Vaginitis (inflammation of the vagina)
Vaginitis means inflammation of the vagina and the skin around it: itching, soreness, discharge that has changed, stinging when passing urine or during sex.
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Medicines commonly prescribed for Vaginitis (inflammation of the vagina)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: VAGINAL SUPPOSITORY/CAPSULE/TABLET, 100 mg clotrimazoleActive substance: clotrimazoleManufacturer: Bayer Hispania S.L.Prescription requiredDosage form: VAGINAL SUPPOSITORY/CAPSULE/TABLET, 500 mg/capsuleActive substance: clotrimazoleManufacturer: Bayer Hispania S.L.Prescription not requiredDosage form: VAGINAL SUPPOSITORY/CAPSULE/TABLET, 100 mg clotrimazoleActive substance: clotrimazoleManufacturer: Bayer Hispania S.L.Prescription not required
Vaginitis means inflammation of the vagina and the skin around it: itching, soreness, discharge that has changed, stinging when passing urine or during sex. The word looks like a diagnosis, but it is not really one. It describes what is happening; it does not answer why. Behind a picture that looks much the same each time lie several quite different causes, and they are treated in quite different ways — what clears one does nothing for another and sometimes makes it worse. So the useful part of this page is not the list of symptoms but the fork in the road.
What it feels like
The set of sensations is short and much the same for everyone: itching or soreness in the vagina and the skin around it; discharge that differs from your usual in colour, thickness or smell; dryness; a burning feeling when urine touches irritated skin; pain or discomfort during sex; sometimes light spotting of blood, and skin at the vaginal opening that is red, swollen or cracked.
All of them together is rare. Two or three is the usual pattern, and it is the combination rather than any single one that points somewhere. It is worth noticing whether there is a smell, when things get worse — before a period, after sex, after swimming, after a new shower gel — and whether this is the first time or a repeat. At an appointment those details are worth more than the most detailed account of "terrible itching": they shorten the route to the cause.
Three infections, treated three different ways
Most often one of three infectious situations lies behind the inflammation, and telling them apart matters because the medicine is not the same.
- Thrush, or candidiasis. A yeast that lives in small numbers in many women's vaginas and multiplies when the balance of the flora shifts — after a course of antibiotics, for instance. The discharge is thick, white and curd-like, usually without a smell; what dominates is intense itching and soreness, with the skin at the opening red and swollen. It is treated with antifungals, either as pessaries and creams or by mouth.
- Bacterial vaginosis. Not an infection you catch, but a shift in your own flora: fewer protective lactobacilli, more of other bacteria. The discharge is thin, even in texture, greyish or milky, and the giveaway is the smell, often described as fishy and stronger after sex and around a period. There may be no itching at all. Antifungals are useless here: what is needed is an antibiotic, local or by mouth.
- Trichomoniasis. A sexually transmitted infection. The discharge is heavy, yellow-green, sometimes frothy and unpleasant-smelling; there may be burning and pain on passing urine and during sex. It is treated with an antibiotic from a particular group, and on one non-negotiable condition: the partner is treated too, or it comes straight back. While you are there, a doctor will usually suggest testing for other sexually transmitted infections, because chlamydia and gonorrhoea often cause no discharge at all and show up only on a test.
When the cause is not an infection
Roughly a third of women who come in with these complaints have no infection at all, and need neither an antibiotic nor a thrush pessary.
- Atrophic vaginitis. After the menopause oestrogen falls, the lining thins, dries out and is irritated more easily. There is little or no discharge, but there is dryness, soreness, pain during sex, sometimes light bleeding afterwards, and cystitis tends to become more frequent. The same thing happens temporarily during breastfeeding and with some forms of contraception. Vaginal moisturisers and lubricants help here, and where symptoms are marked a doctor may prescribe local hormone treatment.
- Irritation and contact reaction. Soap and shower gel used "inside", intimate foams and deodorants, scented pads and wipes, washing powder and fabric conditioner, latex, spermicides, hair-removal products. This kind of inflammation settles by itself once the culprit is taken away, and settles for nothing else.
- Skin conditions. Eczema, psoriasis, lichen planus and above all lichen sclerosus can spend years passing for "chronic thrush". What should raise suspicion: persistent itching that does not respond to antifungals, whitened thickened patches, small splits in the skin, a change in the shape of the labia. This is recognised on examination and treated in an entirely different way.
- Something left inside. A forgotten tampon is the commonest reason for a sudden heavy discharge with a very strong, foul smell. It is an awkward situation but an everyday one, and it takes a minute to sort out at an appointment.
Why the "just in case" antifungal lets you down
The commonest mistake looks harmless: the itching feels familiar, so a thrush treatment goes into the basket at the chemist, because last time it worked. Sometimes it genuinely does. But studies comparing what women concluded themselves with what a laboratory swab showed keep finding the same thing: plenty of people get it wrong, and the error is especially common among those who have already been treating "thrush" on their own more than once.
The cost of getting it wrong is not the money but the time. Bacterial vaginosis, trichomoniasis, a skin condition and atrophy do not clear with an antifungal. Symptoms may dull for a while — pessaries are moisturising in themselves — and then return, so a second course begins, and a third, and it becomes normal to think "I'm always like this". Meanwhile the real cause stays untreated. There is a flip side too: using antifungals often and unnecessarily irritates the lining and keeps the inflammation going.
Hence a simple rule: once, with a familiar picture, is reasonable; if it has not worked, if it keeps coming back, if the picture has changed or a smell has appeared, you need to be examined. At the appointment a doctor or nurse looks at the skin and the lining, if necessary looks inside using a speculum, and takes a swab with a cotton bud. It is quick and should not hurt — if it does, or if you feel uneasy, ask them to stop, that is a perfectly normal thing to ask. The swab answers the question that cannot be settled from the outside: which cause this actually is. For a couple of days beforehand it is better not to use pessaries or creams and not to douche, or the picture will be blurred.
Everyday care: what helps and what only gets in the way
With irritation, and with a tendency to repeated episodes, half the improvement comes from what you stop doing.
What not to do. Do not douche: the vagina cleans itself, and flushing it washes out lactobacilli and directly raises the chance of bacterial vaginosis. Do not use soap or gel inside — warm water on the outside is enough. Avoid scented products: intimate deodorants, perfumed pads, wipes, bubble baths. Do not wear panty liners all the time: as an occasional measure they are fine, but day after day they create a damp, greenhouse-like environment and rub the skin. And do not try home remedies inside the vagina — bicarbonate of soda, yoghurt, honey, garlic, essential oils. They do not restore the flora; they burn the lining.
What does help. Wash the outside with warm water and dry thoroughly. Wear loose cotton underwear and wash it without fabric conditioner or fragrance. Do not sit around in a wet swimming costume or damp sports kit. Use lubricant during sex if you are dry, and a vaginal moisturiser if the dryness is constant. Use condoms with a new partner, and change tampons and pads on time. If episodes keep recurring, a two-line note each time — what happened, when, what you did and whether it helped — saves half an hour of questions at the appointment.
If you are pregnant
Pregnancy changes two things. First: inflammation and thrush are more common than usual because of the hormonal changes, and that on its own is not a sign that anything is going wrong. Second, and more important: the treatment is now chosen by a doctor, not at the pharmacy counter. Some of the medicines that are routine outside pregnancy are not used in this period, or are used only locally, and the decision also depends on how many weeks you are.
Bacterial vaginosis deserves a separate mention: in pregnancy it is treated even when it barely bothers you, because it is linked to complications of pregnancy. So discharge that has changed during pregnancy is not something to put up with, and not a reason to repeat last year's treatment on your own — it is something to raise with whoever is looking after your pregnancy. And any bleeding or lower abdominal pain in this period needs to be seen without waiting.
When to be seen urgently
Almost everything above can wait: book an appointment in the next few days and that is fine. But some signs should not be sat on.
See a doctor the same day if:
- you develop a temperature or shivering together with pain low in the abdomen — that can be pelvic inflammatory disease, which is treated straight away because, left to run, it damages the tubes;
- there is bleeding between periods, after sex, or after the menopause;
- the discharge is heavy with a very strong, foul smell;
- ulcers, blisters or painful sores appear on the labia or at the vaginal opening;
- the pain has become severe and makes walking or sitting difficult, or one labium is markedly swollen and red;
- the symptoms began after sex with a new partner — here it is worth not delaying, and both of you should be tested.
Vaginitis does not usually call for an ambulance. A different situation does: sudden, rapidly worsening pain low in the abdomen, especially with fainting, pallor or heavy bleeding. In Spain, Italy, Portugal, Poland and Ukraine the single number 112 is in use. Until you have been examined it is better not to have sex — if this is a sexually transmitted infection, your partner will get it too.
Online consultation
A subject that is awkward to say out loud lends itself well to talking at a distance: no journey, no shared waiting room, and time to think the questions through beforehand. The doctor will ask about the look of the discharge and any smell, about what you have already tried and how it went, about new hygiene products or washing powder, a change of partner, recent antibiotics, and where you are in life, from pregnancy to menopause.
What usually comes out of that conversation is the main thing: whether this is something to manage with home care and pharmacy products, or whether a swab is needed and which one. The doctor can say which tests are worth doing and how to prepare, go through the ingredients of your washing and hygiene products when irritation is suspected, and explain what to do about repeated episodes so that you stop going round the self-treatment loop. It is worth seeing the limit too: telling thrush from bacterial vaginosis or from a skin condition on the basis of a description is not possible — that takes an examination and a swab. And with a temperature and lower abdominal pain, with bleeding, or with ulcers, you need a doctor in person and the same day.
This material is for information only and does not replace medical advice.
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