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

• No odor

• 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:

1. 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

1. 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

1. 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!