Vaginal inflammation: symptoms, causes & treatment

Vaginal inflammation, medically called vulvovaginitis, is a generic term for various disorders in which the mucous membranes of the vagina and labia are inflamed or irritated. It's one of the most common reasons women go to the GP, and it can occur at any age, from young girls to after menopause.

Your vagina naturally has a delicate balance of different bacteria that keep the environment healthy. These good bacteria produce lactic acid, which gives the vagina a slightly acidic environment. This acidity protects against the growth of harmful microorganisms. When this balance is disturbed, problems can arise.

There are different forms of vaginal inflammation, each with their own cause. In bacterial vaginosis, there is a disturbance in the bacterial balance where certain bacteria multiply too much, while the good lactic acid bacteria decrease in number. Fungal infections are another important group, usually caused by the fungus Candida albicans. This fungus normally lives in small numbers in the vagina without causing problems, but can multiply explosively under certain circumstances. This often happens when your immune system is temporarily reduced, after using antibiotics that also kill the good bacteria, or around menstruation when hormonal fluctuations occur.

Sexually transmitted diseases such as trichomonas or chlamydia can also cause vaginal inflammation. These infections are transmitted through sexual contact and require different treatment than the previously mentioned forms.

The development of vaginal inflammation is closely related to disturbances in the natural balance of the vagina. Various factors can upset this delicate balance and give rise to complaints.

Antibiotics are a frequent causative agent of fungal infections. These drugs not only kill the pathogens for which they are intended, but also the good lactic acid bacteria in the vagina. This gives fungi the opportunity to multiply unhindered. Cortisone-containing medications can also lower the immune system and promote fungal growth. Hormonal changes play an important role in the development of vaginal problems. During pregnancy, around menstruation, when taking birth control pills or after menopause, the hormonal balance changes. These fluctuations affect the vaginal environment and may temporarily make women more susceptible to infections. After menopause, the body produces less estrogen, making the vaginal mucosa thinner, drier and more easily damaged.

Exaggerated hygiene is paradoxically a risk factor. Vaginal showers, vaginal soaps, perfumed intimate sprays and other cleansers upset the natural balance. They remove the protective good bacteria and change the acidity, giving harmful microorganisms more chances. Water alone is sufficient for cleansing the intimate area. Certain clothing can also contribute to problems. Tight pants, synthetic underwear and wet swimwear create a warm and humid environment where fungi and bacteria thrive.

Diabetes significantly increases the risk of fungal infections. When blood sugar levels are too high, there is also more sugar in the vaginal discharge, which nourishes fungi and stimulates their growth. In sexually transmitted infections, the mechanism is different: they are transmitted through direct contact with infected mucous membranes during sex.

The symptoms of vaginal inflammation vary greatly depending on the cause, but increased discharge from the vagina is almost always present. This secretion, also known as fluorine, varies in color, consistency and odor by type of infection and often provides clues to the underlying cause.

In bacterial vaginosis, the discharge is usually dirty white or grayish in color and has a characteristic fishy smell. This smell becomes especially noticeable after sexual contact or during menstruation. Often the discharge is the only symptom and you experience no further pain or itching. Fungal infections paint a completely different picture: the discharge is white and friable, often compared to the texture of cottage cheese or cottage cheese. This form is usually accompanied by intense itching that can be particularly annoying. In addition, a burning, painful sensation occurs, especially when urinating or having sex. The labia may be red and swollen, and sometimes you can see white spots on the mucous membrane.

Sexually transmitted infections such as trichomonas usually cause a yellowish, sometimes greenish discharge that is abundant and has an unpleasant odor. This also causes itching and pain, and the mucous membrane may be red and irritated. The symptoms are often more severe than other forms. In chlamydia, on the other hand, the symptoms can be very mild or even completely absent, while the infection does cause damage.

Some women experience pain while having sex or urinating because the urine runs over the irritated tissue. These symptoms can significantly affect daily life and intimacy. The severity of the symptoms varies considerably between women and even between different episodes in the same woman.

Vaginal inflammation is limited to the area of the female genital organs. The vagina itself, the channel that runs from the outside to the uterus, is almost always involved. The vaginal mucosa becomes inflamed or irritated, leading to the characteristic discharge and other symptoms.

The labia, both outer and inner, can participate in the inflammation. The labia may be swollen, red, and sensitive. In case of fungal infections, you sometimes see white spots or a white coating on the labia. The entrance to the vagina and the area around the urethra may also be affected, which explains why women with vaginal inflammation often experience pain when urinating.

In some infections, inflammation can spread to the cervix. This mainly occurs with sexually transmitted diseases such as chlamydia. If inflammation of the cervix is not treated, it can spread further to the uterus and fallopian tubes.

Treatment for vaginal inflammation depends entirely on the underlying cause. It is therefore important that the diagnosis is made correctly before starting treatment. What helps with a yeast infection does not work for bacterial vaginosis and vice versa.

In the case of bacterial vaginosis, the doctor prescribes antibiotics that are specifically directed against the bacteria that cause the disturbance. You can choose between topical treatment with a cream or vaginal tablets, or treatment with pills you take. Both forms are equally effective. Fungal infections are treated with antifungal medicines, also known as antimycotics. These are available as vaginal tablets, creams, or as pills you take. For most women, a single treatment or a short-term course of a few days is sufficient. Pregnant women can safely use topical antifungal medicines if they have symptoms.

For trichomonas infections, the doctor prescribes specific antibiotics. This sexually transmitted infection should always be treated, even if there are no complaints. It is crucial that all sexual partners are also treated, even if they have no symptoms. Without treatment from the partner, the risk of re-infection is very high. In chlamydia, antibiotic treatment is necessary for both the infected person and all sexual partners. Here, too, treatment takes place regardless of whether there are symptoms, because untreated chlamydia can cause serious complications such as infertility.

Supportive measures help with all forms of vaginal inflammation. Avoid using soap, shower gel, or other products in the vagina. Water is sufficient for cleaning. Wear cotton underwear and avoid tight pants to promote airflow. Change wet swimwear quickly and dry the intimate area thoroughly after showering or swimming.

There are many misconceptions about vaginal inflammation that can lead to the wrong approach or delay in the right treatment. Vaginal showers are often thought to be effective for vaginal problems, but they actually make things worse. Washing away the secretion does not solve the underlying problem and further upsets the natural balance. The good protective bacteria are washed away, while harmful microorganisms can then multiply all the faster.

Scented panty liners, intimate sprays and other odour-concealing products only mask the odour but do not treat the cause. These products often contain substances that disrupt the vaginal environment and can cause irritation. Inserting yogurt into the vagina is a much-discussed home remedy, but there is no scientific evidence that this helps. In fact, yogurt also contains sugars and other substances that can promote mold growth.

Self-treatment based on suspected diagnosis without consulting a doctor often leads to incorrect treatment. Many women think they have a yeast infection when it's something else, or vice versa. Ignoring complaints in the hope that they will go away on their own rarely works. Sexually transmitted diseases, in particular, do not go away on their own and can lead to serious complications if treatment is delayed. Treating yourself alone while your partner is not being treated for a sexually transmitted infection can be pointless due to reinfection.

How do I know what type of infection I have?

The symptoms often provide indications, but you can only know for sure by an examination with a doctor. White, friable discharge with itching usually indicates mold, gray discharge with a fishy smell indicates bacterial vaginosis, and yellow abundant discharge may indicate a sexually transmitted infection. However, self-diagnosis is unreliable, so consult your doctor if in doubt.

Can I get vaginal inflammation from public toilets or swimming pools?

No, you cannot contract vaginal inflammation from toilet seats or swimming pools. The microorganisms that cause vaginal infections do not survive outside the body on these surfaces. Sexually transmitted infections are only transmitted through direct sexual contact with infected mucous membranes.

Can men also have symptoms?

In fungal infections and bacterial vaginosis, male partners usually have no symptoms and do not need treatment. In the case of sexually transmitted diseases such as trichomonas or chlamydia, partners should always be co-treated, even if they have no symptoms.

Why do I keep getting recurring infections?

Recurrent vaginal infections can have various causes. Diabetes, the use of antibiotics for other conditions, hormonal fluctuations, a weakened immune system, or not consistently following preventive measures can play a role. An untreated partner can also be a carrier of an infection. Discuss recurring symptoms with your doctor.

Is it normal to have some separation all the time?

Yes, it's completely normal to have some separation on a daily basis. Healthy vaginal discharge is clear to milky white in color, has no strong odor, and does not cause itching or irritation. The amount may vary throughout the menstrual cycle. Only when the discharge changes color, smell or consistency, or when symptoms are added, is there reason for investigation.

Can I have sex during treatment?

This depends on the type of infection and your own comfort. In the case of fungal infections or bacterial vaginosis, it is not strictly prohibited, but often unpleasant because of the symptoms. In case of sexually transmitted diseases, you should avoid having sex until both partners are fully treated to prevent re-infection.

Should pregnant women be treated differently?

Pregnant women with symptoms should always be treated, but the choice of medicine sometimes varies. Local treatment is often preferred over tablets that you take. Untreated vaginal infections during pregnancy can lead to premature birth or other complications. Always tell us that you are pregnant before starting treatment.

1. Skindr dermatologists
2. Gezondheidenwetenschap.be: Inflammation of the vagina and labia
3. Domus Medica: Guidelines for Vulvovaginal complaints for women with vulvovaginitis and vaginosis
4. Belgian Center for Pharmacotherapeutic Information (BCFI)
5. www.ebpnet.be