You've probably heard us talk about vulvovaginal health many times, and maybe you've heard the term vaginitis or vulvovaginitis before, but no one has told you exactly what it means, how it affects you, and how to protect yourself from it. So today we're talking in detail about this condition: what it is, when it appears, how many types it has, how vulvovaginitis manifests itself, and what we can do to protect our intimate health? Let's take them one by one.

What is vaginitis (vulvovaginitis)?

Vaginitis, also known as vulvovaginitis, is actually a broad medical term that defines infection or inflammation of the vulva or vagina (vulvovaginal area) due to various conditions. Like any inflammation, vaginitis is unpleasant and causes discomfort. It can cause itching, burning, pain, and unusual discharge.

However, the condition itself is not at all uncommon - it can occur at any age, and one in three women will experience at least one form of vaginitis during their lifetime. So you don't need to panic, just go to your gynecologist as soon as possible. Let's talk about how you get vulvovaginitis, how it manifests itself, and how to treat it.

Types of vulvovaginitis:

There are a lot of factors that can infect or inflame a woman's vagina and vulva - and depending on them, there are just as many types of vulvovaginitis.

The infection can be caused by a virus, bacteria, or fungus. The inflammation can also occur in response to skin contact with allergens and harmful chemicals in care products such as shower gel or menstrual products. Vaginal dryness, low estrogen levels, or unprotected sex can also lead to vulvovaginitis.

We will take these factors one by one to see what types vulvovaginitis is classified into.

Bacterial vaginitis

It is the form of vaginitis that most commonly affects women who have not yet reached menopause. As you can guess from the name, it is caused by several bacteria. These bacteria are already normally found in your vagina, but they end up causing inflammation of the vagina when they multiply excessively, just like candida does when the vaginal pH is disturbed.

It is not a sexually transmitted disease, but it occurs more often in women with an active sex life, and the main risk factors are changing sexual partners, vaginal douching, and smoking.

It is important that bacterial vaginosis is diagnosed correctly. Do not confuse it with candidiasis and do not self-treat, because the treatment of candida infections is different from that of bacterial infections and can make them worse!

Atrophic vaginitis

Unlike bacterial vaginosis, which occurs mainly before menopause, atrophic vaginitis affects women mainly during menopause and perimenopause, or after surgical removal of the ovaries. It is a form of non-infectious vaginitis that occurs as a result of low estrogen levels, when the vagina becomes dry.

The vagina can also become drier and atrophic during breastfeeding and postpartum, so you are also prone to atrophic vaginitis if you fall into this category. Also, treatment for endometriosis or breast cancer can lead to low estrogen levels, thus increasing the risk of atrophic vaginitis.

Acute vaginitis

This time from the point of view of the stage of the condition - and not the causes - we can classify it into:

• acute vaginitis, which we are talking about now;
• chronic vaginitis - which we will talk about a little below.

The acute form is the most common, and is what we refer to when we talk about bacterial and candidal vulvovaginitis. Acute symptoms of vulvovaginitis also refer to inflammation of the vulva due to sexually transmitted infections, such as trichomoniasis, Chlamydia, or Gonorrhea.

It manifests itself through burning sensations, pain, itching, vaginal discharge, and pain during sexual intercourse.

Mycotic/fungal vaginitis (candidiasis)

Fungal infections (mycotic) are the second most common cause of inflammation of the vulva and vagina. The most common cause of fungal vaginitis is infection with Candida albicans or other species of Candida.

Candidiasis occurs, as mentioned above, when something disrupts your vaginal balance and candida overgrows. This can happen, including:

• if you are pregnant and hormonal changes occur;
• if you have diabetes and the glucose level in your urine and vagina is too high;
• after taking antibiotics, which also kill the good bacteria normally found in the vagina.

But did you know that I've talked about candidiasis on the blog in a previous article? You can read it HERE to learn more about preventing and treating Candida albicans infection.

Non-infectious vaginitis

Vulvitis (inflammation of the vulva) or vaginitis can also occur without an infection. In this case, we are talking about non-infectious vulvovaginitis, which is simply an allergic reaction. It means that something is irritating your genital area, without causing an infection.

The balance of vaginal flora is delicate, and such irritations can occur both from products you use in the vagina, as well as from materials or substances that simply come into contact with the sensitive skin of your intimate area:

• Spermicides;
• Vaginal douches;
• Vaginal sprays;
• Seminal fluid;
• Foods you are allergic to (peanuts, chocolate, soy, eggs, nuts, etc.)
• Feminine hygiene products containing perfumes and other harmful substances (soaps, shower gels, wet wipes, lubricants, creams);
• Detergents and conditioners used for washing underwear;
• Underwear made of synthetic materials that do not allow the skin to breathe;
• Conventional menstrual products contain plastic, dioxin, fragrances, and other toxic ingredients.

Nonspecific vaginitis

Another way in which we can classify vaginitis into two types according to its origin is in:

• Specific vaginitis, when it comes from specific agents such as viruses, fungi, bacteria, protozoa or arthropods. This category includes vaginitis caused by HPV (human papillomavirus), genital syphilis (the bacterium Treponema pallidum) or trichomoniasis (Trichomonas vaginalis).
• Nonspecific vaginitis, which occurs when the vaginal flora is unbalanced.

There are several ways you can get nonspecific vaginitis, but they all boil down to the multiplication of bacteria that normally live in the vagina. Thus, factors that trigger the excessive multiplication of these bacteria include:

• at a local level: the postpartum period or after an abortion, lack of proper hygiene in the intimate area, injuries following sexual intercourse;
• in general: hormonal changes, diabetes, weakened immune system.

Trichomoniasis

Vulvovaginitis can also be triggered by sexually transmitted viruses, bacteria, or parasites, with trichomoniasis being one such example. So are gonorrhea and chlamydia, the three most common causes of viral (sexually transmitted) vaginitis.

A foul-smelling vaginal discharge and itching are the most common signs of trichomoniasis, which occurs when the protozoan Trichomonas vaginalis (a small, single-celled parasite) infects your vagina. Men who transmit this parasite usually have no symptoms. It takes at least 7 days of sexual abstinence and for all partners to be treated to effectively get rid of such an infection.

Mixed vaginitis

You can already understand from the name what mixed vaginitis refers to. It is very rare, and involves the existence of not one, but at least two infections (or two harmful agents) that simultaneously cause inflammation of the vulvovaginal area:

• Bacterial vaginitis;
• Herpes simplex;
• Trichomonas Vaginalis;
• Neisseria gonorrhoeae;
• Chlamydia trachomatis.

For example, we are talking about mixed vaginitis in a patient with trichomoniasis & another bacterial infection, candidiasis & another bacterial infection, or Chlamydia infection & another bacterial infection. In these cases, treatment for both conditions will need to be followed.

Chronic vaginitis

Much rarer than the acute vaginitis we talked about above, chronic vaginitis - or persistent - has the same symptoms as the acute form, only it lasts 6 months or even longer. The main reason is either that the symptoms appear and disappear after a period of time, or because the patient intuitively treats herself with creams or antifungals, without a visit to the gynecologist.

Once diagnosed and treated correctly, chronic vaginitis heals in a short time. The most common forms of chronic vaginitis are:

• Desquamative inflammatory vaginitis (aerobic): which manifests itself through irritation and inflammation of the genital area, purulent vaginal secretions and a strong feeling of discomfort.
• Untreated atrophic vaginitis, which we already discussed above occurs especially during menopause;
• Irritations, allergies and untreated dermatological problems in the intimate area.

Vaginitis - Symptoms:

The symptoms of vaginitis differ depending on the type of condition each patient suffers from. You have already seen how many forms and causes vulvovaginitis has, and it is normal for the symptoms to be just as numerous and varied. But basically, they all boil down to inflammation of the vulva and vagina, the most common symptoms being:

• Unusual vaginal discharge;
• Stinging sensation, itching, redness, burning;
• Swollen organs in the genital area and inflamed vagina;
• Burning, stinging or painful sensation when urinating;
• Pain and discomfort during sexual intercourse and more. Pain during sexual intercourse is not, however, an exclusive symptom of vaginitis, but can have many other causes, which we have also discussed on our blog: Why do you feel pain during sex?

We have listed above only some general signs and symptoms. But depending on the type of vaginitis, they become specific, so let's see how the categories of vulvovaginitis mentioned above manifest themselves. Here are the main symptoms of:

• Bacterial vaginitis: inflammation of the labia and vulva, abnormal odor and milky, thin texture of vaginal discharge, which becomes more unpleasant after menstruation or after sexual intercourse; bacterial vaginitis can also be asymptomatic, in which case the doctor only detects it during a routine gynecological check-up.
• Fungal/candidiasis vaginitis: vaginal redness and itching, thick and white, or watery and odorless vaginal discharge, small lesions on the vulva, burning sensation when urinating, and sometimes a swollen vagina and inflamed labia.
• Non-infectious vulvovaginitis: Swollen vulva, inflamed labia minora, burning and itching sensations of the vulva and vagina, and thick, yellow or greenish gelatinous vaginal discharge can be symptoms of allergic reactions without the presence of an infection.
• Trichomoniasis: yellow-green color and unpleasant odor of vaginal secretions, pain and itching in the vulva and vagina, burning sensation when urinating and vaginal pain or discomfort in the lower abdomen during sexual intercourse, which intensifies after menstruation. Inflamed labia are also a symptom of trichomoniasis and genital syphilis.
• Chlamydia: Pain in the lower abdomen and pelvic area and light bleeding, especially after sexual intercourse. Sometimes there is also vaginal discharge, but most of the time the symptoms are easy to overlook.
• Herpes: Small sores and lesions inside the vagina or vulva that can only be seen during a gynecological examination. The pain caused by these lesions is the main symptom of herpes vaginitis.
• HPV: There may be white, gray, pink, or purple genital warts, but they don't always appear. With no visible signs, human papillomavirus is only detected during a Pap test.

Vaginitis - Causes & risk factors:

We have already mentioned some of the main causes of vaginitis above, but now let's establish exactly what the causes and risk factors for vulvovaginitis are. So, let's start with the causes:

• Bacterial, fungal, and viral infections are the causes of bacterial vaginitis, fungal vaginitis, and vaginitis caused by infection with viruses, bacteria, parasites, and other sexually transmitted agents, respectively.
• Decreased estrogen levels during menopause, perimenopause, after surgical removal of the ovaries, or other hormonal problems are the causes of atrophic vaginitis.
• Failure to treat acute vaginitis is the cause of chronic vaginitis;
• Vaginitis caused by two or more simultaneous infections is the cause of mixed vaginitis;

Other causes of vulvovaginitis, or inflammation of the vulva and/or vagina, include:

• Parasites: pinworms, scabies or lice in the intimate area;
• Improper hygiene in the genital area;
• Other sexually transmitted diseases;
• The occurrence of a hormonal imbalance, for example after childbirth or an abortion;
• Imbalance of the vaginal flora through the use of products with toxic ingredients for intimate hygiene or care.

And, last but not least, other risk factors that predispose patients to vaginitis are:

• Starting sexual life with a new partner or frequently changing partners;
• Using underwear and clothes made of synthetic materials, which do not allow the skin to breathe;
• Using conventional menstrual products and feminine hygiene products that contain perfumes, bleaches, plastic, parabens, or other harmful chemicals;
• Food allergies;
• Vaginal douches;
• Antibiotic treatments;
• Failure to treat diabetes;
• Thyroid or endocrine system problems;
• Estrogen-rich contraceptives;
• Task;
• Weakening of the immune system;
• Smoking.

Vulvovaginitis in the summer

Some specialists say that the number of patients with vulvovaginitis increases by 50% during the summer, because the high level of humidity in the air and the increased temperature create the perfect environment for imbalance of the vaginal flora and inflammation of the genital area.

To reduce this risk during periods of excessive heat, it is good to pay attention to clothing and hygiene habits, as they are the main risk factors. So, avoid, as much as possible:

• Synthetic, thick, and tight-fitting clothing: the skin needs to breathe, and synthetic fibers in underwear or pants retain sweat and moisture, favoring vaginal balance disruption and the appearance of vaginitis. Organic cotton underwear and cool, breathable clothing made from natural fibers are much more suitable both to prevent such conditions and for your comfort during the summer;
• Wet clothes: again, sweating and maintaining moisture in the intimate area favors the multiplication of bacteria and the appearance of vaginitis. The intimate area must remain dry, and it is a good idea to use organic panty liners even on days without menstruation, which absorb vaginal secretions and do not allow moisture to accumulate. If you exercise and sweat during the summer, take a shower and change your workout clothes immediately after finishing it;
• Douches: Unless your doctor recommends them, you DO NOT need them! Your vagina has a naturally slightly acidic pH to clean itself. Douches will upset this pH, so use only water and a natural intimate gel to clean only your vulva and the outside of your vagina.
• Scented hygiene products: Even fragrances in soaps, shower gels, sprays, intimate deodorants or absorbents can upset your pH balance. You don't need them - use only natural products, free of fragrances and other chemicals that are toxic to your skin.

Is vulvovaginitis transmitted?

Vulvovaginitis itself is not contagious, but the viral infections that cause it can be transmitted to a partner. Trichomoniasis, Chlamydia, Gonorrhea, HPV, herpes - all of these sexually transmitted diseases can be transmitted to a partner and can lead to vaginitis.

Also, bacterial vulvovaginitis is not transmitted, but unprotected sex with multiple partners can increase the risk of it occurring.

When should you consult a doctor?

It is always a good idea to consult a doctor if you notice any changes in the color, odor, or texture of your vaginal discharge, or if you experience discomfort or pain. Whether it is vulvovaginitis or another condition of the intimate area, early diagnosis and treatment will help you get rid of your symptoms more quickly and effectively.

It is even more urgent to see a doctor if you suspect you have vulvovaginitis and notice the following signs:

• You have vaginal discharge with an unpleasant odor;
• Vaginal discharge with an unusual texture or a yellow-green color appears;
• You feel itching, burning, redness;
• You notice swelling in the genital area;
• You feel a stinging, burning or pain when urinating or during sexual intercourse;
• You have never had a vaginal infection before;
• You have recently had one or more new sexual partners;
• You have a fever, pelvic pain, or chills;
• The symptoms of candidiasis do not disappear even though you have followed the prescribed treatment;
• You have recently undergone a course of antibiotics.

Diagnosis of vulvovaginitis

To diagnose the cause and type of vulvovaginitis, your doctor may ask you about your medical history and perform a gynecological exam. They will collect a sample of your vaginal discharge to analyze under a microscope to determine what is causing your vaginitis.

They may also test your pH level to make a correct diagnosis. You may also be advised to avoid sexual intercourse for 24 hours before the consultation.

You can help your doctor make a correct diagnosis by describing all the symptoms you have noticed, such as any abnormal changes in vaginal secretions, the appearance of unusual odors in the intimate area, or discomfort.

Vaginitis/vulvovaginitis treatment:

The first step in treating vulvovaginitis is a correct diagnosis, as the wrong treatment for the patient's type of vaginitis can worsen the symptoms. Depending on the causes of the condition, the appropriate treatment will then be chosen.

For example, in non-infectious vaginitis, treatment is simply to stop using the products that may have caused the inflammation. This may mean replacing your shower gel or soap with one with a neutral pH, stopping using scented feminine hygiene products, opting for cotton underwear, or changing your laundry detergent.

For other types of vaginitis, treatment may consist of administering medications or special creams, which we will discuss below.

Drug treatment

Antibiotics are the main treatment for bacterial vulvovaginitis. As with trichomoniasis, a single dose of antibiotics is the treatment that both you and your partner should take.

The same applies to the treatment of any other form of vaginitis caused by a sexually transmitted disease: both partners must be treated to prevent the spread and reinfection with the respective virus or parasite.

If vaginitis occurs as an allergic reaction, in addition to removing the source of the irritation, your doctor may also recommend antihistamine medications to relieve symptoms.

Ovules for vulvovaginitis

In the case of mycotic vaginitis, ovules (vaginal suppositories) may also be prescribed to treat infections with various types of microorganisms. These ovules contain antifungal, disinfectant, anti-inflammatory and soothing ingredients that fight the infection and prevent its spread.

It is good to know that the ovules for fungal or candidal vulvovaginitis are oil-based, which is why they can reduce the effectiveness of latex condoms. For this reason, it is recommended to avoid sexual contact during treatment to avoid an unwanted pregnancy.

Creams for vulvovaginitis

Fungal infections can also be treated with antifungal creams or gels, and in the case of bacterial infections, an antibacterial cream can be prescribed. The doctor may also recommend an estrogen-based cream to treat atrophic vulvovaginitis, when the cause is hormonal changes.

Is natural treatment recommended for vulvovaginitis?

Postponing or completely ignoring treatment for vulvovaginitis is never recommended. Do not wait for the symptoms to go away on their own, as they may worsen. Also, natural treatment is not recommended, unless after a gynecological consultation and with the consent of the doctor.

After a visit to the gynecologist and a correct diagnosis, if the doctor tells you it's okay, then you can also opt for a natural treatment at home, such as:

• Baths with natural essential oils, without perfume or dyes, which can moisturize the skin and reduce itching, redness, burning and stinging;
• Sitz baths with a little vinegar, sea salt or tea tree oil to destroy certain bacteria;
• Local antibacterial applications with coconut oil, crushed garlic, or a paste of water and baking soda;
• Cold compresses to relieve inflammation and discomfort;
• Warm baths with baking soda to relieve itching;
• Consuming probiotics: There are several studies that claim that vaginitis symptoms can be improved by limiting sugar consumption and increasing the consumption of yogurt and probiotics containing lactobacilli.

Complications of vaginitis:

Without proper diagnosis and treatment for the infections that caused vaginitis, they can get worse. Untreated bacterial vaginosis and trichomoniasis can also lead to serious complications, including:

• Pregnancy problems: premature birth;
• Pelvic inflammatory disease (PID);
• Worsening of HIV infection or other sexually transmitted diseases.

Prevention of vaginitis

Preventing vaginitis actually means preventing the inflammation that occurs when our vaginal flora is unbalanced. That is, preventing such imbalances, which we do by taking care of everything that comes into contact with our intimate area. Specifically, here's how you can best protect yourself from infections and irritations that can cause vaginitis:

• Keep your intimate area dry;
• Avoid standing in a wet swimsuit or sweaty workout clothes;
• Also avoid synthetic, thick, body-hugging clothes that make you sweat and retain moisture;
• Wear clothes and underwear made of cotton and natural fibers that are loose, cool, and breathable.
• Do not clean your vagina with vaginal douches, but only wash its exterior and the vulva;
• Avoid shower gels, soaps, sprays, and intimate area deodorants that contain perfume, dyes, parabens, and other chemicals that can irritate your skin;
• Use only water and a natural intimate gel with neutral pH to maintain your vulvovaginal hygiene - Enroush intimate gel is specially formulated to protect your genital area with 95% natural ingredients.
• Protect yourself from sexually transmitted diseases and other infections by using a condom with every sexual contact;
• Use only organic menstrual products that let your skin breathe and keep it dry without causing irritation. Enroush pads and tampons are made from 100% organic cotton and are free of plastic, fragrances, dioxins, or synthetic fibers.

• Go for a regular gynecological check-up to detect any type of infection early, including asymptomatic ones.

Vulvovaginitis in children

Girls, especially before and during puberty, are prone to vulvovaginitis because their vaginal environment is more alkaline, without vaginal secretions, and the vulvovaginal mucosa is much thinner. So if in an adult woman, the main causes are infections with various viruses, bacteria and microorganisms transmitted through sexual contact, in children vulvovaginitis occurs mainly due to mistakes in maintaining proper hygiene.

This means both poor and excessive hygiene. It can occur in girls of all ages, from the baby stage, if the diaper causes irritation, to puberty. Especially if hygiene is insufficient or the intimate area is not wiped properly, bacteria will remain there and will favor the appearance of inflammations and infections.

Other causes of vulvovaginitis in children include excessive use of wet wipes, wearing underwear that is too tight, using detergents or conditioners with harmful chemicals when washing underwear and clothes, increased humidity in the intimate area, or using shower gels, soaps, or bath foams with perfumes and other ingredients that are invasive to the skin.

The symptoms of vaginitis in girls are mainly swelling of the vulva and vagina, redness and the appearance of burning sensations, itching, stinging when urinating and an unpleasant odor. After the doctor makes this diagnosis based on the signs of the condition, treatment will be done primarily by eliminating the source of irritation, and, depending on the severity, by administering antibiotics.

To prevent this problem from occurring in a girl's life, the most important thing is for parents to be very attentive to her hygiene, and as she grows, to teach her how to wipe herself properly, how to wash herself properly, and how to protect herself from infections and irritations. These preparatory steps are essential for the girl to be prepared to maintain her own hygiene properly as she approaches puberty and wants more and more privacy. I have already written on the blog about this period full of changes in a woman's life, so we invite you to read there a lot of other useful information about puberty in girls .

Vaginitis in pregnancy

According to some studies, bacterial vaginosis is one of the most common genital tract problems that pregnant women face. There are statistics that claim that between 10% and 30% of women develop this condition during pregnancy, mainly due to the hormonal changes that occur during this period.

The most common and obvious symptom of vaginitis in pregnant women is an unusual, pungent odor in the intimate area, but there are also cases in which grayish watery discharge, a burning sensation when urinating, or itching in the vulvovaginal area appear. Bleeding is not among the common symptoms of vaginitis in pregnancy, but it can indicate other health problems. So if you are pregnant and notice unusual bleeding, the information we have prepared for you about bleeding during pregnancy may help you.

The biggest risk of bacterial vulvovaginitis during pregnancy is premature birth and low birth weight. Both can cause other health problems for the baby later. Vaginitis caused by sexually transmitted diseases is also dangerous, because these diseases can be transmitted from mother to fetus before, during, and even after birth.

Your doctor may prescribe antibiotics, which are safe for your baby, treat bacterial vaginosis, and can reduce the risk of sexually transmitted diseases. They can be taken orally as pills, or applied topically as a gel or cream.

It is preferable to avoid them, however, because antibiotics can also kill the good bacteria inside the vagina. An alternative treatment, if antibiotics are not absolutely necessary, could be vaginal probiotics. These contain the right doses of micronutrients (iron, manganese, zinc) that help restore a healthy vaginal flora, so that your vaginal balance is no longer disturbed during pregnancy.