Burning. Itching. Discomfort. They’re not words that we want to associate with a vagina. But vaginitis, an umbrella term for conditions that cause vaginal irritation, is common.
Irritation is sometimes accompanied by other unpleasant symptoms, such as changes in the color, smell or amount of your vaginal discharge and pain during urination or sex.
If you’re experiencing irritation, UNC Health family nurse practitioner Mariah L. Carey wants you to know these symptoms are treatable.
“Vaginal health is important, and no one should have to deal with discomfort,” Carey says. “This is what we’re here to do, and there’s no need to be embarrassed about it. It’s important to have a proper assessment so you can get quicker resolution of your symptoms.”
Only your provider can tell you what’s causing your discomfort after an exam and testing. But these common conditions could be the cause.
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Bacterial vaginosis
The most common cause of vaginitis is bacterial vaginosis (BV). Like your gut, your vagina has a mix of “good” and “bad” bacteria living in it, and when the bad bacteria outnumber the good, BV can happen.
“It’s not a sexually transmitted infection, but it can be caused by intercourse, because that can change the vaginal bacteria balance,” Carey says.
Washing your vagina with anything but water can also affect that bacterial balance.
In addition to vaginal itching, symptoms of BV may include changes in vaginal discharge, a fishy odor, and pain or irritation during urination or sex. It is treated with an oral or topical antibiotic.
A note about vaginal discharge, which helps to clean the vagina and eliminate bad bacteria: Everybody’s is different, and it can change a little throughout your menstrual cycle. Pay attention to your body so you have a sense of what’s normal for you.
“Everyone wants to know if their discharge is normal, but they don’t always ask,” Carey says. “Always ask if you have a concern.”
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Yeast infection
A yeast infection is caused by an overgrowth of the fungus candida. The symptoms are similar to BV—itching or irritation of the vagina or vulva, discomfort during intercourse or urination, and changes to odor or discharge. Discharge tends to be thick and white.
As with BV, sexual activity can increase your risk for a yeast infection, but this isn’t a sexually transmitted infection either. Potential causes include hormonal changes from pregnancy or oral contraceptives, diabetes, antibiotics or a weakened immune system.
Clothing can play a factor in creating an environment where yeast can thrive: If you stay in a wet swimsuit or don’t change out of sweaty workout pants, it can increase your risk for an infection, as can wearing pants with a tight crotch. Using any product other than water on the vagina can affect the bacteria that keeps yeast in check.
Over-the-counter yeast infection treatments are effective, but Carey recommends seeing your provider for confirmation of the infection before you use one, especially if you’ve never had a diagnosed yeast infection before.
“We should ensure you’re not treating the wrong thing, and even if it is a yeast infection, using too short a treatment might make it somewhat better without resolving it completely,” Carey says.
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Sexually transmitted infection
Several sexually transmitted infections can cause vaginal irritation, itching or burning, including chlamydia, gonorrhea, genital herpes, genital warts and trichomoniasis. Specific symptoms of each vary, but in addition to vaginal irritation, you may notice changes in discharge, pain during sex or urination, odor, bleeding or changes to the skin.
“If you’ve been potentially exposed to a sexually transmitted infection, go ahead and get tested,” Carey says. “It’s important to prevent transmission to other partners, and STIs can progress to cause more problems and be harder to treat.”
Left untreated, some infections can lead to pelvic inflammatory disease, which causes infertility, and some can cause complications during pregnancy. Using condoms can help prevent these infectious diseases.
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Hormonal changes
Changes in estrogen can cause changes in your vaginal tissue, so you may notice some symptoms of vaginitis during or directly after pregnancy or while you’re breastfeeding. While an increase in discharge during pregnancy is normal, Carey recommends telling your provider so they can make sure you don’t have an infection.
Perimenopause and menopause, when estrogen fluctuates and then decreases, can also cause discomfort.
“Estrogen helps to keep the vaginal tissues more elastic, and without it, the tissue isn’t as well hydrated,” Carey says. “There can be a lot of discomfort due to that lack of estrogen.”
That may mean pain during sexual activity, but it may also mean that you notice more discomfort, dryness or itching, as well as urinary symptoms. During the perimenopausal years, when you’re still having periods, it may be more difficult to use a tampon.
If your irritation is related to menopausal hormonal changes, these symptoms can be managed with over-the-counter lubricants or moisturizers, or your doctor might prescribe topical hormone therapy.
If you experience any bleeding after menopause, tell your provider.
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Physical activity or contact dermatitis
You may experience soreness after physical activity that puts pressure or friction on the genitals, such as riding a bike or a horse. Tight clothing can irritate the area, and some women are more sensitive to bubble baths or hot tubs. If you experience irritation during or after sex, you may not adequately lubricated; if you experience pain, you should talk to your provider.
Vaginal irritation can also be caused by contact dermatitis, or a reaction to something that is put close to that sensitive skin. You might have an allergy or not be able to tolerate certain detergents, soaps or feminine products.
If you’re using these products because you’re concerned about odor, talk to your provider. Odor is normal, but some odors do indicate one of these conditions.
“There are lots of products out there—washes, supplements, douches—but don’t waste your money,” Carey says. “We don’t recommend any douching or over-the-counter vaginal cleaners. Your vagina has a way of naturally cleaning and balancing itself to fight off infections. Washing with water is the way to go, and there’s no cost.”
Questions about a symptom you’re experiencing? Talk to your doctor or find one near you.