Bacterial Vaginosis

Almost all women, at least once in their lives, experience the uncomfortable symptoms of vaginal itching, burning, and discharge. It is common wisdom that these symptoms are diagnostic of a “yeast infection.” However, recent medical studies have shown that the majority of women who have these symptoms do not have a yeast infection. If it isn’t a yeast infection, what else might it be? To answer this question we need to discuss the symptoms of itching, burning, and discharge.


You feel terrible itching and burning. It feels like you have a thousand mosquito bites in your vagina. When a mosquito bites you, it injects a chemical called histamine into the bite. Histamine reacts on nearby nerve endings to cause the sensation of itching and burning. But, of course, you didn’t get a thousand mosquito bites in your vagina, so what’s going on? Anything that causes inflammation in the vagina causes your own body to release histamine. This leads to the symptoms of itching and burning. So what can cause inflammation?


Any vaginal infection can cause inflammation. The most common vaginal infection is not yeast, it is instead an infection caused by bacteria called bacterial vaginosis. In addition, another organism called Trichomonas can also cause vaginal infections. But, infections are also not the only cause of inflammation. Perfumes and dyes in soaps or bubble baths, spermacides or lubricants, laundry detergents and fabric softeners can also cause inflammation, irritation, or allergic reactions that stimulate the release of histamine. Since so many different conditions can cause these types of symptoms, it is very difficult for medically untrained woman to correctly self diagnose the cause of her vaginal itching, burning, and discharge. As most women are aware of the diagnosis of a yeast infection, they are not aware of the other possible causes of these symptoms and often mistakenly self diagnose a yeast infection.


The term vaginitis refers to any infection or inflammation in the vagina. Studies have shown that in addition to vulvovaginal candidiasis other common forms of vaginitis are bacterial vaginosis and Trichomonas. Approximately 30 to 35% of all vaginitis is caused by an overgrowth of bacteria in the vagina called bacterial vaginosis, 10% of all vaginitis is caused by Trichomonas, 10% is caused by inflammation due to chemicals or allergic reactions, and 20 to 25% of all vaginitis is caused by yeast infections. Approximately 15 to 20% of all vaginitis is actually a combination of two or more of the other types of vaginitis. As most women are aware of yeast infections, but not aware of bacterial vaginosis and Trichomonas, there is a tendency for women to consider vulvovaginal candidiasis for their vaginal symptoms and not the more common diagnosis of bacterial vaginosis.

This study illustrates the fact that the symptoms of vaginitis are non-specific. An examination by a healthcare profession is essential to make the accurate diagnosis. Only a healthcare professional has the diagnostic tools and the experience to make an accurate diagnosis, and this must be done in person. In order to differentiate among the three most common types of vaginitis, a physical examination should be performed. In addition a microscopic examination of the vaginal secretions and measuring the pH of the vaginal secretions is absolutely essential. Additional tests such as a culture or DNA testing are often necessary to make an accurate diagnosis.

When you do go to your healthcare provider’s office the first thing your healthcare provider should do is ask you your symptoms. As we said before symptoms are generally non-specific to yeast infections; however, some symptoms may give your doctor a clue as to what type of vaginitis you have. Itching, soreness, and pain during intercourse are more likely to be a yeast infection than bacterial vaginosis. Symptoms of a malodorous discharge without pain during sex are more likely to be bacterial vaginosis, and symptoms of a malodorous vaginal discharge with pain during sex are more likely to be Trichomonas. Next your healthcare provider should perform a physical examination. Again there may be some clues on physical examination that may point towards a yeast infection as opposed to a bacterial vaginosis or a Trichomonas. Redness of the labia, swelling of the labia, and cracks or fissures of the labia are more likely to be a yeast infection that bacterial vaginosis. A sticky-adherent discharge it is more likely to be a bacterial vaginosis or Trichomonas. Next your healthcare provider will test the pH of the secretions. A pH of 4 to 4.5 is more likely to be vulvovaginal candidiasis while a pH of greater than 4.5 is more likely to be bacterial vaginosis or Trichomonas. However, as we pointed out earlier approximately 15%-20% of all vaginitis is a mixed infection and therefore these “rules” may not hold true.

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