Vaginal Infections Specialist
Vaginal infections can cause painful symptoms, and left untreated, they can become serious. Board-certified gynecologists at Maiden Lane Medical helps patients from New York, NY, get the treatment they need, so they can relieve symptoms, avoid complications and feel better.
What is vaginitis?
Vaginitis is referred to as an infection or inflammation of the vagina causing vaginal discharge, odor and skin irritation. Associated symptoms may include pain with intercourse and irregular vaginal spotting.
What causes vaginitis?
There is a complex balance maintained at the vagina of the skin and normal flora (noninfectious bacteria normally found at the vagina). The pH maintained at the vagina inhibits infection but can be disrupted by many factors causing negative symptoms.
The most common causes of vaginitis are:
- Bacterial vaginosis (BV) is caused by an unclear decrease in the vaginal bacteria Lactobacilli and increased concentrations of other bacteria normally present in the vagina. While BV is not considered a sexually transmitted infection (STI), sexual activity and douching may be risk factors for this imbalance.
- Candida vulvovaginitis (yeast) is not an STI but rather symptoms of vaginal and vulvar inflammation in the presence of an overgrowth of the Candida species.
- Trichomonas infection is a sexually transmitted infection caused by a parasite.
- STI such as Neisseria gonorrhea or Chlamydia trachomatis
Additional causes are not due to infection but may cause the same symptoms, including the following:
- Atrophic vaginitis is caused by decreased moisture and thinning at the vaginal skin due to decreased levels of estrogen with menopause or certain forms of birth control
- Retained foreign body i.e. retained tampon
- Dermatitis in reaction to hygienic products i.e. body wash, soap, detergent, feminine products, antibiotics
- Vaginal scars,. lesions / growths or fistulas
- Skin disorders of the vagina: lichen sclerosis, eczema, psoriasis, malignancy
- Vestibulodynia (pain on penetration of the vagina 3-6 months in the absence of infection)
- Desquamative inflammatory disorder: rare skin disorder of skin sloughing without infection in perimenopausal women
How is vaginitis diagnosed?
Diagnosis of the most conditions is based on history and physical exam. Vaginal discharge is tested for pH levels and examined n a slide under the microscope. Vaginal cultures may be done to rule out other STIs. Vaginal skin biopsy may aid in the diagnosis if infection has been ruled out and symptoms are persistent.
How is vaginitis treated?
The most common causes of vaginitis are treated with antifungal or antibiotic oral or vaginal medications. Candida is treated equally well with oral or vaginal treatments. Oral fluconazole is a convenient single dose method while vaginal treatments may offer fewer side effects.
Bacterial vaginosis is treated with metronidazole or clindamycin. They are administered in the form of oral tablets or a cream or gel vaginal suppository. Asymptomatic women do not require treatment of either Candida or BV. Diagnosed Trichomoniasis always requires treatment most commonly with a single dose of metronidazole or tinidazole. Partners must be treated for all diagnosed STIs and should refrain from sexual activity 1-2 weeks after treatment.
Recurrent vaginitis is not uncommon and may require special cultures to test for resistant strains of infection. In cases of ongoing recurrence, long-term suppressive therapy may be useful in vaginitis prevention. Behavioral and hygienic practices are also very important including the use of gentle soaps, detergents and lotions. Vaginal douching is discouraged. Women with female partners tend to have higher incidence of vaginitis and both partners should take precautions.
Noninfectious causes of vaginitis are often treated by a specialist. A variety of topical medications such as anti-inflammatory, hormonal or analgesic agents are used depending on the diagnosed condition.