Discharge, itching and burning, oh my!

I remember hearing commercials on TV for Monistat as a young teenager and being underwhelmed. How bad could something be when the treatment featured active women and flowery pastel logos? Sometime later in medical school, I had my first experience with a yeast infection. Ouch! I was convinced that the intense itching and burning was a sign of something gone horribly wrong and was shocked when my gynecologist diagnosed me with “just” a yeast infection. Vulvovaginitis is uncomfortable and very common but can still be a mystery.

What is vulvovaginitis?

Vulvovaginitis is general term for a variety of conditions that affect the vulva (external genitalia) and/or vagina (internal cavity) and can be caused by infections, irritants or inflammation and disruption in the normal vaginal flora or “good” bacteria. Common causes of vulvovaginitis include Candida or yeast infections, bacterial vaginosis (BV), trichomonas-a sexually transmitted infection, irritation from soap or other products, retention of a foreign body and menopausal changes. Skin conditions and other sexually transmitted infections like chlamydia, gonorrhea or herpes, or even urinary tract infections can also present similarly. Symptoms include itching, burning, stinging, increased or altered discharge, painful intercourse, and an unpleasant odor.

What should I do if I have symptoms?

There are several over-the-counter treatments available, like vagisil, monistat and boric acid. However, without a clear diagnosis, those may not help, and could even worsen symptoms. Unless you have experience with have had multiple episodes diagnosed and know your symptoms well, I recommend making an appointment with a gynecologist. We can look for infectious causes like yeast and BV, check for sexually transmitted infections that can cause similar symptoms and rule out other causes like atrophy.

How can I treat vaginitis?

Depends on the cause. Oral and vaginal treatments are available for yeast and BV. Other conditions involve avoiding irritants or possibly use of a steroid to help with inflammation. Atrophy can be treated with hormonal formulations or moisturizers.

Are there ways to prevent it?

It’s important to generally practice good vulvovaginal hygiene, both for healing and to prevent it from coming back. First, I recommend absolutely no soap in the vagina, and preferably on the vulva. Warm water (not hot!) is fine alone. The vagina, like an oven, is self-cleaning. Furthermore, the vulva and vagina are both very sensitive. Soaps may disrupt the normal flora (good bacteria) and allow infections to flourish. Many soaps also have added odors and colorings that can cause inflammation. Douching can cause similar problems and can make it easier to contract certain sexually transmitted diseases. Avoiding daily pantyliner use and tight clothes and using cotton underwear helps. If underwear gets wet from seat or discharge, which is normal, changing to avoid exposure to moisture can help. Going commando at bed is good for vulvar health too. Sometimes irritation can occur from scented laundry detergents and switching to a free and clear variety can help. Women with frequent infections may benefit from avoiding shaving and waxing, or by limiting it to bikini lines. Finally, probiotics can be helpful although the evidence is not as strong. If you were to try a probiotic, make sure to choose one with one or more lactobacillus strains.

Itching and burning can make for an angry feeling vagina. If you’re suffering from symptoms like these, schedule an appointment to get checked out and feel yourse

Author

Dr. Jacqueline Kohl M.D. Jacqueline Elyse Kohl, MD, is an experienced obstetrician and gynecologist at Philadelphia Women's Health & Wellness in Philadelphia, Pennsylvania. Dr. Kohl earned her Bachelor of Arts in psychology in 2006 at the University of Pennsylvania. In 2011, she earned both her master’s degree in public health as well as her medical degree from Thomas Jefferson University in Philadelphia, Pennsylvania. Upon graduation, she began her residency in obstetrics and gynecology with Abington Jefferson Health, serving as Administrative Chief Resident from 2014 to 2015. After spending two years working at the Hanjani Institute for Gynecologic Oncology in Abington, Pennsylvania, Dr. Kohl developed a special interest in gynecologic surgery using a minimally invasive approach, which she carries into her medical practice today. Dr. Kohl has also taken her medical expertise abroad by assisting with labor and deliveries at a district hospital in Rwanda. Dr. Kohl is a member of the American College of Obstetrics and Gynecology.