Vaginitis is a typical women's condition that disrupts daily life through repeated recurrence. In most cases, frequent recurrence is not a matter of hygiene but a result of the cause not having been found.
Treatment differs according to the cause, from bacterial, candidal and trichomonal vaginitis to hormonal changes around menopause. This article sets out the tests and treatment for each cause, together with daily care.
To give the conclusion first, confirming the exact cause and combining the matching treatment with daily care is the most reliable way to reduce recurrence.
Why does vaginitis keep coming back?
Beneficial bacteria called lactobacilli inside the vagina maintain a mildly acidic environment and stop harmful bacteria from multiplying. When this balance breaks down, harmful bacteria overgrow and vaginitis recurs easily. Tight clothing, lack of sleep and stress are causes, as are blood sugar problems, long-term use of antibiotics and hormonal changes.
Trichomonal vaginitis is not caused by a fungus or bacteria but is a typical sexually transmitted infection, so the approach is different. If green discharge is accompanied by itching, swelling and a burning sensation, infection should be suspected. If the partner is not treated as well, it leads to ping-pong infection, so a woman who is sexually active needs her partner to be treated at the same time.
- Bacterial vaginitis — appears when the balance of lactobacilli breaks down and harmful bacteria overgrow
- Candidal vaginitis — occurs when a fungus that normally lives in the body increases sharply because of lowered immunity or hormonal changes
- Trichomonal vaginitis — a sexually transmitted infection, a type that requires the partner to be treated at the same time
Is the cause of vaginitis different after menopause?
A paper on atrophy of the vaginal lining caused by a lack of oestrogen after menopause explains that symptoms such as dryness, infection and atrophy commonly occur as the lining becomes thinner through the shortage of hormones. The change is like moist soil drying out and cracking in a drought. As female hormones are depleted, the protective barrier inside the vagina is destroyed, and chronic vaginitis follows.
In this case the female hormone itself is the cause, so treatment that only controls the inflammation is not enough, and the root of the problem, the hormone deficiency, needs to be addressed as well. The paper states that oestrogen preparations relieve the symptoms, and that non-hormonal moisturisers can be a useful alternative when the atrophy symptoms are mild or when a woman feels uneasy about hormonal medication.
What tests and daily care are needed to prevent recurrence?
A careful examination of vaginitis does not stop at checking the inflammation of the lining, because if it is left untreated it can become an ascending infection and spread to the cervix, the lining of the uterus and the fallopian tubes. The first step is not to finish with a discharge and bacterial test alone but, if necessary, to go on to an STD test that checks for sexually transmitted infection, and to set a treatment plan that matches the cause.
When vaginitis appears because the environment has broken down, as with the bacterial and candidal types, daily care can also reduce recurrence considerably. The basic habits are avoiding tight clothing, choosing breathable cotton underwear, and managing sleep and stress. Excessive washing dries out the lining and should be avoided, and after a period it is safer to keep the area mildly acidic.
- Discharge and bacterial test — tells whether the vaginitis is bacterial or candidal, so that the ingredient of the medicine can be matched to the organism causing it
- STD test — carried out together when a sexually transmitted infection such as trichomonas is suspected
- Cotton underwear and stress management — ventilation and looking after general condition help keep the balance inside the vagina from breaking down
