CAUSES OF CHRONIC VAGINITIS
Vaginitis refers to any inflammation of the vagina. This can result in discharge, itching, and pain. Usually caused by a change in the balance of the vaginal microbiome.
There are 3 common causes of vaginitis I see in practice, that continue to be chronic complaints for my patients with vulvas:
1. Bacterial Vaginosis: dysbiosis of vaginal flora, causing depletion of key Lactobacillus species and an overgrowth in gram negative anaerobes (such as Garnerella)
Odor: fishy, unpleasant, often worse after intercourse
Discharge: thin, milky white, or grey
Itching, burning, or irritation: sometimes
Sometimes pain with intercourse
Increased pH (>4.5)
Vaginal culture shows increased gram variable coccobacilli, presence of Clue cells
2. Vaginal Candidiasis: an overgrowth of candida/yeast (a fungus), normally occurring but just in excess, in the vagina
Discharge: thick, white, cottage cheese-like consistency
Itching, burning, and irritation: usually
Pain with intercourse
Normal vaginal pH
Vaginal culture shows increased yeast + pseudohyphae
3. Cytolytic Vaginosis: an overgrowth of lactobacillus bacteria in the vagina
Not often an odor
Discharge: thin and watery, or thick & curd-like
Mild to moderate vulvar or vaginal discomfort, sometimes pain with intercourse
Symptoms more prominent during the second half of your menstrual cycle
Decreased pH (<4.0)
Vaginal culture shows reduced white blood cells, and increased lactobacilli - no signs of yeast or BV.
This type of vaginosis is not often acknowledged by the conventional medical system, and is moreso a diagnosis of exclusion - really common as the root cause of chronic discharge and irritation, after many treatments of antifungals or antibiotics, with no success.
Note: STI's, such as Trichomoniasis, Chlamydia, and Gonorrhea can produce yellow & green discharge, with an unpleasant & foul odor, pain or bleeding with intercourse, and/or burning during urination. These should be ruled out as well.
Goals of treatment:
Kill off excess of bacteria or yeast (internal + external)
I often use a combination of external treatments, such as suppositories inserted into the vaginal canal, as well as internal antimicrobials to improve efficacy of treatment
Re-balance pH of vagina (external inserts)
I often prescribe vaginal douches specific to what vaginal pH we are trying to achieve; whether we are looking to increase acidity, or decrease acidity
Re-inoculate with proper bacteria if necessary (internal + external)
We want to add in proper levels of good bacteria if indicated, which can be specific strain and dose of vaginal + oral probiotic
There are conventional methods to treat the above, including antibiotics and antifungals, however there are other alternatives that are used to kill off & rebalance the vaginal microbiome. Especially if vaginal complaints are chronic, we need to take a deeper look at what is going on! Your vaginal health shouldn't be weighing you down on a day to day basis, or even month to month.
Reach out to investigate more about your vaginal microbiome!