Common Vaginal & Vulval Conditions

There are a number of conditions that can affect your vagina and vulva (the outside part of the female genitals). Some are uncomfortable, others can be painful and irritating. Most can be easily treated. Sometimes vaginal and vulval symptoms can be due to other more serious causes - if your symptoms do not get better, make sure you see your doctor for a check-up.

What is normal vaginal discharge?

All women have a natural vaginal discharge which keeps the vagina healthy. The amount of discharge varies from woman to woman. At different times in you period, or if you use hormonal contraception, it can be heavier or lighter, and sometimes you won't notice it at all. Menopausal women often notice that they have less vaginal discharge. If your normal vaginal discharge changes, this could mean you have a problem such as an infection.

How do I know if I have a vaginal infection?

You might notice:

• an increase in the amount of vaginal discharge or an unusual or unpleasant smell
• itching, burning or soreness around the vaginal area
• pain when you pass urine
• pain when you have sex

If you have any of these symptoms you could have one of the vaginal conditions described below. Other possible causes of vaginal symptoms include sexually transmitted infections such as chlamydia, gonorrhoea or trichomonas. You should get medical help as soon as you notice any changes in your vaginal smell or discharge, especially if you are pregnant.

Bacterial vaginosis (BV or Gardnerella)

This condition is caused by a change in the bacteria that keep the vagina healthy - some women will notice an unpleasant strong, fishy smell and a white or grey watery discharge. Women who get bacterial vaginosis often notice the symptoms can come and go or can be associated with their periods - even with treatment the symptoms can come back. If you are pregnant and have bacterial vaginosis, it is important to get treatment. If left untreated, this condition during pregnancy can cause the baby to be premature (born early). Bacterial vaginosis is generally not considered to be an STI (sexually transmitted infection).

There are several different treatment options available which include oral antibiotic tablets, vaginal antibiotic cream or vaginal antibiotic gel. Most women only need to take antibiotics for a short time - if you continue to have symptoms or the symptoms go away and keep coming back again, you may need to use them for longer. Aci-Jel Therapeutic Vaginal Jelly® is an acidic jelly for the vagina, which is available from chemists without prescription - it can be used to help correct the acid balance of the vagina. Some women find it stops the infection coming back.

Douching (washing and cleaning inside the vagina with water or female hygiene products) should be avoided as it can cause vaginal infections. Your sexual partners don't need to be checked or treated for bacterial vaginosis.

Vaginal thrush (candida)

Thrush is a common infection of the vagina caused by yeast that is found in the vagina, mouth and bowel. The yeast usually causes no problems because it is kept in balance by other organisms that live normally in the body and on the skin. If this natural balance is upset (for example by pregnancy, diabetes or some medications), overgrowth of the yeast can result. Some women using the contraceptive pill, vaginal ring or menopausal hormone therapy may develop symptoms of thrush. Thrush symptoms include a cheesy, thick, white discharge that smell yeasty but not unpleasant - the area around the vagina and vulva is often red, itchy and sore. Thrush is not an STI - your sexual partner/s do not need to be treated. It's not necessary to avoid sex, although sex may be uncomfortable while you have the infection. Although thrush is common, it is not the only thing that can cause itchiness or pain in the vagina - your doctor or nurse will check that the symptoms are from thrush and not some other condition.

The most common treatments for thrush are vaginal creams or vaginal tablets (pessaries) that you get from the chemist without a prescription - you should see your doctor if the itchiness and pain doesn't go away or comes back again after treatment. Your doctor may suggest an oral antifungal treatment - this is available without prescription. If the infection keeps coming back you may need a longer course of antifungal treatment which is prescribed by your doctor.

Vulval dermatitis

Dermatitis is a very common cause of irritation around the vaginal entrance - the main symptom is usually itching, but if a woman scratches the area the skin can tear and split and this can also cause burning and stinging. Dermatitis can be caused by anything that irritates the sensitive skin around the entrance of the vagina - detergents, panty liners, perfumed toilet papers and pads, soaps, perfumes, bubble baths, shower gels, vaginal deodorants, lubricants and spermicides. Dermatitis can also be caused by an allergy, perhaps to the latex in some condoms, to tea-tree oil, or to one of the ingredients in vaginal creams or pessaries - in these cases you will often also have other allergic conditions like asthma, hay fever or eczema.

A gentle unperfumed moisturiser like aqueous cream may be advised by your doctor to stop any splits in the skin - soap substitutes are usually recommended. A weak steroid ointment or cream is often used to treat mild symptoms - ointments are a bit messier to use than creams but they cause less irritation and are longer lasting. Sometimes a stronger steroid or cream is needed for a short time when symptoms are more severe. Using a specialised cold moist compress can help to relieve the symptoms and antihistamine tablets can be useful when the cause is an allergy.

Other more serious vulval skin conditions can be associated with itching, pain or irritation so it is always important to have a check-up with a doctor if the symptoms do not improve.

What can I do to keep my vagina & vulva healthy?

• wear cotton or silk underwear and change daily - wear tights or pantyhose for a limited time
• wash underwear in hot water and pure soap and double rinse to remove any irritants
• change out of damp swimming costumes or sports clothes as soon as possible
• use tampons instead of sanitary pads or panty liners - if using pads or panty liners, change them regularly and avoid perfumed or deodorised products
• avoid tight fitting clothes such as jeans - this creates a moist, warm environment that encourages the overgrowth of bacteria and yeasts
• never douche unless specifically prescribed by a doctor to treat an infection - douching increases your risk of vaginal irritation. A healthy vagina does not need vaginal deodorant
• avoid using soap, bubble bath, bath salts, perfume or talc around the vagina - never ever use anything harsh such as disinfectants, even diluted, near your vagina.
• a gentle moisturiser may be advised - use water or soap substitutes to wash the area
• always wipe from the front to the back after going to the toilet to stop bowel organisms being swept into the vagina - don't use perfumed toilet paper

For more information

Family Planning NSW Talkline - www.fpnsw.org.au/talkline or 1 300 658 886

National Relay Service (for deaf people) - 13 36 77

TIS National's interpreting service - 131 450

Visit you nearest Family Planning NSW clinic - www.fpnsw.org.au/clinics