Vaginitis

The most common causes of vaginitis are bacterial vaginosis, candida (yeast) infection and trichomonas infection. They account for 90 percent of cases. Less common but significant causes of vaginitis are infections caused by sexually-transmitted organisms such as chlamydia, gonorrhoea and herpes.

Not all cases of vaginal discharge are due to infection. Vaginal discharge can be normal (‘physiological discharge’). It can also be caused by presence of foreign objects in the vagina, allergic reactions, cervical conditions and rarely genital tract cancer. In postmenopausal women, vaginal discharge is commonly due to atrophic changes (‘atrophic vaginitis’).

* Cervical ectropion is a condition in which the inner cervical cells are found on the outer part of the cervix.

The vaginal environment and physiological (‘normal’) vaginal discharge

The normal vaginal environment is a delicate ecosystem of ‘healthy’ bacteria and small amounts of candida (yeast). The normal pH of the vagina is usually acidic in nature. Lactobacillus is the main regulator of vaginal pH by making lactic acid. Maintaining the vaginal pH at an acidic level inhibits overgrowth of ‘healthy’ bacteria and yeast and prevents infections from bad bacteria and viruses.

Discharge flows from the vagina daily as the body’s way of maintaining a normal healthy environment. Normal physiological vaginal discharge consists of cervical and vaginal cells, bacteria, water, electrolytes and other chemicals. Normal discharge is usually clear or white, thick and mucouslike. There may be a slight odour. Vaginal discharge may become more noticeable near ovulation and in the week before the menstrual period.

The vaginal pH can change under the influence of various factors:

• Age
• Stress
• Diabetes
• Medical conditions which cause low immunity
• Hormonal changes (during the menstrual cycle, pregnancy, puberty, menopause)
• Birth control pills
• Intrauterine contraceptive devices
• Douching and other vaginal products
• Vaginal medications
• Antibiotics
• Foreign objects

Disturbance of the normal vaginal pH can alter the composition and balance of the vaginal ecosystem. This leads to overgrowth of ‘healthy’ organisms and infections from bad organisms, resulting in vaginitis.

How do I know if my vaginal discharge abnormal?

Although vaginal discharge can be physiological, it is advisable to seek medical advice under any of the following circumstances:

• Change in the nature of vaginal discharge – especially if it is foamy, greenish, foul-smelling or blood-stained;
• Other symptoms such as vaginal itch or discomfort, dysuria, dyspareunia, abnormal spotting, abnormal menstrual periods or abdominal pain;
• New sexual partner or more than one partner in the last year;
• Previous history of sexuallytransmitted disease or pelvic infection;
• Recent vaginal or caesarean birth or recent invasive gynaecological procedure e.g. abortion, insertion of an intrauterine device, in-vitro fertilisation etc.

What you can do to maintain a healthy vaginal environment
– Do’s and Don’ts