Etiology
An overgrowth of anaerobic bacterial organisms such as Gardnerella vaginalis, Prevotella species, Mobiluncus species, Atopobium vaginae and Megasphaera type 1 are proven to be the main cause of bacterial vaginosis.[4]
Candida albicans, the second-most common cause of vaginitis, is the principal yeast responsible for vulvovaginal candidiasis. Species that are more resistant to treatment, like Candida glabrata and Candida tropicalis, are also known to be etiologic factors.[4]
Trichomonas vaginalis, a highly transmissible flagellated protozoan, is associated with vaginitis. The microorganism can be identified in up to 80% of male partners.[10][11]
Atrophic vaginitis occurs due to declining estrogen levels, predominantly in women who are postmenopausal. In addition, the microenvironment in the vagina is supported by the presence of estrogen. In premenopausal women, atrophy is rare, but may be due to interference with ovarian production of estrogen: for example, antiestrogen medication or surgery.[8][9]
Situations that alter the vaginal environment, such as douching, poor or excessive hygiene, antibiotics, certain soaps, tobacco, tampons, contraceptive devices, and HIV, will increase the chances of acquiring the condition.[1][12]
Pathophysiology
Altering the vaginal pH leads to overgrowth of normal microorganisms present in the vagina. Hydrogen-peroxide producing lactobacilli are important in preventing overgrowth of the anaerobes normally present in the vaginal flora. During the reproductive years, the normal pH of the vagina is 3.8 to 4.2; as long as this low pH is maintained, no overgrowth can occur.
In postmenopausal women, declining estrogen levels lead to vaginal atrophy. The vaginal mucosa becomes thinner and drier, less elastic and more prone to inflammation.
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