What Is Vaginal Irritation (Vaginitis)?

Vaginal irritation, known medically as vaginitis or vulvovaginitis, is inflammation of the vagina that makes tissues red, swollen, and painful. Vaginitis can also affect the external part of the genitals, also known as the vulva.

Bacteria or yeast in the vagina become imbalanced and can cause an infection. Hormonal changes and allergic reactions can also cause vaginal irritation. 

Vaginitis is common in people with female reproductive organs between 15-49 years old, which is considered reproductive age. Worldwide, an estimated 75% experience vaginitis at least once. Symptoms of vaginal irritation typically include itching, burning, abnormal discharge, and foul odor.

A healthcare provider like an obstetrician-gynecologist (OB-GYN) can often treat vaginal irritation after identifying the infection or irritant. However, people who have recurrent vaginal infections may experience vaginitis more frequently. In rare cases, people can experience chronic vaginitis.

Types of Vaginal Irritation 

Vaginal irritation may be categorized as an infection or condition. Types of vaginitis that irritate vaginal or vulval tissue include: 

• Bacterial vaginosis (BV): This common vaginal infection and irritation is caused by an imbalance of beneficial and harmful bacteria in the vagina. 
• Candida vulvovaginitis: Also called a vaginal yeast infection, this infection is caused by an overgrowth of Candida (a type of yeast) in the vagina.
• Trichomoniasis: This sexually transmitted infection (STI) is caused by the parasite Trichomonas vaginalis.
• Allergic vulvovaginitis: Vaginal irritation can be linked to a sensitivity or allergic reaction to products like vaginal sprays, spermicides, soaps, detergents, or fabric softeners.
• Atrophic vaginitis: This non-infectious vaginal irritation is caused by hormonal changes during breastfeeding or menopause that thin and dry the vaginal tissue. 
• Desquamative inflammatory vaginitis: This rare and chronic (long-term) form of vaginal irritation is caused by an unexplained decrease in beneficial bacteria and an increase in harmful bacteria during perimenopause (the transition from menstruating to menopause). 

Vaginal Irritation Symptoms 

Vaginal irritation symptoms depend on the type of vaginitis. However, vaginal irritation typically includes inflammation, discomfort, and abnormal discharge. If you have vaginal irritation, the vulva and entrance to your vagina usually appear red and swollen. 

You may also feel some discomfort and pain, such as a burning, soreness, or itching sensation. You may experience painful urination (dysuria) or pain before, during, or after sex (dyspareunia). Itching is common if you have a vaginal yeast infection, atrophic vaginitis, or allergic vulvovaginitis. However, you can experience itching with some bacterial vaginosis infections. Vaginal dryness is typically the main symptom of atrophic vaginitis and chronic vaginitis.  

Abnormal discharge—with or without odor—is also a common symptom of vaginal irritation. For example:

• Bacterial vaginosis can cause a thin white, gray, or greenish discharge with a strong fishy smell.
• Trichomoniasis can cause similar green-gray or yellow-gray discharge with a fish-like odor.
• Vaginal yeast infections cause thick, white discharge that often looks like cottage cheese.

You may also experience watery discharge with a yeast infection or notice a change in your typical discharge with atrophic and chronic vaginitis.

What Causes Vaginal Irritation? 

Vaginal irritation typically occurs when your vaginal microbiome—a delicate balance of naturally occurring yeast and bacteria—is disrupted. In some cases, vaginal irritation can also be caused by hormonal vaginal dryness, trichomoniasis (a parasitic STI), or directly irritating your vaginal tissue. 

A healthy vagina needs a balance of bacteria and yeast to maintain its moderately acidic pH—a measurement of a substance's acidity or basicity—and protect the vagina from infection. An imbalance of vaginal microorganisms, or vaginal dysbiosis, happens when yeast overgrows, beneficial bacteria are depleted, or harmful bacteria increases.

Situations that can disrupt bacteria and yeast in the vagina include:

• Taking antibiotics
• Douching
• Having unprotected sex
• Having multiple sex partners
• Pregnancy
• Having diabetes
• Having an intrauterine device (IUD)

Using products on or near your vagina that you're allergic or sensitive to can disrupt vaginal flora and dry the vaginal tissues. You can also experience irritation during breastfeeding and menopause as the drop in estrogen levels depletes lubricating vaginal moisture, causing vaginal dryness and irritation. 

How Is Vaginal Irritation Diagnosed?  

Seeing an obstetrician-gynecologist (OB-GYN)—a healthcare provider who specializes in the female reproductive system—can help diagnose the cause of your vaginal irritation. During your appointment, your provider will ask you about your medical history, sexual activity, and symptoms. They will then complete a pelvic exam to look at your vulva for swelling, redness, abnormal discharge, or sores.

During a pelvic exam, your OB-GYN will also feel your abdomen and insert lubricated, gloved fingers into your vagina to check for abnormalities inside. Sometimes they will use a tool called a speculum to gently widen your vagina for examination.

Your provider may also take a sample of your vaginal discharge and perform the following diagnostic tests: 

• Wet mount: Also called a vaginal smear, this test involves looking at a sample under a microscope for bacteria, yeast, abnormal cells, and other signs of infections. 
• STI screening: Your vaginal discharge will be tested for the presence of the trichomoniasis-causing parasite and other STIs. You may also give a urine sample to be tested for STIs.
• Vaginal pH test: Testing the pH of vaginal fluid can identify higher acidity to help diagnose bacterial vaginosis and vaginal dysbiosis (when used in combination with other tests).
• PCR test: This test checks samples for genetic material linked to harmful bacteria and abnormal cells. It may be used to identify desquamative inflammatory vaginitis.

A biopsy may be done for desquamative inflammatory vaginitis or other similar conditions. A biopsy is a procedure that removes a sample of cells or tissue so it can be examined under a microscope and tested, The lab will send the results to a pathologist.

Treatment for Vaginal Irritation

Treating vaginal irritation involves treating the underlying cause of your vaginal swelling, discomfort, redness, or other symptoms. If an infection is causing vaginal irritation, medication can typically cure the infection and relieve symptoms.

Bacterial vaginosis is treated with antibiotics like Flagyl (metronidazole) and Cleocin (clindamycin). You can take these medications orally or apply them as a cream or gel in your vagina. Trichomoniasis is also treated with the antibiotic metronidazole. Your sexual partner(s) must be treated to avoid spreading the infection back to you or onto others. 

Yeast infection treatments include over-the-counter (OTC) antifungal suppositories or creams that you insert into the vagina. Common OTC yeast infection treatments include:

• Lotrimin (clotrimazole)
• Monistat (miconazole)
• Vagistat-1 (tioconazole)
• Gynazole-1 (butoconazole)

Your provider may also recommend taking the oral antifungal Diflucan (fluconazole). If you are pregnant, consult with your provider before taking any OTC yeast infection treatments.

Atrophic vaginitis can be treated with an estrogen cream, tablet, or ring that helps restore estrogen levels and relieve symptoms. Your provider may also recommend a water-based lubricant to help alleviate vaginal dryness during sex. While rare, desquamative inflammatory vaginitis is treated with a 2% clindamycin vaginal cream or suppository to kill harmful bacteria. 

How To Prevent Vaginal Irritation

You can help prevent vaginitis by implementing lifestyle and hygiene habits that help decrease your risk of disrupting vaginal flora and irritating vaginal tissue. Some steps you can take to avoid vaginal irritation include:

• Avoid using douches and vaginal soaps, deodorants, or sprays
• Avoid using scented tampons, pads, and other scented period products
• Clean your vulva with warm water only
• Wear latex or polyurethane condoms during sex
• Wear dental dams during oral sex
• Wear cotton underwear to allow better airflow to your vagina and vulva
• Clean any menstrual cups, menstrual discs, cervical caps, diaphragms, and spermicide applicators after each use
• Eat probiotic foods when taking antibiotics
• Change out of wet workout clothes or swimsuits soon after exercising or swimming

Some people with bacterial vaginosis have recurrent infections that return after treatment. In these cases, healthcare providers may suggest taking boric acid suppositories with antibiotics to help treat and prevent recurrent bacterial vaginosis infections. However, boric acid suppositories can sometimes further irritate the vagina and are unsafe for pregnant people. 

Vaginal Irritation Complications 

Certain types of vaginal irritation can make you more susceptible to additional infections, pregnancy complications, and fertility issues. If left untreated, bacterial vaginosis and trichomoniasis can increase your risk of:

• Preterm labor or birth: Pregnant people with these infections are more likely to give birth before 37 weeks. 
• Low birth weight babies: Babies born to pregnant people with trichomoniasis or bacterial vaginosis are more likely to weigh less than 5.5 pounds. 
• STIs and HIV: These infections make it easier to get or pass the human immunodeficiency virus (HIV) and STIs to other partners. 
• Pelvic inflammatory disease (PID): This infection of the female reproductive organs can lead to scarring that causes infertility and chronic pelvic pain. It can also cause miscarriage, ectopic pregnancy, and preterm labor.
  

A Quick Review

Vaginal irritation, or vaginitis, is inflammation that makes the vagina or vulva red, swollen, and sore. Other symptoms can include itching, burning, pain during sex or urination, and abnormal discharge. Vaginal irritation is typically caused by an infection, hormonal changes, or allergic reactions.

See your healthcare provider if you experience vaginal irritation. Depending on the cause, vaginal irritation can be treated with antibiotics, antifungals, or estrogen creams.