- Bacterial vaginosis (BV)
- Lichen sclerosus
- Vulval cancer
We’re going to examine the symptoms, causes and treatments for each of these.
Sexually transmitted infections (STIs or STDs) often have vaginal itching as a symptom too, so look at the section on sexual health if you don’t find your answers here.
1. What are the symptoms of bacterial vaginosis (BV)?
The most common symptoms are:
- Vaginal itching and/or burning but this may not be the main symptom
- A white/grey/yellowish vaginal discharge
- The discharge may be worse after your period or after having sex
- A fishy smell to the discharge that is often worse after washing with soap or after having sex
- Redness and swelling of the vulval area and outer vagina.
About half of all women with BV have no symptoms at all.
What tests will the doctor do for BV?
Many healthcare professionals may examine you and listen to your symptoms and be happy to make a diagnosis without any further tests.
Sometimes the doctor/nurse will take a swab from the vagina and send it to the lab for testing.
Sometimes s/he will use a piece of litmus paper to test the acidity or alkalinity of the vagina. This is also known as the pH. When you have BV the vagina is more alkaline.
What is the treatment for BV?
- Because many women have no symptoms, not treating BV is an option if you’re not pregnant or about to have surgery to your vagina or womb. The infection often goes away on its own.
- If you’re pregnant, untreated BV has been associated with early labour, miscarriage and low birth weight babies, so treatment is advisable.
- Treating with antibiotics works well.
Metronidazole is the antibiotic of choice for BV. You take 400-500mg twice a day for 7 days, or 2mg as a single dose (but not if you’re pregnant). The single dose is thought not to be as effective and may cause more side effects than the 7-day course. Metronidazole is safe in pregnancy.
An alternative is metronidazole gel put into the vagina, which is as effective as taking the 7-day tablet course but causes fewer side effects.
Clindamycin vaginal cream is also effective, especially if you’re breast feeding (although metronidazole is safe).
- It is essential not to miss doses and to finish the course.
- Don’t drink alcohol while you’re taking metronidazole, or for 48 hours after finishing the course as you may have unpleasant side effects.
- Sexual partners don’t need to be treated (see below).
- There is no evidence that treating with natural yoghurt works for curing BV.
- If you are under 16 or over 60, have abdominal pain or are otherwise unwell with your vaginal symptoms, you should see your doctor.
What causes BV?
BV is not sexually transmitted and it’s not caused by bad hygiene.
It is caused by an imbalance in the normal bacteria that live in the vagina. One type of bacteria develop too much and causes the problem.
This overgrowth of bacteria often happens as a result of over washing or douching.
Who gets BV?
Any woman can get BV and it’s estimated that 1 in 3 women will get it in their lives – so many of your friends may have had it. It is the most common cause of an abnormal vaginal discharge.
Women who use the contraceptive coil (IUCD/IUD or IUS) as their contraceptive may be more prone to getting BV.
Women who smoke are more likely to get it.
Genetics may also play a part, so if you have a sister or your mother who gets it, you may get it too.
What’s the outcome for BV?
Antibiotics clear the problem quickly but not treating is an option as it may clear by itself.
How can I prevent BV?
If you smoke, stop.
Avoid adding bath oils etc to bath water or using strong smelling soaps or wash gels.
Avoid using strong detergents to wash your undergarments.
Wash the vaginal area with a mild soap once a day.
2. What are the symptoms of thrush?
- Intense vaginal itching
- A thick, cottage cheese-like vaginal discharge.
- Swelling and redness in the vulval area
- Painful sexual intercourse
- Sometimes you may have pain on passing urine
- There is not usually a smell to the vaginal discharge
Thrush doesn’t harm the baby if you are pregnant.
What tests will the doctor do for thrush?
If you have repeated infections or there is any doubt about the diagnosis the doctor may take a vaginal swab that’s sent to the lab for confirmation.
What is the treatment for thrush?
Thrush is caused by a fungus (see below) so you need an antifungal drug.
- The most common ones are miconazole, clotrimazole and econazole. Some of these are available over the counter at the pharmacy and are pessaries and creams that are put directly into the vagina.
The pessary is a pill that goes into the vagina and treat the infection and the cream will sooth the external itching. It’s a good idea to use both for fast relief.
They can be taken if you’re pregnant or breastfeeding but talk to your doctor or pharmacist.
- A capsule that you swallow is also available over the counter. It is called fluconazole and is also a one-off treatment.
- Another tablet taken by mouth is itraconazole which is 2 doses taken during one day.
These tablet treatments are not suitable if you’re pregnant or breastfeeding.
- Natural remedies for thrush include using live yoghurt in the vagina, or adding vinegar/sodium bicarbonate to bath water, or using tampons with tea tree oil in them.
There is not a lot of scientific data behind these natural remedies but you may find them helpful and soothing.
If you are under 16 or over 60, have abdominal pain or are otherwise unwell with your vaginal symptoms, you should see your doctor.
What causes thrush?
Thrush is a yeast infection.
It is not sexually transmitted but it’s a good idea for sexual partners to be treated, especially if you are prone to getting repeated attacks of thrush. It could be that a partner is passing it back to you after you’ve been treated.
There are several types of yeasts, as well as harmless bacteria, that live in the vagina. If one particular type of yeast (Candida) gets out of balance then this can cause thrush.
Thrush can occur in other places – the mouth and on the skin, especially in the skin folds.
Who gets thrush?
Thrush is the 2nd most common cause of an abnormal vaginal discharge (see above for the most common) so many women will have it during their lifetimes.
It’s more common if you have diabetes, have a weakened immune system due to treatment for cancer or are taking high doses of steroids.
What’s the outcome for women with thrush?
Thrush is successfully treated with antifungal meds but if it’s very mild it may go by itself.
It will not affect your fertility.
It can become a re-occurring problem. If this is the case you should talk to your healthcare professional and ensure that any sexual partners are also treated.
How can I prevent thrush?
Avoid douching as this will upset the balance of the environment in the vagina.
Wear cotton undergarments that allow the skin and vulval area to ‘breath’ and to prevent a build up of perspiration. Some manufacturers make tights/pantyhose with a crotch cut out to achieve the same aim.
Avoid using perfume soaps etc, just use plain soap and wash once a day.
If you have diabetes then keep your blood sugars under control.
3. What are the symptoms of trichomonas (‘trich’)?
- Vaginal itching
- Pain/burning/itching when passing urine.
- A green/yellow watery and frothy vaginal discharge
- An unhealthy odour to the vaginal discharge.
- Sex can be uncomfortable or painful.
- About 70% of people with ‘trich’ don’t have symptoms.
- You can be infected with trich for a long time before you have symptoms or they can come on a week to a month later.
What tests will the doctor do for trichomonas?
Although the doctor will listen to your symptoms, s/he will need to take a swab for testing in the lab to confirm that this is trichomoniasis.
Trich is a sexually transmitted disease so you should talk to your doctor about tests for other STDs while you’re with him/her.
What is the treatment for trich?
Trich is considered one of the most curable STDs. You will need a single dose of antibiotic from the doctor.
These antibiotics are either metronidazole or tinidanzole and they are safe for pregnant women. You should avoid alcohol when you take them and for 48 hours after as you may vomit, experience flushing or heart palpitations.
What causes trich?
This is an infection by a parasite. It is transferred from the inside of the penis to the vagina during sex and can be transferred from vagina to vagina in same-sex couples.
Who gets trichonomoniasis?
Men and women can get this STD and it is highly infectious.
What’s the outcome for women with trichonomas?
An untreated infection can persist for many years and be passed on to other partners.
For pregnant women, there is a risk of miscarriage or early delivery and low birth weight babies.
For men and women there is an increased risk of infection with HIV/AIDS because the inflammation in the genital area makes it easier for the virus to be caught or passed on.
Trich is considered to be one of the most treatable STDs so a treated infection is cured (if symptoms don’t go then see your healthcare professional again). However you can become re-infected via an infected and untreated partner.
How can I prevent trich?
Using condoms correctly will help to reduce your risk of being infected.
The only way to avoid infection completely is to abstain from sex.
If you are under 16 or over 60, have abdominal pain or are otherwise unwell with your vaginal symptoms, you should see your doctor.
4. What are the symptoms of lichen sclerosus?
Lichen sclerosus is an unusual cause of vaginal itching, affecting about 1 woman in 1000.
- Vaginal itching, or itching in the vulval area and/or around the anal area.
- The itching is worse at night.
- Small pearly white spots form on the vulval area.
- The white spots can become bigger and join up to damage the skin and cause it to become thinner and more fragile. This can cause it to split, which makes sex painful.
- As well as, or instead of the itching, there may be soreness in the vulva.
What tests will the doctor do for lichen sclerosus?
An examination will probably be all that the doctor needs to do to confirm the diagnosis, but if necessary a biopsy of the skin can be taken.
What is the treatment for lichen sclerosus?
Strong steroid creams will reduce the inflammation and the itching.
Your doctor will advise you on your personal regimen for treatment. A common way of using the steroid cream is nightly for 4 weeks; then alternate nights for 4 weeks and then 2 times each week for 4 weeks.
The irritation may take a couple of weeks to lessen and the skin should start to look and feel better after about 3 months if the symptoms were caught early. If you’ve had symptoms for a while then the skin changes may not go back to normal.
You may need to treat the area regularly to keep the symptoms at bay.
Also avoid perfumed soaps and wash the vulval area with emollients which are more soothing.
What causes lichen sclerosus?
No one is sure what causes this problem. It’s thought it might be an autoimmune disorder as it sometimes occurs in women with other autoimmune problems such as thyroid disease, pernicious anaemia and vitiligo.
An auto immune condition is one where the body attacks its own cells as it thinks they are foreign invaders.
Who gets lichen sclerosus?
It’s most common in middle-aged women.
What’s the outcome for women with lichen sclerosus?
When treated initially and then with ongoing creams every 1-2 weeks, the condition and symptoms can be contained.
If it’s left untreated the skin damage can make it painful to pass urine or have sex.
There is also thought to be a slight increase in the risk of vulval cancer (see below).
5. What are the symptoms of vulval cancer?
- One of the symptoms of vulval cancer is persistent itching.
Other symptoms include:
- Pain in the vulval area
- A sore that doesn’t get better
- A lump or swelling in the vulva
- Vaginal bleeding after the menopause.
- A mole on the vulva that change its shape or colour or gets bigger.
- Raised or thickened areas of skin that are red, white or darker in colour.
What tests will the doctor do for vulval cancer.
You will have an examination of the area and the doctor will take a biopsy of the skin/lesion.
What is the treatment for vulval cancer?
Treatments will tailored to the stage and severity of the cancer. You could be recommended to have surgery, chemotherapy or radiotherapy or a combination of these. Your oncologist (cancer specialist) will advise you.
What causes vulval cancer?
This is a rare type of cancer and, like any cancer, it’s a tumour that develops from one abnormal cell that divides.
Who gets vulval cancer?
- The risk factors for women getting vulval cancer include:
- Being over 55 years of age
- Having a condition called VIN
- Having human papilloma virus (HPV) – some types of the virus can make you more suceptable to having VIN. These are types 16, 18and 31
- Having lichen sclerosus (see above)
- Having genital herpes can increase the risk also.
What’s the outcome for women with vulval cancer?
The outcome will depend on how early the cancer is diagnosed and treated. The earlier the treatment starts the better the outcome – as for any cancer.
If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault in some way, read this page now: How to talk to a doctor about an embarrassing problem.