Vaginitis: causes, symptoms, diagnosis and treatment

Causes and distinguishing types

Causes fall into infectious and noninfectious categories. The most frequent infectious causes are bacterial overgrowth, fungal infection (yeast), and parasitic infection. Bacterial vaginosis is the most common cause overall. Other common agents and contributors include Candida species and Trichomonas vaginalis. Noninfectious causes include irritant or allergic reactions (soaps, spermicides, fragrances), hormonal changes such as postmenopausal atrophy, foreign bodies, and skin conditions. Local symptoms such as itching, pain, and irritation of the vulva help direct evaluation.

Symptoms and clinical features

• Discharge: changes in color, amount or smell.
• Itch or burning: common with yeast and irritant causes (itching).
• Odor: an unpleasant or fishy smell is often reported (odor).
• Pain: discomfort with intercourse or urination (pain with sex).
• Redness or swelling: visible inflammation of the vulvovaginal area.

Diagnosis

Evaluation typically includes a pelvic exam, speculum inspection, assessment of vaginal pH, and microscopy of vaginal fluid. A simple bedside tests and laboratory assays—such as saline or potassium hydroxide microscopy, pH measurements, or nucleic acid tests—help distinguish bacterial vaginosis, candidiasis, and trichomoniasis. When available, clinicians may perform cultures or molecular tests for stubborn or recurrent cases. For more on typical diagnostic steps see diagnostic testing and practical guidance at clinical resources.

Treatment, prevention and when to seek care

Treatment targets the cause: antibiotics or topical agents for bacterial vaginosis, antifungal agents for yeast, and specific antiparasitic drugs for trichomoniasis; partner treatment is important for some sexually transmitted causes. Noninfectious vaginitis responds to removing irritants or addressing hormonal factors. Preventive measures include avoiding douching, scented products, and tight nonbreathable clothing, and using condoms to reduce sexually transmitted infections. Seek medical attention for severe pain, fever, pregnancy, abnormal bleeding, or symptoms that persist or recur despite treatment. Recurrent or complicated vaginitis may require specialist referral.

Distinguishing vaginitis from cervicitis or vulvitis and addressing sexual health, pregnancy implications, and appropriate partner management are important elements of care. For patient information and further reading see additional resources.