Bacterial Vaginosis

Vaginal Infections (Vaginitis)
A Guide for Teens

Have you heard about bacterial vaginosis? How about yeast infections? Do you know about normal vaginal discharge? While most women have heard about yeast infections, many women have not heard about or do not know much about bacterial vaginosis. Vaginal infections happen to women of all ages, to sexually active women and to women who aren't sexually active. Most women have a vaginal infection at least one time during their lives. Vaginal infections are actually the number one reason that adult women see their health care providers.

Leukorrhea (what normal discharge looks like under a microscope)
 

What is normal discharge?

Most girls notice a yellow or white stain on their underwear after they go through puberty. This is a normal fluid that helps clean and moisten your vagina. You are completely healthy and normal if your discharge is cloudy white has no odor or has a slightly salty odor increases and become "stringy" (like egg whites) during the middle of your menstrual cycle when you are ovulating

If you find that your normal discharge is annoying, you can wear panty liners/shields on your underwear. Also, to keep your vaginal discharge under control, make sure you wear cotton underwear (which absorbs moisture and lets air circulate). Take daily showers or baths and make sure that you wash outside your vaginal area every day with mild soap, and then rinse and dry yourself. Don't use deodorized panty liners or deodorant sprays in your vaginal area.

If your discharge changes, it may be a sign that you have a vaginal infection and you need to see your health care provider.

What is a vaginal infection?

A vaginal infection is known medically as "vaginitis." The 3 most common causes of vaginal infections are yeast infections, bacterial vaginosis, and trichomoniasis. Vaginal discharge may also occur if you have an infection in your cervix with gonorrhea or chlamydia. There are other causes of vaginal infections that are less common. Each type of vaginitis is caused by a different type of germ or organism, so each type must be treated differently.

What are the signs/symptoms of a vaginal infection?

If you have a vaginal infection, you may have any of the following:

• Vaginal odor

• Vaginal itching

• Vaginal burning

• Pain or irritation with urination or sexual intercourse

• Discharge different than normal

However, some women may not have any symptoms. Some women may not even notice any of these symptoms if they aren't too bad. A health care provider may notice signs of a vaginal infection, such as discharge or an odor, during a gynecologic examination and then may do a test of the vaginal fluid to see if an infection is present. It is important to have regular checkups with a health care provider so if you miss something about your health, he/she may discover it.

What do I do if I think I have a vaginal infection?

If you have any of the symptoms of a vaginal infection, you should see your health care provider right away. Each type of vaginal infection has different symptoms, so you may think you know what type of vaginal infection you have. However, you may confuse the symptoms since sometimes the outward symptoms (symptoms you are able to notice) of vaginal infections can appear the same. Sometimes you can have more than one type of vaginal infection at a time. It's also a good idea to go your health care provider if you notice symptoms of a vaginal infection, because you might have something more serious, like a sexually transmitted disease. It is possible to confuse vaginal infections with the STDs gonorrhea or herpes, since they can have similar symptoms to vaginal infections. Only health care providers can find out if you definitely have a vaginal infection, and if you do, exactly what type you have. You should be completely honest with your health care provider about what symptoms you have, such as odor, burning, or strange vaginal discharge, even if it is embarrassing. This way, your health care provider can make a correct diagnosis as to what type of vaginal infection you have. This is very important, because how you treat a vaginal infection depends on what type of vaginal infection you have.

For example, anti-yeast medications only help to cure yeast infections. They do not work against other kinds of vaginal infections, like bacterial vaginosis, that need prescription medications. Also, if you use anti-yeast medications when you actually have bacterial vaginosis, it may make if harder for your health care provider to give you a correct diagnosis.

Once your health care provider gives you a diagnosis, he/she can then give you medications or a prescription for medications to fight the infections. There are also medications for yeast infections that you can buy in drugstores without a prescription.

Can I douche if I have a vaginal infection?

You should never douche! Douching can cause infections by changing the normal balance of organisms in your vagina. Douching can also make an infection worse if you already have one, push the infection up into your reproductive area, or hide symptoms of a vaginal infection so it is harder to diagnose it and treat it. Other things that can cause vaginal infections are scented tampons, deodorant spray, and harsh soaps. You do not need any of these things to clean your vagina. Your vagina cleans itself best when you don't use any of these things.

How can a health care provider definitely tell if I have a vaginal infection?

Your health care provider will use a cotton swab to take a sample of your vaginal discharge for culture and sensitivity and do a vaginal exam with a speculum (a metal or plastic instrument inserted into your vagina and then opened up in order to get a better look at your vagina and cervix). Ask your health care provider which is best for you to find out if you have a vaginal infection. The tests are very simple and quick.

Does my health care provider check to see if I have a vaginal infection when he/she does my Pap smear?

An annual Pap smear is very important to see if there are changes in the cells of your cervix that can lead to cervical cancer. If the outward symptoms, like discharge or odor, are obvious enough, your health care provider will do some tests to see if you do have a vaginal infection. You need to make sure to tell your health care provider if you are having some symptoms of a vaginal infection.

What can I do to prevent vaginal infections?

The best way to prevent vaginal infections is to practice good feminine hygiene. Vaginal infections can happen more than once. You should always follow this advice:

• Keep your vaginal area clean and dry. You should wash outside your vaginal area every day with mild soap, and then rinse and dry yourself well.

• Do not douche. Douching can upset the normal balance of organisms in your vagina, which can cause a vaginal infection, make an infection worse, or spread the infection further up into your reproductive area (into your uterus or fallopian tubes).

• Do not use perfumed soaps, perfumed bubble bath or gel, scented tampons, vaginal powders, or vaginal deodorant sprays. They can irritate your vagina and cause a vaginal infection. IF your vaginal area is already irritated, you should not use scented toilet paper, spermicides, or harsh soaps.

• Make sure you wipe yourself from front to back after going to the bathroom, so that the bacteria normally present in your rectum doesn't get spread to your vaginal area.

• Don't wear tight or damp clothing, because they can keep moisture in and irritate your vagina. This can cause bad bacteria to grow. If you do have to wear tight clothing, don't wear it for a long time.

• Wear white cotton underwear. Avoid nylon and lycra. Cotton helps to absorb moisture and allows air to circulate. Never wear pantyhose without wearing cotton underwear underneath.

• Practice safer sex. You shouldn't have sex with someone with a sexually transmitted disease. But no matter what, you should always use latex (or polyurethane) condoms to lessen your chance of getting sexually transmitted diseases.

• Keep your stress level down.

• If you use diaphragms, cervical caps, or any medication applicators, you need to make sure you clean them with warm water and soap and dry them well.

Vaginal Yeast Infections (Candidiasis)

You probably have heard a lot about yeast infections because of all the ads on TV and in magazines. Most women get at least one yeast infection during their lifetime. Some women have many yeast infections. Women of all ages can get yeast infections.

Candida (what yeast looks like under a microscope)

What causes yeast infections?

Yeast infections are caused by an overgrowth of a type of fungus called Candida, also known as yeast. Small amounts of yeast and other organisms are normally found in your vagina, as well as in your mouth and digestive tract. Yeast infections occur when the balance of organisms in your vagina is upset and the amount of yeast in your vagina overgrows, causing an infection. Yeast infections are most likely to act up just before or just after your menstrual period. Different things can change this balance of organisms in your vagina and include:

• Antibiotics (for acne, throat, and ear infections or even vaginal infections) because they can kill the normal bacteria in your vagina and let the yeast grow

• Being overweight

• Diabetes

• Pregnancy

• HIV infection

• Steroids

• Poor feminine hygiene

• Too much exposure to moisture (occurs a lot when there is an increase in temperature or humidity, especially in the summer)

• Tight underwear made of material like nylon or lycra that traps moisture and heat (you should wear cotton underwear because it absorbs moisture better).

What are the signs/symptoms of a yeast infection?

The outward signs of a yeast infection may include vaginal discharge that is thicker than normal and is white and curd-like (almost like cottage cheese). The discharge will be odorless. Other signs are itching, burning, redness, and irritation of the vaginal area. Severe yeast infections may cause swelling of the lips of the vagina. Sometimes, women have painful and/or frequent urination because of inflammation of the urinary opening.

Sexual intercourse may also be painful for women because of inflammation of the vagina.

What serious health problems can yeast infections cause?

Yeast infections are not known to cause any serious health problems. But the yeast infection itself can be very unpleasant, so you want to get it diagnosed and treated as soon as possible.

Is there anything else I can do to prevent yeast infections that is not in the above list?

It is possible that eating one cup of yogurt (which contains acidophilus bacteria) a day is helpful in preventing yeast infections. However, realize that eating yogurt alone will not cure or prevent vaginal yeast infections.

If you have to take antibiotics and are getting lots of yeast infections, talk to your health care provider about using anti-yeast cream.

What if I get yeast infections all the time?

Some women get yeast infections every month around the time of their menstrual periods, because of changes in the pH of the vagina. If you have this problem, definitely talk to your health care provider. He/she may tell you that you need to self-treat yourself every month before you get the yeast infection, so you can stop the symptoms from developing. This means that you will need to use anti-yeast medication that you buy in a drugstore without a prescription. Or you may be told that you need to take or use oral pills or vaginal creams for longer. But do not start self-treating yourself until your health care provider tells you.

Getting yeast infections every month could also mean that you have a more serious problem, like diabetes. So it's very important to talk with your health care provider if you have this problem!

Bacterial Vaginosis

Bacterial vaginosis is the most common type of vaginal infection, although you may not have heard as much about it as you have heard about yeast infections. Bacterial vaginosis can also be the most serious type of vaginal infection.

Clue cells of baterial vaginosis (how they look under the microscope)

What causes bacterial vaginosis?

Bacterial vaginosis is caused by an overgrowth in your vagina of anaerobic bacteria (meaning that they don't need any oxygen to survive or grow) and an organism called Gardnerella. Small amounts of these anaerobic bacteria and Gardnerella can normally be found in your vagina. Bacterial vaginosis occurs when the balance of organisms in your vagina is upset and the anaerobic bacteria and Gardnerella overgrow. The good, protective bacteria Lactobacilli is then outnumbered and is not able to do its normal job, which is to produce a natural disinfectant (like hydrogen peroxide) which helps keep organisms at the normal, healthy balance in your vagina. An infection then occurs.

The exact reasons that bacteria overgrow are not known. It is not clear if bacterial vaginosis is sexually transmitted, but it is more common in women with multiple sexual partners. Many times, bacterial vaginosis develops after sexual intercourse with a new partner. However, women who are not sexually active can also get bacterial vaginosis. It is also possible that douching, a change in sexual partners, multiple sexual partners, and poor feminine hygiene may increase your chances of getting bacterial vaginosis.

What are the signs/symptoms of bacterial vaginosis?

The outward signs of bacterial vaginosis may include a foul or fishy vaginal odor and a clear, milky-white, or gray vaginal discharge. The discharge may be light or heavy. The odor may get worse around the time of menstruation or after unprotected sexual intercourse. When semen (male sperm) mixes with vaginal secretions, the odor becomes stronger. The vagina may also be itchy and/or may burn.

However, many women have bacterial vaginosis but don't have any outward symptoms. The health care provider may notice vaginal discharge or odor during a physical examination and do a test of the vaginal fluid and then recommend treatment. So always get regular checkups with a health care provider so you catch and treat bacterial vaginosis.

How can a health care provider definitely tell if I have bacterial vaginosis?

A health care provider will use a cotton swab to take a sample of your vaginal discharge. He/she can then measure the acidity of the discharge with pH paper. If your vagina is less acid than it should be (pH of more than 4.5), this is a sign that you may have bacterial vaginosis. Your health care provider can look at the sample under a microscope. If the normal bacteria (lactobacilli) are not there, or if numerous "clue" cells (cells from the vaginal lining that are coated with vaginosis bacteria) are present, then you have bacterial vaginosis.

Trichomoniasis (Trichomonal Vaginitis)

Trichomoniasis is another common form of vaginitis. It occurs in both adolescents and adults.

Trichomonas (how it looks under a microscope)

 What causes trichomoniasis?

Trichomoniasis is caused by a single-cell parasite called a trichomonad. Unlike yeast infections, you get trichomoniasis through sexual intercourse, so it is a sexually transmitted disease. Trichomoniasis lives and multiplies in men but hardly ever causes symptoms in men. Therefore, women are often continuously reinfected by their partner since they are not aware that their sexual partner is infected. Women may not know they have trichomoniasis for days or months because the parasite can live inside the woman without causing any symptoms. Then suddenly, the parasite rapidly multiplies and causes very unpleasant symptoms. The parasite affects the vagina, urethra (the canal that carries urine from the bladder to outside the body), and bladder (a sac where urine is held) of women. Since the parasite lives in both males and females, both sexual partners need treatment.

If a woman has more than one sexual partner, her chance of getting trichomoniasis is much higher. Very rarely, the parasite can be passed on by wet towels, washcloths, and bathing suits.

What are some signs/symptoms of trichomoniasis

The outward signs of trichomoniasis may include a yellow-gray-green, frothy vaginal discharge with a foul or fishy odor. The vagina may be sore and red and may burn and itch. It may be painful to urinate or have sexual intercourse. However, some women with trichomoniasis may not have any symptoms.

How can a health care provider definitely tell if I have trichomoniasis

A health care provider will use a cotton swab to take a sample of your vaginal discharge and do some simple tests on it. Your health care provider knows that you have trichomoniasis if your vaginal pH level is higher (less acidic) than 4.5, and if the trichomonad parasite can be seen under the microscope. Sometimes, a health care provider can diagnose you with trichomoniasis by a Pap smear or culture.

Other Causes of Vaginal Infections

There are other causes of vaginal infections besides the 3 most common causes, yeast infections, bacterial vaginosis, and trichomoniasis. These causes may include sexually transmitted diseases (STDs), a tampon you left in by accident, a congenital (something you have since birth) vaginal or uterus problem (very rare), or an allergy to or irritation from:

• Spermicides

• Vaginal hygiene products

• Detergents

• Fabric softeners

These products can cause irritation to the vagina. But when a health care provider does tests on your vaginal discharge, he/she can figure out if your infection is one of the 3 more common ones or is different. If it's different, your health care provider will have to treat it depending on what caused it. So you should always see your health care provider when you notice symptoms of a vaginal infection to make sure that you get it diagnosed and treated correctly!

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