Vaginitis: Causes, Symptoms, and Effective Treatment

What Is Vaginitis?

Vaginitis is inflammation of the vaginal lining, causing symptoms such as abnormal discharge, itching, burning, and pain. It is the most common gynecological condition — an estimated 75% of women will experience vaginitis at least once, and 40-50% will have at least one recurrence.

The normal vagina has a complex microbiome ecosystem in which Lactobacillus bacteria (the “good” bacteria) predominate. Lactobacillus produces lactic acid to maintain vaginal pH at an acidic level (3.8-4.5), creating an unfavorable environment for harmful bacteria and fungi. When this balance is disrupted, vaginitis occurs.

BSCKI. Trần Thị Thúy Lâm, with over 30 years of experience in gynecological examination and treatment, emphasizes: “While vaginitis is common, it should not be taken lightly. The most important thing is to identify the correct cause for proper treatment. Many women self-medicate, making the condition worse or causing recurrence.”

Common Types of Vaginitis

1. Vulvovaginal Candidiasis (Yeast Infection)

Accounts for 20-25% of vaginitis cases. 75% of women experience it at least once; 5-8% have recurrent episodes (>4 times per year).

Characteristic symptoms:

• Intense itching of the vulva and vagina — the most prominent symptom
• White, thick discharge resembling cottage cheese or yogurt, odorless or mild odor
• Burning during urination and intercourse
• Red, swollen vulva, possibly with scratch marks
• Symptoms often worsen before menstruation

Causes and risk factors:

• Prolonged broad-spectrum antibiotic use — disrupts bacteria-yeast balance
• Poorly controlled diabetes (high blood sugar feeds yeast)
• Pregnancy — hormonal changes favor yeast growth
• Immune suppression (HIV, chemotherapy, corticosteroid use)
• Tight, damp underwear
• High-dose estrogen contraceptives

Treatment:

• Mild to moderate: Antifungal vaginal suppositories (clotrimazole 7 days or miconazole 3 days) or fluconazole 150mg single oral dose
• Severe/recurrent: Extended oral fluconazole, 6-month maintenance protocol

2. Bacterial Vaginosis (BV)

The most common type — accounting for 40-50% of vaginitis in reproductive-age women.

Characteristic symptoms:

• Gray or white-gray discharge, thin, homogeneous
• Characteristic fishy odor — especially strong after intercourse or when using soap
• Usually NO itching (unlike Candida)
• 50% of cases are asymptomatic

Pathophysiology:

• Protective Lactobacillus bacteria decrease sharply
• Anaerobic bacteria (Gardnerella vaginalis, Atopobium vaginae, Prevotella) increase 100-1,000 fold
• Vaginal pH rises above 4.5
• Not an STD but associated with sexual activity

Treatment: Metronidazole 500mg twice daily for 7 days, or metronidazole vaginal gel, or clindamycin vaginal cream.

Note: BV frequently recurs (30% within 3 months, 50% within 12 months). Full treatment adherence and risk factor elimination are essential.

3. Trichomonas Vaginitis (Trichomoniasis)

Sexually transmitted — caused by the protozoan Trichomonas vaginalis.

Characteristic symptoms:

• Yellow-green, frothy discharge, copious, foul-smelling
• Intense itching, vulvar burning
• Pain during intercourse and urination
• Cervix may show red spots (strawberry cervix)
• 20-50% of infected women are asymptomatic

Treatment:

• Metronidazole 2g single oral dose OR 500mg twice daily for 7 days
• Partner treatment is mandatory — otherwise reinfection will occur
• Avoid alcohol during metronidazole treatment
• Abstain from intercourse until both partners complete treatment

4. Atrophic Vaginitis

Occurs in menopausal and perimenopausal women due to estrogen deficiency.

Symptoms:

• Vaginal dryness — the primary symptom
• Pain during intercourse
• Light bleeding after intercourse or spontaneously
• Itching, burning in the genital area
• Urinary urgency, frequency, recurrent urinary tract infections

Treatment:

• Vaginal estrogen (cream, tablets) — most effective, minimal systemic absorption
• Water-based lubricants during intercourse
• Over-the-counter vaginal moisturizers

5. Allergic/Irritant Vaginitis

• Caused by intimate wash products, soaps, perfumes, condoms (latex), spermicides
• Symptoms: itching, burning, redness, no characteristic discharge
• Treatment: discontinue the offending agent, antihistamines if needed

Causes of Vaginitis — Detailed Analysis

Vaginal microbiome imbalance

Normal vaginal pH is 3.8-4.5 (acidic). When pH rises (becomes alkaline), harmful bacteria thrive more easily. Factors that increase pH:

• Vaginal douching, alkaline intimate wash products
• Menstrual blood (pH 7.4)
• Semen (pH 7.2-8.0)
• Broad-spectrum antibiotics

Hormonal factors

• Pregnancy — increased glycogen feeds yeast
• Menopause — decreased estrogen causes mucosal atrophy
• Hormonal contraceptives — alter the microbiome

Lifestyle factors

• Improper intimate hygiene (washing too deeply, using soap)
• Tight, non-breathable underwear (nylon)
• Prolonged hot baths
• Leaving tampons in too long

Medical conditions

• Poorly controlled diabetes
• Immune suppression
• Unprotected sexual intercourse
• Prolonged stress

When to See a Doctor

See a doctor soon (within 1-2 days):

• Discharge changes in color (dark yellow, green, gray), odor (fishy, foul), or suddenly increases in amount
• Genital itching and burning not improving after 2-3 days despite proper hygiene
• Recurrent infection symptoms — need to re-identify the cause

See a doctor urgently (same day):

• Lower abdominal pain with fever — suspected spread to the pelvic area
• Abnormal bleeding outside of menstruation
• Currently pregnant with infection symptoms — risk of gynecological infection during pregnancy affecting the fetus

Important: Do not self-medicate without identifying the cause. Each type of vaginitis requires a completely different medication:

• Candida → antifungal
• BV → metronidazole antibiotic
• Trichomonas → antibiotic + partner treatment
• Atrophic → estrogen

Using the wrong medication not only fails to cure but causes drug resistance, further disrupts the microbiome, and makes the condition worse.

Complications If Untreated

Untreated vaginitis can lead to:

• Cervicitis — Infection spreading from the vagina to the cervix
• Pelvic inflammatory disease (PID) — Infection spreading to the uterus, fallopian tubes, and ovaries
• Tubal blockage → Infertility, ectopic pregnancy
• Pregnancy complications: Preterm birth, premature rupture of membranes, neonatal infection, postpartum endometritis
• Increased HIV risk — Vaginitis breaks down the mucosal protective barrier
• Psychological impact: Anxiety, loss of confidence, effects on sexual life

Effective Vaginitis Prevention

Proper intimate hygiene

1. Wash externally only with clean water or pH-appropriate intimate wash (3.8-4.5)
2. DO NOT douche inside the vagina — this is the most common mistake
3. Wash front to back — prevent bacteria from the anus reaching the vagina
4. Dry thoroughly after washing
5. Limit intimate wash to 1-2 times daily maximum

Healthy habits

6. Wear cotton underwear — breathable and absorbent. Avoid nylon and tight lace
7. Change underwear daily, wash and dry in sunlight
8. Change sanitary pads every 3-4 hours during menstruation
9. Avoid wearing tight pants for extended periods
10. Change clothes immediately after swimming or exercising

Proactive prevention

11. Practice safe sex — use condoms, especially with new partners
12. Regular gynecological exams — every 6 months
13. Control blood sugar if diabetic
14. Limit unnecessary antibiotic use — always follow doctor’s prescriptions
15. Eat yogurt and probiotics — help maintain vaginal Lactobacillus

Preventing recurrence

• Complete the full course of medication — don’t stop early even if symptoms improve
• Treat partner if the infection is an STD
• Eliminate risk factors — stop douching, switch to pH-appropriate intimate wash
• Follow up after treatment to confirm complete cure
• Vaginal probiotics — may help restore balanced microbiome

Practical Advice from the Specialist

BSCKI. Trần Thị Thúy Lâm shares practical clinical insights:

1. “Not all discharge means infection” — Clear or whitish, odorless discharge is completely normal. Don’t worry excessively.

2. “Itching + white thick discharge does not always mean yeast” — Many women self-diagnose yeast and buy antifungals. In reality, only 30-50% of self-diagnoses are correct. Lab confirmation is needed.

3. “BV is not an STD but is related to sex” — Bacterial vaginosis is not sexually transmitted in the traditional sense, but sexual activity (especially with new partners) is a risk factor.

4. “Menopausal women need check-ups too” — Vaginal dryness and atrophic vaginitis don’t resolve on their own. Topical estrogen is very effective and safe, significantly improving quality of life.

Treatment at Phòng Khám Bác Sỹ Lâm

Phòng Khám Sản Phụ Khoa Bác Sỹ Lâm provides comprehensive gynecological examination and treatment with a standardized process:

1. Examination — Female specialist conducts direct, gentle, private examination
2. On-site testing — Wet mount, pH measurement, whiff test — same-day results
3. Advanced testing — Culture, STD PCR when needed — in coordination with Medlatec Hospital Hanoi
4. Accurate diagnosis — Identifying the exact type of infection and causative agent
5. Targeted treatment — Prescribing the right medication for the cause, with detailed usage instructions
6. Follow-up — Post-treatment check to ensure complete cure, recurrence prevention counseling

BSCKI. Trần Thị Thúy Lâm has over 30 years of experience in gynecological care, is a member of the Vietnam Sexual Health Association, and formerly served as an OB-GYN physician at the Provincial General Hospital of Lào Cai.

Vaginitis is completely treatable when properly diagnosed. Don’t self-medicate — see a doctor to identify the cause and receive effective treatment.

Call now: 0986 321 000 | Address: 125 Hàm Nghi, Kim Tân, Lào Cai

The clinic is open Monday through Saturday, mornings 7:30-11:30, afternoons 1:30-5:00 PM. Appointments can be made by phone and Zalo.