A medical guide to dealing with a pervasive female disorder vaginal infections


What is a vaginal infection?
The vagina normally contains large numbers of organisms (germs) called Lactobacillus (or acidophilus). Vaginal infections happen when other organisms grow and change the normal balance of organisms in the vagina. Most women have a vaginal infection now and then, and many women have them often. You may have a vaginal infection if your normal vaginal discharge changes color, becomes heavier or smells different, or if you notice itching, burning, swelling or redness around the vagina.

What is a normal vaginal discharge?
A normal discharge usually does not smell bad and is not accompanied by redness, swelling or itching of the vaginal area. Most vaginal discharges are normal. You may notice a vaginal discharge on your panties at some stages of your menstrual cycle. This discharge may be most noticeable at the middle of the cycle, which is close to the time of ovulation. Some women have a discharge on most days, and some women must use sanitary pads because of the amount of discharge.

What are common causes of vaginal infections?
The most common form of vaginal infection is called bacterial vaginosis. Women with this infection have a large number of organisms called Gardnerella vaginalis, as well as many other organisms, in their vagina. If you have this infection, you may notice a different vaginal smell that is strongest after sexual intercourse, and perhaps an increased amount of thin vaginal discharge, which may be white or discolored.

A yeast infection, or Candida vaginitis, is another common type of vaginal infection. If you have this kind of infection, you may notice larger amounts of thick, white discharge, or no discharge at all. Other common symptoms include itching, swelling, irritation or redness around the vaginal area.

Trichomonas vaginitis, which is sometimes called "trick," is the third most frequent vaginal infection. Like bacterial vaginosis, this infection often causes an increased amount of discharge, which may be discolored. Sometimes the discharge smells different. Itching may be present but is less likely than with a yeast infection.

How can vaginal symptoms be treated?
The treatment for vaginal symptoms depends on the cause. Bacterial vaginosis is often treated with a prescription medicine called metronidazole (Flagyl, Protostat). This medicine is taken by mouth. Sometimes it causes an upset stomach or nausea. If you drink alcohol while taking this drug, you may have nausea and vomiting. There are other medicines that may be taken by mouth for this infection, such as clindamycin (Cleocin), and there are also vaginal creams or gels.

A yeast infection is usually treated with creams or suppositories that are placed in the vagina. The length of treatment may vary from one to seven days. Some of these medicines are now available without prescription, such as miconazole (Monistat) and clotrimazole (Gyne-Lotrimin or Mycelex-G), and you may use them when you know you have a yeast infection. If the infection doesn't get better or comes back soon, you should see your doctor to make sure of the diagnosis and treatment. When the infections are frequent or when they are hard to cure, your doctor may prescribe medicine to be taken by mouth.

Trichomonas vaginitis is also treated with metronidazole, taken by mouth. However, because this infection is often passed back and forth between sexual partners, your sexual partner also ought to take the medicine, to stop your infection from coming back.

How can the cause of the vaginal symptoms be determined?
It is very hard to know the cause of vaginal symptoms unless your doctor talks with you, does a pelvic examination and looks at any vaginal discharge through a microscope. If these steps are taken, a fairly accurate diagnosis can be made most of the time, and the right medicine can be started. If the cause of the symptoms is still unclear, a sample of the vaginal discharge can be sent to a laboratory for testing to find out the right medicine to use.

What if the symptoms aren't caused by one of these common infections?
In about one of every three women with vaginal symptoms, the cause of the symptoms may be harder to find. Another-type of infection, such as gonorrhea, chlamydia or herpes, may be present. Low hormone levels, related to menopause, or an allergy may also cause vaginal symptoms. Sometimes no cause for the symptoms can be found.

Even with medical treatment, some women keep having vaginal irritation or discharge. We still don't know all the causes of vaginal symptoms, and scientists are still investigating. If you continue to have problems with vaginal symptoms, ask your doctor about new treatments.

The American Academy of Family Physicians

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