CONDITIONS

Vaginal Infections

What Is Vaginal Infections

Vaginal infections are a common health problem. More than three quarters of all women will have a vaginal yeast infection in their lifetime. Bacterial infections may be even more common, especially in young and middle-aged women. About 3 out of every 10 women have bacterial vaginosis. And the vast majority of those don’t even show symptoms. 

While vaginal infections are very common, many women find it difficult or embarrassing to talk about the health of their vaginas. A vaginal infection is nothing to be ashamed of, and no cause for alarm–but it does need to be treated, to prevent more serious consequences. 

There are three main types of vaginal infections:

  • Bacterial vaginosis, caused by an overgrowth of bacteria
  • Candidiasis, or yeast infections, caused by the fungus Candida albicans or other Candida species
  • Trichomoniasis, caused by a very small parasite that is spread through sex

What Causes Vaginal Infections

There are three main types of vaginal infection, and each has a different cause.

Bacterial vaginosis is caused by an overgrowth of bacteria in the vagina. It is natural to have some bacteria living there all the time. In the right balance, these bacteria are normal and healthy. However, these bacteria need to stay in balance, or they could cause problems. Normally, a type of bacteria known as Lactobacillus is the dominant group in your vagina. A group of Lactobacillus bacteria are known as lactobacilli when other types of bacteria outnumber the lactobacilli, then they can disrupt the natural balance and cause bacterial vaginosis.

Yeast infections are caused by a fungus called Candida. Like bacteria, Candida is normally in your vagina, but it can grow out of control when the population of lactobacilli is reduced by antibiotics or other causes. Yeast infections are usually caused by a species known as Candida albicans, but there are other Candida species that can also invade your body. These other species may be harder to treat because doctors aren’t used to them and may not be as well prepared. 

Trichomoniasis is caused by a single-cell parasite that is not normally found in a healthy body. This organism is spread from person to person during sex.

Risk Factors For Vaginal Infections

Because they have different causes, different vaginal infections have different risk factors. All three types of vaginal infection can be spread during sex, so unprotected sex and sex with multiple partners can increase your risk for all types of vaginal infections. However, yeast and bacterial infections are often caused by organisms that already live inside your body, and you can get these infections even if you’ve never had sex, or if you’ve been faithful to one partner for years.

Risk factors for bacterial infections include:

  • Rinsing your vagina with a douche, which can upset the natural balance of bacteria there.
  • Having sex with other women, which may increase your risk of sexually transmitted bacterial vaginosis
  • Natural lack of lactobacilli. Some women’s bodies just don’t produce a good environment for lactobacilli to flourish. This may lead to overgrowth of other bacteria and a higher risk of bacterial vaginosis.

Risk factors for yeast infections include:

  • Using antibiotics, especially broad-spectrum antibiotics. These medicines are very effective against harmful bacteria, but they can also wipe out healthy bacteria and create an environment where yeast can thrive.
  • Excessive estrogen. If you are pregnant, or using estrogen-based birth control or hormone treatments, you may be at higher risk for Candida
  • Poorly controlled diabetes. High blood glucose levels can feed yeast and allow it to grow out of control.
  • A weakened immune system, caused by some medicines, HIV, or other health problems, may put you at risk for more frequent Candida infections

Trichomoniasis is spread mainly through sex. Aside from having more than one partner, the main risk factor is having had trichomoniasis or other sexually transmitted infections in the past.

Diagnosing Vaginal Infections

To diagnose a vaginal infection, your doctor will start by asking you about:

  • Your symptoms
  • Your medical history
  • Your sexual history
  • The hygiene products you use—particularly douches, which could upset the balance of bacteria, and harsh cleansers that may irritate the skin around your vagina

Your doctor will also perform a pelvic exam. Depending on your symptoms, your doctor may take a sample of the fluids from your vagina to send to a lab for testing. Lab tests are not always necessary for trichomoniasis or for simple yeast infections.

Symptoms of Vaginal Infections

Different types of vaginal infections have different symptoms, though there’s a lot of overlap. All three major types of vaginal infection can cause itching, irritation, and pain or burning when you urinate. They can all cause unusual discharge from your vagina, though the discharge may look different depending on the type of infection you have. Bacterial infections and trichomoniasis may cause an unpleasant smell, but most yeast infections are odorless. Sometimes a vaginal infection may not cause any symptoms at all.

Symptoms of bacterial vaginosis include

  • Thin, grayish-white vaginal discharge
  • A “fishy” smell, which may be stronger after sex
  • Itching
  • A burning feeling when you urinate

However, bacterial infections often have no noticeable symptoms. According to the U.S. Centers for Disease Control and Prevention, 84% of women diagnosed with bacterial vaginosis did not report any symptoms at all.

Symptoms of a yeast infection include:

  • Thick, white, lumpy vaginal discharge that looks a little like cottage cheese
  • Itching and irritation in and around the vagina
  • Pain and soreness
  • Redness and swelling in the outer vagina, or vulva
  • A burning feeling when you urinate, or when you have sex

In a complicated yeast infection, the swelling and itching may escalate into open sores, cracks, or tears. You may also have a complicated yeast infection if you’ve had more than three yeast infections in the past year.

Symptoms of trichomoniasis include:

  • A lot of foul-smelling white, gray, yellow, or green vaginal discharge
  • Redness, burning, or itching
  • Pain when you urinate or when you have sex

It’s important to note that 7 out of 10 people with trichomoniasis never develop symptoms.

 

Prognosis

Vaginal infections are usually not serious if they are identified early and treated. However, it is important to identify the infection and get the right treatment.

Sometimes yeast infections can be harder to treat. These are known as complicated yeast infections, and they may need stronger treatments and/or a long-term maintenance plan to keep the infection from coming back. Factors that can complicate a yeast infection include:

  • Severe symptoms, such as open sores
  • 4 or more infections in the past year
  • An unusual strain of Candida
  • Pregnancy
  • Uncontrolled diabetes
  • A weakened immune system

Untreated vaginal infections may cause pelvic inflammatory disease, or increase your risk of sexually transmitted diseases or complications after surgery. If you are pregnant, an untreated vaginal infection can lead to early birth. If you have trichomoniasis while you are pregnant, you may pass it on to your baby during birth.

Living With Vaginal Infections

For the most part, vaginal infections go away with treatment. You may need to abstain from alcohol temporarily, or take special precautions if you have sex during treatment, but most people don’t need long-term management.

If you have recurring bacterial or yeast infections, you may want to take precautions to keep them from coming back as often. For instance:

  • Don’t use douches
  • Avoid hot tubs and very hot baths
  • Also avoid scented soaps that may cause irritation
  • Wear loose-fitting cotton underwear and avoid tight jeans, leggings or pantyhose
  • Change out of bathing suits and other wet or sweaty clothes as soon as you reasonably can.

Screening

Most medical guidelines don’t recommend routine screening for vaginal infections.Screening tests for trichomoniasis are available to your doctor and may be used if you are at high risk—for instance, if you have been diagnosed with another sexually transmitted disease.

If you are concerned that you might have a vaginal infection, but you’re not sure you should see a doctor, home tests are available that are similar to the tests your doctor would use. These tests are available at drugstores and pharmacies.

Prevention

Sometimes infections can happen no matter what you do, but there are steps you can take to make them less likely. Being careful about sex can prevent trichomoniasis and help you avoid some bacterial and yeast infections, but not all. Other things you can do to avoid yeast and bacterial infections include

  • Bathe in warm water—not hot—with mild, unscented soaps. Rinse the outside around your vagina thoroughly after washing, and dry it well when you leave the tub.
  • Don’t douche. Douching can harm the healthy bacteria that prevent infections, and create a place for yeast and unhealthy bacteria to grow.
  • Avoid hot water such as hot tubs and whirlpool baths.
  • Avoid tight jeans. Wear comfortable cotton underwear and skirts or loose-fitting pants.
  • Change out of wet or sweaty clothes right away, when possible.

Common Treatment

Most vaginal infections can be cured with antibiotics or antifungal treatment. The specific type of treatment depends on the type of infection.

Bacterial infections are treated with antibiotics such as:

  • This antibiotic may be prescribed as a pill (Flagyl) that you take by mouth, or as a gel (Metrogel-Vaginal) that you put directly into your vagina. It may cause nausea or upset stomach, and you should avoid alcohol while taking metronidazole.
  • Tinidazole (Tindamax). This antibiotic is only available as a pill. Tinidazole may cause nausea or upset stomach, and you should stay away from alcohol during treatment.
  • Clindamycin (Cleocin, Clindesse), an antibiotic cream that you put inside your vagina. If you have sex during treatment, Clindamycin may weaken condoms, so if you aren’t trying to get pregnant, you should abstain or use a backup form of birth control.

When you take an antibiotic, always take the full dose your doctor prescribes, even if you feel better. If you take less than the full course of treatment, then the bacteria may develop antibiotic resistance and become harder to treat the next time.

Yeast infections may be treated with topical antifungals used inside the vagina. Topical antifungals for Candida include:

  • Miconazole (Monistat)
  • Clotrimazole (Gyne-Lotrimin)
  • Butoconazole (Gynazole)
  • Terconazole (Terzol)

These antifungals are available without a prescription in your local drugstore. As with antibiotics, make sure to finish your course of treatment even if you feel better. These treatments may damage condoms or diaphragms, so if you use barrier contraceptives you should avoid sex or use a backup birth control method until you finish treatment. 

If your infection doesn’t clear up after you finish treatment, call your doctor. Your doctor may prescribe a different topical treatment, or the single-dose antifungal fluconazole (Diflucan) taken by mouth.

The standard treatment for trichomoniasis is the same oral antibiotics used for bacterial infections, metronidazole (Flagyl) or tinidazole (Tindamax). However, instead of a course of treatment, these antibiotics are given as a single large dose, all at one time. 

Avoid alcohol for 1 day after taking metronidazole or 3 days after tinidazole. Make sure your sexual partner is treated as well, and avoid unprotected sex for a week after treatment.

Complementary and Alternative Treatment

A very common home remedy for vaginal infections is yogurt. The idea is to restore the proper balance of bacteria by introducing new Lactobacillus bacteria into your body—either by mouth or directly into your vagina.This method has not been as extensively studied as medical treatments, but it seems to work in small studies and according to word of mouth.

If you use yogurt to treat a vaginal infection, be sure to choose a brand that says on the package that it contains live, active cultures. And use only plain yogurt—nothing with extra sweeteners or fruit mixed in. You can also purchase Lactobacillus acidophilus as a pill or suppository. If you suffer from frequent yeast or bacterial infections, you may want to make yogurt a regular part of your diet, or even apply it topically once a week to prevent infection.

Other home remedies for vaginal infections include:

  • Garlic supplements, or a clove of garlic a day, taken by mouth or as a vaginal suppository
  • Vitamins C and E
  • Eating more fish and nuts, and cutting back on fats from land animals
  • Calcium and magnesium, as supplements or in food
  • Pau d’arco bark tea as a drink or cooled off and applied directly to the vagina
  • Pearl barley tea (about 1 tablespoon of barley boiled in a full saucepan)

Always tell your doctor about any treatments you use, including complementary and alternative treatments. Some of these treatments may have side effects, or they can affect the way other medicines work.

Care Guide

Vaginal infections generally clear up with treatment. If you have recurrent yeast or bacterial infections, there are steps you can take to make them happen less often. Things you should avoid to prevent yeast or bacterial infections include:

  • Douches
  • Hot tubs and very hot baths
  • Harsh or scented soaps
  • Wet clothes
  • Artificial fibers

You may also want to consider introducing more yogurt or acidophilus supplements into your diet, or trying another of the home remedies listed in the Complementary and Alternative Treatments section.

When To Contact A Doctor

Vaginal infections often clear up with over-the-counter treatment, but they should not be ignored. Call your doctor if

  • This is the first time you’ve had a vaginal infection, or the symptoms seem different from past infections
  • Your symptoms don’t clear up with over-the-counter treatments
  • You’ve recently had sex with a new partner

Questions For Your Doctor

Your gynecologist or your primary care doctor can treat most vaginal infections. If you don’t have a gynecologist, you can find one in the online directory provided by The American Congress of Obstetricians and Gynecologists (ACOG).

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What is causing my symptoms?
  • What treatment do you recommend?
  • Should I watch out for this sort of infection in the future?
  • What signs and symptoms should I watch for?
  • Is there anything I can do to prevent future infections?
  • What should I do if my symptoms return?
  • Is there anything else I should know about my vaginal infection?

Resources

Other useful resources to help you learn about vaginal infections and take charge of your treatment can be found at:

ACOG’s Patient Information page has comprehensive information from one of the preeminent professional organizations for doctors specializing in women’s health.

Women’s Health.org, a nonprofit organization devoted to improving women’s health.