Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms. Symproms vary among particular types of vaginitis, with some overlap:
- Vaginal discharge and odor that usually has an unpleasant odor, although 50% to 75% of women with the condition experience no symptoms. Discharge is generally grayish-white but can be of any color or consistency.
- Normal discharge is common when estrogen levels are high. Normal vaginal discharge is commonly milky white or mucoid, odorless, and nonirritating.
- Slight bleeding often occurs when estrogen levels abruptly decrease
- Discharge due to vaginitis is accompanied by pruritus (itching), vaginal soreness / redness from inflammation, and sometimes dysuria (burning, painful urination) or mild bleeding. Itching may interfere with sleep. Painful intercourse may also occur.
- In atrophic vaginitis. Discharge is scant, dyspareunia is common, and vaginal tissue appears thin and dry. Atrophic vaginitis is an inflammation of the vagina (and outer urinary tract) due to the thinning / shrinking of the tissues and decreased lubrication -all commonly due to lack of estrogen, which happens naturally during perimenopause and more so in post-menopause
In women of reproductive age. Vaginitis is usually infectious. The most common types are bacterial vaginosis, candidal vaginitis and trichomonal vaginitis (which is sexually transmitted). Normally in women of reproductive age:
- Lactobacilli are the predominant constituent of normal vaginal flora . Their c olonization keeps vaginal pH in the normal acidic range (3.8 - 4.2), thereby preventing overgrowth of pathogenic bacteria.
- High estrogen levels maintain vaginal thickness, bolstering local defenses
- Factors that predispose to overgrowth of bacterial vaginal pathogens. May include the following:
• An alkaline vaginal pH due to menstrual blood, semen, or a decrease in lactobacilli
• Poor hygiene
• Frequent douching
- Usually, a marked decrease in estrogen causes vaginal thinning, increasing vulnerability to infection and inflammation. Some treatments (eg, oophorectomy, pelvic radiation, certain chemotherapy drugs) result in loss of estrogen. Decreased estrogen predisposes to atrophic vaginitis.
- Poor hygiene. Can lead to chronic vulvar inflammation due to chemical irritation from urine or feces or due to nonspecific infection. (E.g. in patients who are incontinent or bedridden)
- Bacterial vaginosis, candidal vaginitis, and trichomonal vaginitis are uncommon among postmenopausal women. May occur in those with risk factors.
In women of all ages :
- Conditions that predispose to vaginal or vulvar infection include :
• Fistulas between the intestine and genital tract - allow intestinal flora to seed the genital tract
• Pelvic radiation or tumors - which break down tissue and thus compromise normal host defenses
- Noninfectious vulvitis accounts for up to 30% of vulvovaginitis cases. Possibly resulting from:
• Hypersensitivity or irritant reactions. To hygiene sprays or perfumes, menstrual pads, laundry soaps, bleaches, fabric softeners, fabric dyes, synthetic fibers, bathwater additives, toilet tissue, or, occasionally, spermicides, vaginal lubricants or creams, latex condoms, vaginal contraceptive rings, or diaphragms
