Introduction:

Vaginitis is a vaginal infection that disrupts the normal vaginal flora. Experts estimate that 40% of all types of vaginitis are caused by candida, a yeast like fungus. When it multiplies in the vaginal tract, the disorder is called vulvovaginitis. Women often refer to it as a "yeast infection." About 75% of women get candida vaginitis at some time in their lives. Vaginal candida does not generally occur in the absence of estrogen, so premenarchal girls and postmenopausal women not on estrogen replacement almost never develop vaginal yeast.

Signs and Symptoms:

• Itching in the vagina and vulva
• Vaginal discharge (small amounts are normal, however)
• Red, swollen, painful vaginal mucous membranes and external genitalia
• Satellite lesions (tender, red, pus filled bumps, which can spread to the thighs and anus)

What Causes It?:

Candida is a yeast like fungus that grows in the vagina. When there is too much, the fungus causes infection. The following increase your chance of getting a yeast infection:

• Antibiotics
• Pregnancy -- from increased heat, moisture, and hormonal shifts
• Diabetes
• Corticosteroid use
• Sexually transmitted diseases
• Human immunodeficiency virus (HIV) infection
• Birth control pills
• Obesity
• High sugar intake
• Wearing panty hose, tight clothing, or noncotton underwear

What to Expect at Your Provider's Office:

Your health care provider will give you a pelvic examination and swab your vagina to check for candida. You may also have a Pap smear. Some women have chronic yeast infections. If this happens, your health care provider may want to do additional tests.

Treatment Options:

Treatment Plan

Physicians usually recommend topical treatments before oral medications. For chronic infections, your health care provider may increase the dosage and length of treatment. If you have vaginitis, you should avoid excessive exertion and sweating, keep the vaginal area as dry as possible, and avoid sex until symptoms clear. Take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight fitting pants can help prevent infection.

Drug Therapies

Topical and oral therapies are equally effective.

Topical therapies (these may initially cause burning from inflammation):

• Polyenes (nystatin) -- one tablet twice a day for 2 weeks placed high in the vagina with applicator. This treatment is 70 - 80% effective and causes no side effects on other parts of the body.
• Azole derivatives such as imidazole (such as miconazole, butoconazole) and triazole (such as fluconazole, terconazole) -- vaginal cream 1 - 5 days, also may be used externally. This treatment is 85 - 90% effective and causes no side effects on other parts of the body.

Oral therapies:

• Fluconazole -- 75 - 92% effective. 150 mg once. This is often considered the treatment of choice. It should not be used during pregnancy. Appears to help HIV infected women.
• Ketoconazole -- 83% effective. 400 mg/day for 5 days, or for 2 weeks with recurring infection. Oral nystatin helps reduce intestinal problems.

Complementary and Alternative Therapies

Alternative therapies may help treat acute and chronic vaginitis. Always tell your health care provider about the herbs and supplements you are using. The following douches and suppositories should be discussed with your doctor to make sure they are not too irritating.

Douches:

Use only one of the following douches at one time. Do not douche during menstrual periods. For first time or acute infection try the vinegar douche or boric acid capsules. For chronic vaginitis, use the herbal combination douche. For recurrent vaginitis, use the Betadine douche. Stop douching if you are in pain or your symptoms get worse.

• White vinegar: 1 - 2 tablespoons to 1 pint of water. Douche daily for 10 - 14 days.
• Boric acid: One capsule (600 mg) inserted daily for 10 - 14 days. May cause irritation or problems from absorption into the bloodstream.
• Herbal combination: Mix equal parts of oregano leaf (Oreganum vulgare), goldenseal root (Hydrastis canadensis), and coneflower (Echinacea purpurea). Steep 1 heaping tablespoon of herbal mixture in 1 pint of water. Cool and douche daily for 10 - 14 days.
• Povidone iodine (Betadine): Douche with one part iodine to 100 parts water twice daily for 10 - 14 days. Prolonged use can suppress thyroid function.

Suppositories:

• Tea tree oil (Melaleuca alternifolia) vaginal suppository, insert one suppository vaginally daily, for symptoms of vaginitis. Ask your health care provider about the use of tea tree oil, as it can be irritating if not used properly.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy is present), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoon of oil 1 - 2 times daily, to help decrease inflammation and help with immunity. Cold water fish, such as salmon or halibut, are good sources. Fish oil supplements can increase the effects of certain blood thinning medications.
• Vitamin C, 500 - 1,000 mg 1 - 2 times daily, as an antioxidant, immune support and to protect the vaginal lining.
• Zinc lozenge, 1 lozenge 1 - 2 times daily, when needed for immune support during vaginitis outbreak. Do not exceed 45 mg of zinc daily.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate your probiotic supplements for best results.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily, for antibacterial, antifungal, and antiviral activity, and for immunity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted. Some herbs can interfere with medications so you should talk to your health care provider before beginning an herbal therapy.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for anticancer, immune and antibacterial or antifungal activity. Cat's claw can interact with many medications. Speak with your physician.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg 2 - 3 times daily, for detoxification support.
• Garlic (Allium sativum), standardized extract, 400 mg 2 - 3 times daily, for antifungal and immune activity. Garlic can have a blood thinning effect so talk to your doctor if you are taking blood thinning medications.

Homeopathy

Some of the most common remedies for vaginitis are listed below. Usually, the dose is 3 - 5 pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better.

• Calcarea carbonica for intense itching with thick white or yellowish discharge that is worse before you start your period
• Borax for burning pains with egg white colored discharge
• Sepia for burning pains with milky white discharge and pressure in vaginal area, especially if you feel depressed and irritable
• Graphites for backache with thin white discharge that is worse in the morning and when walking
• Arsenicum album for when you have burning, discharge
• Tea tree oil to help treat symptoms
• Homeopathic combinations are available as creams to apply vaginally

Acupuncture

Acupuncture may be helpful in improving immune function.

Following Up:

To prevent recurrence of infection, take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight fitting pants can help prevent infection. Recurrent signs and symptoms of vaginitis may be an indication of HSV-2. See your healthcare provider if you are suffering from recurrent infections.

Special Considerations:

Yeast infections occur twice as often during pregnancy. 

Alternative Names:

Vaginal inflammation