• Vaginitis is inflammation or irritation of the vagina causing typical symptoms of vaginal discharge, burning, and itching.
    • May be due to infection such as trichomoniasis, candidiasis, or bacterial vaginosis (BV); see Appendix, Table 7.
    • Noninfectious causes include foreign body or exposure to an irritant or allergen.
  • Vulvovaginitis is irritation or inflammation of both the vulva and the vagina; most often due to Candida albicans
  • In postpubertal females, BV is the most prevalent cause of vaginal discharge and typically causes a fishy odor.
  • Physiologic leukorrhea (i.e., “physiologic discharge”) is usually associated with pubertal onset and frequently precedes menarche. It is typically thin, white, and mucoid.


  • Vaginitis affects females of all ages.
  • In prepubescent girls, 25–75% of vaginitis is nonspecific in etiology.
  • Approximately 75% of women have had at least one episode of vulvovaginitis due to candida in their lifetime.
  • The most common causes of postpubertal vaginitis are as follows:
    • BV (22–50%)
    • Vulvovaginal candidiasis (17–39%)
    • Trichomonas vaginalis (4–35%)

Risk Factors

  • For prepubertal females, poor hygiene is a common risk factor.
  • Irritant risk factors often include soaps, tampons, topical products and medications, extreme cleansing, clothing, and douching.
  • For BV:
    • Vaginal douching
    • Smoking
    • Intrauterine device usage
    • Non-white race
    • Prior pregnancy
    • Unprotected sexual intercourse
    • Use of spermicide
    • Homosexual relationships
  • For trichomoniasis:
    • Multiple sexual partners
    • Other sexually transmitted infections
    • Lack of condom use
    • Smoking
  • For vulvovaginal candidiasis:
    • Use of systemic antibiotics
    • Uncontrolled diabetes mellitus
    • Diet high in refined sugars


  • In prepubescent females, with prepubertal hormones, the vagina has a neutral pH, atrophic mucosa, and a warm environment that easily allow for bacterial overgrowth.
  • Physiologic leukorrhea
    • Estrogen levels; the volume of discharge varies with the menstrual cycle and is especially heavy at the time of ovulation.
  • Candida vulvovaginitis
    • Use of antibiotics increases the occurrence of candidiasis by eliminating competitive organisms.
  • BV
    • Caused by shift in vaginal flora
    • Normal Lactobacillus species decrease and overgrowth of bacteria, including Gardnerella vaginalis, Mycoplasma hominis, and anaerobes such as Prevotella and Mobiluncus species


  • All ages:
    • Chemical, irritant, allergy
    • Nonspecific vaginitis (may be associated with hygiene)
    • Foreign body or material such as rolled up toilet paper
    • Candidiasis associated with antibiotic use
    • Trauma, mechanical irritation
    • Sexual abuse
  • More common in prepubertal females:
    • Group A β-hemolytic Streptococcus
    • Haemophilus influenzae
    • Shigella
    • Pinworms or scabies
    • Congenital abnormalities
  • More common in postpubertal females:
    • Physiologic leukorrhea (may cause discharge but not irritation)
    • BV
    • Trichomoniasis
    • Sexually transmitted infections (STIs) such as gonorrhea and chlamydia
    • Pubic lice

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