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Vaginitis in Adolescents

What is vaginitis?

Vaginitis refers to any inflammation or infection of the vagina. This is a common gynecological problem found in females of all ages, with one-third of females having at least 1 form of vaginitis at some time during their lives. When the walls of the vagina become inflamed, because some irritant has disturbed the balance of the vaginal area, vaginitis can happen.

What causes vaginitis?

Bacteria, yeast, viruses, or chemicals in creams or sprays, or even clothing can cause vaginitis. Sometimes, vaginitis happens from organisms that are passed between sexual partners. In addition, the vaginal environment is influenced by a number of different factors. These include a female's health, her personal hygiene, medicines, hormones (particularly estrogen), and the health of her sexual partner. A disturbance in any of these factors can trigger vaginitis.

What are the most common types of vaginitis?

The following are the most common types of vaginitis:

  • Candida or "yeast" infection

  • Bacterial vaginosis

  • Trichomoniasis vaginitis

  • Viral vaginitis

  • Noninfectious vaginitis

Each of these types of infection has a different cause and can present different symptoms. This makes diagnosis often complicated. In addition, more than 1 type of vaginitis may be present at the same time, with or without symptoms being present.

There are other causes of vaginal discharge that should be considered. These include gonorrhea and chlamydia. However, these organisms do not infect the vagina directly. If left untreated, gonococcal and chlamydial infections can lead to serious conditions, such as PID. PID increases a female’s risk of infertility, pelvic adhesions, chronic pelvic pain, and ectopic (tubal) pregnancy. Chlamydia is 1 of the most common sexually transmitted diseases in the United States. It often goes undiagnosed.

What is candida or "yeast" infections?

Yeast infections, as they are commonly called, are caused by 1 of the many species of fungus known as candida, which normally live in the vagina in small numbers. Candida can also be present in the mouth and digestive tract in both males and females.

Yeast is normally present and well-balanced in the vagina. Infection happens when something in a female's system upsets this normal balance. For example, an antibiotic to treat another infection may upset this balance. In this case, the antibiotic kills the bacteria that normally protects and balances the yeast in the vagina. In turn, the yeast overgrows, causing an infection. Other factors that can cause this imbalance to happen include pregnancy, which changes hormone levels. Also, diabetes, which allows too much sugar in the urine and vagina, can be a factor.

What are the symptoms of a vaginal candida infection?

The following are the most common symptoms of a candida infection. However, each adolescent may experience symptoms differently. Symptoms may include:

  • A thick, white, cottage cheese-like vaginal discharge. It is watery and usually odorless

  • Itching and redness of the vulva and vagina

  • Pain with urination or sex

The symptoms of a vaginal candida infection may resemble other conditions or medical problems. Always talk with your health care provider for a diagnosis.

Who is at risk for vaginal candida infections?

While any female can develop a yeast infection, the following females may be at an increased risk for the condition:

  • Females who have had a recent course of antibiotics

  • Females who are pregnant

  • Females who have diabetes that is not well-controlled

  • Women with HIV

  • Females who are using an immunosuppressant medicine

  • Females who are using high-estrogen contraceptives

  • Females who are undergoing corticosteroid therapy. This slows the immune system.

How is a vaginal candida infection diagnosed?

In addition to a complete medical history and physical and pelvic exam, diagnostic procedures for vaginal candida infections often include a microscopic exam of the vaginal discharge.

Treatment for vaginal candida infections

Specific treatment for candida will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Severity of the symptoms

  • Your tolerance for specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment for candida may include:

  • Antifungal vaginal creams and suppositories

  • Vaginal tablets

  • Oral antifungal medicines 

What is bacterial vaginosis?

Yeast infections are the most commonly discussed vaginal infection. And bacterial vaginosis is actually the most common type of vaginitis in females of reproductive age. This infection is caused by bacteria, not yeast. With a bacterial vaginosis infection, certain species of normal vaginal bacteria grow out of control and trigger inflammation. The cause of bacterial vaginosis is not known.

What are the symptoms of bacterial vaginosis?

The following are the most common symptoms of bacterial vaginosis. However, each adolescent may experience symptoms differently. Symptoms may include:

  • A milky, thin discharge at times, or a heavy, gray, and sometimes green, discharge

  • "Fishy" odor of discharge

The symptoms of bacterial vaginosis may resemble other conditions. Always talk with your health care provider for a diagnosis.

Treatment for bacterial vaginosis

Specific treatment for bacterial vaginosis will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Severity of the symptoms

  • Your tolerance for specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Bacterial vaginosis is caused by bacteria. It is generally treated with antibiotics.

What is trichomoniasis?

Trichomoniasis, trichomonas, or trich as it is commonly called, is a sexually transmitted infection. It is caused by a 1-celled parasite called Trichomonas vaginalis. This parasite passes between partners during sexual intercourse. Since most males do not present symptoms with trichomoniasis, the infection is often not diagnosed until the female develops symptoms of vaginitis.

What are the symptoms of trichomoniasis?

The following are the most common symptoms of trichomoniasis. However, each adolescent may experience symptoms differently. Symptoms may include:

  • A frothy, often musty-smelling, greenish-yellow discharge

  • Itching or burning in and around the vagina and vulva

  • Swelling or redness at the opening of the vagina

  • Light bleeding, especially after intercourse

  • Burning during urination

  • Discomfort in the lower abdomen

  • Pain during intercourse

Some females with trichomoniasis have no symptoms. The symptoms of trichomoniasis may resemble other conditions or medical problems. Always talk with your health care provider for a diagnosis.

Treatment for trichomoniasis

Specific treatment for trichomoniasis will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Severity of the symptoms

  • Your tolerance for specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Both partners must be treated for trichomoniasis to avoid reinfection. Treatment generally involves taking oral antibiotics. If a female has more than 1 sexual partner, each partner (and any of their other partners) should also be treated.

What is viral vaginitis?

Viruses are a common cause of vaginitis, with most being spread through sexual contact. One type of virus that causes viral vaginitis is the herpes simplex virus (HSV, or simply herpes). Its primary symptom is pain in the genital area associated with lesions and sores. These sores are generally visible on the vulva, or vagina, but occasionally are inside the vagina. They can only be found during a pelvic exam. Often stress or emotional situations can be a factor in triggering an outbreak of herpes.

Another source of viral vaginitis is the human papillomavirus (HPV), a virus that is also transmitted through sexual contact. HPV is the main cause of cervical cancer in women. This virus also causes painful warts to grow on the vagina, rectum, vulva, or groin. However, visible warts are not always present. The virus is generally found by a test for HPV done with a Pap test.

Two HPV vaccines are effective in preventing infection by the particular strains of HPV that cause most cervical cancers. But they do not treat existing HPV infection or genital warts. One of the vaccines also is effective against genital warts as well as some cancers of the vulva, vagina, and anus. Both vaccines are approved for use in females between the ages of 9 and 26. One of the 2 vaccines is available for boys and men, ages 9 through 26, and protects against most genital warts. The vaccines are given as a 3-dose series. 

What is noninfectious vaginitis?

Noninfectious vaginitis usually refers to vaginal irritation without an infection being present. Most often, this is caused by an allergic reaction to, or irritation from, vaginal sprays, douches, or spermicidal products. Noninfectious vaginitis may be also be caused by sensitivity to perfumed soaps, detergents, or fabric softeners.

What are the symptoms of noninfectious vaginitis?

The following are the most common symptoms of noninfectious vaginitis. However, each adolescent may experience symptoms differently. Symptoms may include:

  • Vaginal itching

  • Vaginal burning

  • Vaginal discharge

  • Pelvic pain (particularly during intercourse)

The symptoms of noninfectious vaginitis may resemble other conditions or medical problems. Always talk with your health care provider for a diagnosis.

Treatment for noninfectious vaginitis

Specific treatment for noninfectious vaginitis will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Severity of the symptoms

  • Your tolerance for specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment for noninfectious vaginitis depends greatly on the cause. If the cause is a reaction to an irritant, the irritant should be avoided.