Medicines for Vaginitis

What it is

Vaginitis is inflammation or irritation of the vagina, which can cause symptoms such as itching, soreness, discomfort, and changes in vaginal discharge. It is very common, and can affect women of any age. Vaginitis is a general term, and there are several common causes, the most frequent being: thrush (a common yeast infection, causing itching, soreness, and a thick white discharge); bacterial vaginosis (a common condition caused by a change in the balance of bacteria normally in the vagina, often causing a thin, greyish discharge with a distinctive fishy smell, and not usually much itching); and irritation (irritant or allergic vaginitis, for example from soaps, perfumed products, or other irritants). Other causes include some sexually transmitted infections (such as trichomoniasis), and, particularly around and after the menopause, thinning and dryness of the vaginal tissues due to lower oestrogen (which can cause soreness, dryness, and irritation). The symptoms of vaginitis depend on the cause but can include: vaginal itching, soreness, or irritation; a change in vaginal discharge (in amount, colour, consistency, or smell); discomfort or pain, including during sex or when passing urine; and redness or swelling. Because the different causes are treated differently, and because some causes are infections (including STIs), it is helpful to identify the cause — often this can be done from the symptoms, and sometimes tests (such as swabs) are used, particularly if the diagnosis is unclear, symptoms persist or recur, or an STI is possible. Most causes of vaginitis are common and treatable — for example, thrush with antifungal treatment, bacterial vaginosis with antibiotics, irritant causes by avoiding the irritant, and menopausal changes with moisturisers or oestrogen treatments. It is worth seeking advice (from a pharmacist, GP, or sexual health clinic) for symptoms, so the cause can be identified and treated, particularly if symptoms are new, persistent, recurrent, or if there is any concern. The key messages are that vaginitis is common inflammation or irritation of the vagina with several common, treatable causes (such as thrush, bacterial vaginosis, and irritation), and that identifying the cause allows the right treatment.

How it is treated

Vaginitis is managed by identifying the cause and treating it accordingly, and most causes are common and treatable; seeking advice helps get the right treatment, particularly for new, persistent, or recurrent symptoms. Because the causes are treated differently, identifying the cause is helpful — often this can be done from the pattern of symptoms (for example, itching and a thick white discharge suggesting thrush; a thin greyish discharge with a fishy smell suggesting bacterial vaginosis; soreness and dryness around the menopause suggesting vaginal changes from lower oestrogen), and sometimes tests (such as vaginal swabs) are used, particularly if the diagnosis is unclear, symptoms persist or keep coming back, an STI is possible, or during pregnancy. A pharmacist can advise on and treat some common causes (such as thrush), while a GP or sexual health clinic can assess and treat the range of causes and test where needed. Treatment depends on the cause: thrush is treated with antifungal medicines (as creams, pessaries, or tablets); bacterial vaginosis is treated with antibiotics (as tablets or vaginal treatments); irritant or allergic vaginitis is managed by identifying and avoiding the irritant (such as perfumed soaps, bubble baths, or other products) and soothing the skin; STIs (such as trichomoniasis) are treated with appropriate antibiotics, with partner treatment and STI testing as relevant; and vaginal dryness and thinning around the menopause are treated with vaginal moisturisers and lubricants and, where appropriate, vaginal oestrogen treatments. General measures can help and prevent some causes — such as avoiding perfumed soaps, bubble baths, and douching (washing inside the vagina), using plain water or gentle products to wash the external area, and avoiding irritants. For recurrent thrush or bacterial vaginosis, further assessment and management (including longer or preventive treatment) may be needed, and identifying any contributing factors helps. It is worth seeking advice for symptoms that are new, persistent, recurrent, severe, or if there is any concern (such as unusual bleeding, pain, or the possibility of an STI), so the cause can be identified and treated, and other conditions excluded. The reassuring messages are that vaginitis is very common and usually due to common, treatable causes (such as thrush, bacterial vaginosis, or irritation), that identifying the cause allows the right treatment, and that a pharmacist, GP, or sexual health clinic can help — so it is worth seeking advice rather than putting up with symptoms.