Also indexed as: Atrophic Vaginitis, Bacterial Vaginosis,
Gardnerella Infection, Hormone-Related Vaginitis, Irritant Vaginitis, Trichomoniasis,
Vulvovaginitis
Soothe the discomfort of vaginitis and get back to enjoying life.
First, uncover the cause. Then control the irritating symptoms. According to research or other
evidence, the following self-care steps may be helpful:
- Give yogurt a go
- Help prevent recurrences of bacterial or candidal vaginitis by
eating 5 ounces (113 grams) a day of yogurt containing live Lactobacillus
acidophilus, a friendly bacteria
- Try topical acidophilus
- To relieve symptoms, apply a daily topical preparation or a
suppository containing live Lactobacillus acidophilus for up to two weeks; for
prevention in those with recurrent infections, apply weekly
- Steer clear of irritants
- Reduce vaginal irritation by minimizing friction and reducing your
exposure to perfumes, spermicides, and other chemicals
- Get a checkup
- Visit your healthcare provider to find out if your vaginitis is
caused by a treatable medical condition
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full vaginitis article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About vaginitis
Vaginitis is inflammation of the vagina.
Vaginitis is responsible for an estimated 10% of all visits by women to their healthcare
practitioners. The three general causes of vaginitis are hormonal imbalance, irritation, and
infection. Hormone-related vaginitis includes the atrophic vaginitis generally found in postmenopausal or postpartum women and, occasionally, in young girls
before puberty. Irritant vaginitis can result from allergies or irritating substances. Infectious
vaginitis is most common in reproductive-age women and is generally caused by one of three
types of infections: bacterial vaginosis (BV), candidiasis (yeast infection), or trichomoniasis. A healthcare
professional should be consulted for the diagnosis and treatment of any vaginal infection.
Although it is a type of vaginitis, yeast infection is not discussed on this page. For
specific information on yeast infections (i.e., vaginitis caused by Candida
albicans), see the yeast infections
article.
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vaginitis
What are the symptoms?
Hormone-related vaginitis is marked by dryness, irritation, thinning of the vaginal mucous
membranes and painful intercourse. Irritant vaginitis is characterized by itching and
soreness. Infectious vaginitis also itches and typically includes vaginal discharge that
varies in color, consistency, and odor, depending upon the infectious organism. Discharge may
range from scant to thick and white and may or may not be accompanied by a strong odor.
Symptoms are often worse immediately after intercourse or the menstrual period.
Medical options
Over-the-counter drugs are available to treat vaginitis caused by candida. They include clotrimazole (Gyne-Lotrimin, Mycelex), miconazole (Monistat), and butoconazole (Mycelex-3). Irritant vaginitis can be
treated either by removal of the offending irritant or with an antihistamine agent, such as diphenhydramine (Benadryl).
Prescription drug therapy varies with the cause of the vaginitis. Hormone-related vaginitis
is commonly treated with estrogen replacement therapy, including conjugated estrogens (Premarin), estradiol (Estrace, Vagifem), and estropipate (Ogen). Bacterial vaginosis and
trichomoniasis are each commonly treated with
metronidazole (Flagyl). Butoconazole
(Gynezole-1) is prescribed to treat candida infections.
Dietary changes that may be helpful
Food allergies are believed to be a
contributory factor in some cases of recurrent irritant vaginitis.
In a controlled trial, women with recurrent BV or vaginal candidiasis ate 5 ounces (150
grams) of yogurt containing live Lactobacillus acidophilus daily.1
They had more than a 50% reduction in recurrences, while women who consumed pasteurized yogurt
that did not contain the bacteria had only a slight reduction.
In another study, women who ingested 45 grams of soy flour per day showed an improvement in the
estrogen effect on their vaginal tissue.2 That observation suggests that
supplementing with soy may be helpful for preventing or reversing atrophic vaginitis.
Lifestyle changes that may be helpful
For irritant vaginitis, minimizing friction and reducing exposure to perfumes, chemicals,
irritating lubricants, and spermicides can be beneficial.
Vitamins that may be helpful
Lactobacillus acidophilus is a
strain of friendly bacteria that is an integral part of normal vaginal flora. Lactobacilli
help maintain the vaginal microflora by preventing overgrowth of unfriendly bacteria and
Candida. Lactobacilli produce lactic acid, which acts like a natural antibiotic. These friendly bacteria also compete with
other organisms for the utilization of glucose. The production of lactic acid and hydrogen
peroxide by lactobacilli also helps to maintain the acidic pH needed for healthy vaginal flora
to thrive. Most of the research has used
yogurt containing live cultures of Lactobacillus acidophilus or the topical
application of such yogurt or Lactobacillus acidophilus into the vagina. The
effective amount of acidophilus depends on the strain used, as well as on the concentration of
viable organisms.
Vaginal application of a proprietary Lactobacillus acidophilus preparation may
help nonspecific vaginitis. In one trial, 80% of women with nonspecific vaginitis who used the
preparation were either cured or experienced marked improvement in symptoms.3 In
another trial, women who were predisposed to vaginal Candida infection because they were HIV-positive received either Lactobacillus
acidophilus vaginal suppositories, the
antifungal drug, clotrimazole (e.g., Gyne-Lotrimin®), or placebo weekly for 21
months.4 Compared to those receiving placebo, women receiving Lactobacillus
acidophilus suppositories had only half the risk of experiencing an episode of Candida
vaginitis—a result almost as good as that achieved with clotrimazole. In a preliminary
trial, women with vaginal Trichomonas infection received vaginal Lactobacillus
acidophilus suppositories for one year.5 Over 90% of them were reported to be
cured of their clinical symptoms in that time.
Some doctors recommend vitamin E (taken
orally, topically, or vaginally) for certain types of vaginitis. Vitamin E as a suppository in
the vagina or vitamin E oil can be used once or twice per day for 3 to 14 days to soothe the
mucous membranes of the vagina and vulva. Some doctors recommend vaginal administration of vitamin A to improve the integrity of the vaginal
tissue and to enhance the function of local immune cells. Vitamin A can be administered
vaginally by inserting a vitamin A capsule or using a prepared vitamin A suppository. Vitamin
A used this way can be irritating to local tissue, so it should not be used more than once per
day for up to seven consecutive days.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
In a double-blind, placebo-controlled trial, a cream containing neem seed extract, saponins of Sapindus
mukerossi (reetha), and quinine hydrochloride (5 ml applied vaginally once at bedtime)
eliminated all symptoms in 10 of 14 women with chlamydia compared with none of four women
given placebo cream.6 Neither cream was effective in women with trichomoniasis or
candidal vaginitis.
Topically applied tea tree oil has been
studied and used successfully as a topical treatment for Trichomonas,
Candida albicans, and other vaginal
infections.7 Tea tree oil must be diluted when used as a vaginal douche, and
should only be used for this purpose under the supervision of a healthcare practitioner. Some
physicians suggest using tea tree oil by mixing the full-strength oil with vitamin E oil in the proportion of 1/3 tea tree oil to
2/3 vitamin E oil. A tampon is saturated with this mixture or the mixture is put in a capsule
to be inserted in the vagina each day for a maximum of six weeks.
Teas of goldenseal, barberry, and echinacea are also sometimes used to treat infectious
vaginitis. Although all three plants are known to be antibacterial in the test tube, the
effectiveness of these herbs against vaginal infections has not been tested in humans. The
usual approach is to douche with one of these teas twice each day, using 1–2 tablespoons
(15–30 grams) of herb per pint of water. One to two pints (500–1,000 ml) are
usually enough for each douching session. Echinacea is also known to improve immune function in humans.8 In order to
increase resistance against infection, many doctors recommend oral use of the tincture or
alcohol-preserved fresh juice of echinacea (1 teaspoon (5 ml) three or more times per
day)—during all types of infection—to improve resistance.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
References:1. Shalev E, Battino S, Weiner E, et al. Ingestion of yogurt containing
Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent
Candidal vaginitis and bacterial vaginosis. Arch Fam Med 1996;5:593–6.
2. Wilcox G, Wahlqvist M, Burger H, et al. Oestrogenic effects of plant
foods in postmenopausal women. BMJ 1990;301:905–6.
3. Karkut G. Effect of lactobacillus immunotherapy on genital infections
in women. Geburtshilfe Frauenheilkd 1984;44:311–4 [in German].
4. Williams A, Yu C, Tashima K, et al. Weekly treatment for prophylaxis
of Candida vaginitis. Presentation. 7th Conference on Retroviruses and Opportunistic
infections. Foundation for Retrovirology and Human Health in collaboration with the (US)
National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and
Prevention. January 30–February 2, 2000.
5. Litschgi MS, Da Rugna D, Mladenovic D, Grcic R. Effectiveness of a
lactobacillus vaccine on Trichomonas infections in women. Preliminary results.
Fortschr Med 1980;98:1624–7 [in German.]
6. Mittal A, Kapur s, Garg S, et al. Clinical trial with Praneem
polyherbal cream in patients with abnormal vaginal discharge due to microbial infections.
Aust NZ J Obstet Gynaecol 1995;35:190–1.
7. Pena E. Melaleuca alternifolia oil: Its use for trichomonal vaginitis
and other vaginal infections. Obstet Gynecol 1962;19:793–5.
8. Melchart D, Linde K, Worku F, et al. Immunomodulation with
Echinacea—a systematic review of controlled clinical trials. Phytomedicine
1994;1:245–54.