wendall, Karen A. and Kimberly Workowski, Trichomoniasis: Challenges to Appropriate Management Clinical Infectious Disease, Supplement 3, S123- S129}

Part 4

Part 4 of 4:

Understanding Other Forms of Vaginitis

1
Learn about atrophic vaginitis. There is only a certain group of people who have to worry about atrophic vaginitis. This type of vaginitis is caused by the normal hormonal changes that occur as you age as well as decreased estrogen production. These tend to lower the production of the natural secretions that keep the vagina lubricated. Up to 40% of post-menopausal people will have this disorder.^{[26]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source}
- It is often accompanied by pelvic floor weakness and other genitourinary symptoms that predispose you to urinary tract infections. These other disorders should be ruled out by your doctor with a test.^{[27]XResearch source Bachmann, Gloria A. and Nicole S Nevadunsky, Diagnosis and Treatment of Atrophic Vaginitis, American Family Physician, 2000 May 15, 61(10), 3090-3096}
Atrophic vaginitis is a disorder that causes vaginal dryness and thinning of the vaginal mucosa. This causes itchiness and painful intercourse. This can happen outside of normal menopause when someone gets sent into premature menopause by removal of the ovaries for other conditions.^{[28]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source}
3
Treat atrophic vaginitis with hormone replacement therapy. You can treat this type of vaginitis with oral hormone replacement therapy (HRT). This will replenish the hormones that you lose when you go through menopause.^{[29]XTrustworthy SourceAmerican Academy of Family PhysiciansOrganization devoted to improving the health of patients, families, and communitiesGo to source}
- HRT is taken daily in pill form.
- An alternative to HRT is called Osphena, taken once a day to treat vaginitis.
Estrogen creams can also be used to help with the symptoms of this condition. This cream is absorbed into the skin when you apply it to the vaginal area. This helps produce its effects and treat the symptoms concentrated in your vaginal region.^{[30]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source}
5
Understand contact dermatitis vaginitis. Similar to any other contact or allergic dermatitis, this kind of vaginitis is an allergic reaction. Instead of presenting symptoms elsewhere, the skin of your vagina reacts instead. This can be caused by the detergent you used to wash your underwear, a douche, a condom, a lubricant, or any other product that comes into contact with the area.^{[31]XResearch source}
- To treat contact dermatitis vaginitis, you should remove the object that is causing the issue. This may take some investigation, but you should try to find what you are allergic to as soon as possible to relieve the symptoms. You can then use steroid creams that are available over the counter, such as hydrocortisone cream 1%, and apply them to the area twice a day for five days. This will reduce the signs of itchiness and inflammation.
- You can also take antihistamines such as Zyrtec or Claritin to help with the reaction. Take one 10 mg tablet daily. In severe cases, you may want to see a physician for a prednisone taper to get immediate relief.^{[32]XResearch sourceHainer, Barry L. and Maria V. Gibson, Vaginitis: Diagnosis and Treatment American Family Physician 20ll , April 1, 83, (7)}