In this episode of the Healthful Woman podcast, Dr. Nathan Fox speaks with Dr. Stephanie Lam about vaginitis, one of the most common reasons women visit a gynecologist. Dr. Lam estimates that 20 to 25 percent of her patients will deal with it at some point. She suspects the real number is higher, because many women treat themselves at home. Together, they explain the different causes behind burning, itching, and discharge, how each is diagnosed and treated, and why it isn’t always a yeast infection.
What Is Normal, and What Isn’t
First, some reassurance: “every woman will have a discharge and a discharge is normal to some degree,” Dr. Lam explains. Discharge changes over the menstrual cycle, and it often increases during pregnancy without any infection. Learn more about what’s typical on our vaginal discharge page.
Signs of vaginitis worth a visit include vulvar itching, an odor or “off” smell, burning (including burning with urination), and discharge that is colored, heavier than usual, or blood-tinged. Blisters, cuts, or skin changes that don’t go away should always be checked.
The Common Causes of Vaginitis
Yeast infections. “Yeast, candida, fungus are the same thing,” Dr. Fox notes. Yeast often follows a course of antibiotics, heavy alcohol use, a diet high in sugar or carbohydrates, or time spent in wet workout or swim clothes. The discharge is usually white and has no odor.
Bacterial vaginosis (BV). BV is an overgrowth of bacteria and is not sexually transmitted. It typically causes an odor and sometimes burning with urination. In fact, Dr. Lam stresses that with vaginitis, “the vast majority are not sexually transmitted.”
Trichomoniasis and other STIs. Trichomoniasis is sexually transmitted and can look a lot like a bacterial infection, so partners should be tested and treated as well. A change in discharge color or symptoms in a partner may also call for STI/STD testing for chlamydia, gonorrhea, or herpes.
Other causes. Falling estrogen during menopause can cause atrophic vaginitis, with dryness, burning, and irritation. Skin conditions such as eczema, psoriasis, or reactions to products can mimic an infection. A forgotten tampon often causes a strong odor. In young girls, foreign bodies such as toilet paper are a common cause.
Diagnosis and Treatment
A visit usually starts with a conversation about recent antibiotics, diet, alcohol, new partners, and habits like hot tubs or wet swimwear. An exam and, if needed, office tests follow: cultures, a microscope check, and urine testing when bladder symptoms overlap. When symptoms are classic, Dr. Lam may start treatment before results come back. In her words, “it looks like a duck, it quacks.”
Treatment depends on the cause. Yeast can be treated with oral pills or vaginal creams and suppositories. BV is usually treated with a short course of oral or vaginal antibiotics. Atrophic vaginitis often responds to vaginal estrogen, and skin conditions may need steroid ointments. In pregnancy, doctors tend to treat more readily, since BV may be linked to preterm birth in some high-risk women.
That’s why Dr. Fox warns against guessing or treating over the phone: “it’s a gamble.” Treating the wrong infection can make the other one worse.
Prevention: Leave the Vagina Alone
Both doctors agree that douching and cleansing products do more harm than good. “You’re basically just washing out bacteria that are supposed to be there,” says Dr. Fox. Dr. Lam puts it simply: “I say leave the vagina alone.” Change out of wet clothes promptly, take extra care after antibiotics, and pay attention to diet and hydration. Some patients also find probiotics or yogurt helpful.
Learn More
Listen to the full episode of the Healthful Woman podcast to hear Dr. Lam and Dr. Fox discuss vaginitis in more detail.
If you are experiencing itching, burning, or unusual discharge, or have questions about your vaginal health, Carnegie Women’s Health provides compassionate, personalized care for women at every stage of life. Contact Carnegie Women’s Health through the online appointment request form to schedule a visit.
Carnegie Women’s Health blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!
