Something else? Ask Aunt Vadge – bottom left of your screen!
There are some confusing terms floating around. What is the difference between vaginitis and vaginosis?
Anything with ‘itis’ at the end of it always refers to inflammation, whereas ‘osis’ means an abnormality of an organ, and refers to the name of the ‘disease’.
Think of tonsillitis, conjunctivitis, and hepatitis; versus scoliosis, multiple sclerosis and liver sclerosis.
So here is the short version. Vaginitis means your vagina or vulva is inflamed – red, sore, itchy, burning.
Vaginosis means the balance of bacteria has shifted, but the tissue itself is not inflamed, so it does not hurt or itch.
One is a fire; the other is a quieter change in the bacterial neighbourhood with nothing obvious to show for it. You can have either, or both at the same time.
Understanding vaginitis
Vaginitis is a set of signs and symptoms: vaginal discharge that has white blood cells in it (this shows your body’s immune system is working overtime for some reason), some pain during sex or otherwise, itching or general irritation.
Vaginitis is usually caused by an infection, but other influences such as allergies can be at work, for example in histamine intolerance.
This is where ‘don’t wear tight undies, don’t use perfumed toilet paper, etc.’ all come into play.
If you are sensitive, you can end up with vaginitis pretty easily, but in most cases it is caused by an infection of some kind.
Vaginitis is characterised by symptoms that involve your vaginal or vulvar cells being unhappy – itch, pain, burning, soreness, redness, heat.
When a cause can be pinned down, the big three are bacterial vaginosis, yeast (candida) and trichomoniasis, in that order of frequency.1
Yes, bacterial vaginosis lives on both lists, and we will come back to that. The rest is a mix of less common culprits.
- A yeast infection (vulvovaginal candidiasis), which tends to itch, burn and produce a thick discharge.
- Aerobic vaginitis, an inflammatory cousin of BV where different bacteria move in and the tissue itself reacts and inflames.
- Desquamative inflammatory vaginitis, an uncommon, intensely inflamed state.
- Low-oestrogen tissue, now grouped under genitourinary syndrome of menopause (GSM), where thinner, drier tissue irritates easily.
- Irritant and allergic reactions – soaps, washes, lubricants, latex, and the histamine picture mentioned above.
The unifying thread is inflammation. Something has annoyed the tissue, your immune system has turned up, and you can feel it.
And how it differs from vaginosis
Vaginosis, on the other hand, does not have the pain, itching or inflammation. So if you have those symptoms, you do not necessarily have vaginosis – it is more likely to be something else, or something on top of it.
You can have both at once. Bacterial vaginosis is the classic example of vaginosis: a shift in the bacterial community rather than an inflamed, immune-charged tissue reaction.
In BV, the protective bacteria that normally run the show thin out, and a mixed crowd of anaerobic bacteria moves in to take their place.2
Vaginosis can be characterised by many tell-tale signs – a thin, greyish discharge and a fishy smell are the usual ones for BV – but at its core it is not inflamed, so it will not itch, burn or hurt.
That is exactly why so many people miss it: there is often nothing dramatic to feel.
There is even an ‘osis’ at the opposite end of the spectrum. In cytolytic vaginosis, protective lactobacilli overgrow and drive the vagina too acidic, which can mimic a yeast infection.
Same naming logic, opposite problem – an imbalance without the hallmark inflammation.
Why the difference actually matters
This is not just word nerdery. The two point to different treatments, and getting them mixed up is one of the most common reasons symptoms drag on.
An antifungal does nothing for BV. An antibiotic does nothing for yeast.
Soothing an irritant reaction will not shift a bacterial imbalance, and reaching for antibiotics when the tissue is simply dry and low in oestrogen can make things worse.
Conventional treatment reflects this.
BV is usually treated with metronidazole or clindamycin, yeast with an antifungal such as fluconazole or a topical azole, and trichomoniasis with metronidazole or tinidazole for both partners.1
Each one is aimed at a different problem, which is precisely why a correct label matters before you start.
It is also why the same symptoms can drag on for months.
Someone treats a presumed yeast infection over and over with antifungals, gets a few days of relief, then it returns – because the real issue was a bacterial imbalance, or an irritant, or low-oestrogen tissue all along.
Naming the problem correctly is the step that turns a frustrating loop into a plan.
The vaginal microbiome sitting underneath it all
Both vaginitis and vaginosis make a lot more sense once you look at the vaginal microbiome – the community of bacteria living in the vagina.
In most people of reproductive age, that community is dominated by protective Lactobacillus species, which produce lactic acid and keep the environment acidic, at a pH below about 4.5.3
That acidity is not a side note. It is one of the vagina’s main defences, holding back the disruptive bacteria and yeasts that cause trouble when they get the upper hand.3
Researchers now sort vaginal microbiomes into a handful of community state types, some dominated by sturdy protective species like Lactobacillus crispatus, and others with very little lactobacilli at all.
When that protective layer thins, you tip toward vaginosis – the quiet bacterial shift of BV.
When the tissue itself reacts and inflames, you are in vaginitis territory, which is what happens in aerobic vaginitis, where the flora is disturbed, the lining thins, and there is visible inflammation.4
This is where our functional-medicine approach comes into its own.
Clearing the immediate infection is half the job; the other half is asking why the protective community fell over in the first place, and helping it re-establish so the problem does not simply return.
Hormones, gut health, blood sugar, stress, antibiotics and what you put in and around the vagina all feed into that balance.
It is not natural medicine versus conventional medicine here – the two work well together.
A short course of an antibiotic or antifungal can knock back an acute problem, and rebuilding a protective, lactobacilli-rich environment is what helps it hold.
For recurrent BV in particular, restoring those protective bacteria, rather than only clearing the disruptive ones, is central to how we work, and a growing evidence base supports it.5
How vaginitis and vaginosis are told apart
You cannot reliably tell these apart from symptoms alone, and plenty of careful, body-literate people get it wrong – because the clues really do overlap.
In a clinic or lab setting, BV is often diagnosed with the Amsel criteria: a thin, even discharge, a positive ‘whiff’ test, clue cells visible under the microscope, and a vaginal pH above 4.5.
Three of those four make the diagnosis.1 A raised pH is a useful nudge, but on its own it does not tell you which problem you are dealing with.
Where symptoms keep coming back, or never quite fit, a comprehensive vaginal microbiome test using PCR or next-generation sequencing can show exactly which bacteria are present and in what proportions.
That is often the moment the picture finally clicks into place.
What this means for your vagina
The practical takeaway: itching, burning and soreness point toward vaginitis, while a smell or discharge change with no real discomfort points more toward vaginosis.
But those signposts only narrow it down – they do not seal the deal.
In our clinic, the people who finally get somewhere are usually the ones who stop guessing and get a comprehensive test.
It is remarkable how often the symptoms point one way and the bacteria point another, and treating the wrong thing is what keeps the merry-go-round turning.
It is worth getting checked in person rather than self-treating if any of these apply:
- Pain, fever, or pelvic or lower-tummy pain.
- Bleeding that is not your period, or pain and bleeding after sex.
- You are pregnant, or think you might be.
- Symptoms that keep returning, or do not settle with treatment.
- Sores, ulcers or blisters, or any chance of a sexually transmitted infection.
None of that is cause for panic. It just means the smart move is to find out what is actually going on before you spend weeks treating the wrong thing.
Frequently asked questions
Can you have vaginitis and vaginosis at the same time?
Yes. A bacterial imbalance like BV can sit alongside an inflamed problem such as a yeast infection or aerobic vaginitis. This is one reason symptoms can be so confusing, and why a single guess often misses part of the picture.
Is bacterial vaginosis the same as a yeast infection?
No. BV is a bacterial imbalance, while a yeast infection is an overgrowth of candida.
BV tends to bring a fishy smell and thin discharge without much itch, whereas yeast tends to itch and burn with a thicker discharge. They are treated completely differently.
Does vaginosis always smell?
Not always. A fishy odour is common with BV, especially after sex, but some people have very few symptoms at all. That is part of why vaginosis is so easy to overlook.
Is vaginitis always an infection?
No. Infections are the most common cause, but irritants, allergies and low-oestrogen tissue can all inflame the vagina and vulva without any infection being involved.1 That is why slathering on an antifungal does not always help.
How do I know which one I have?
You often cannot tell from symptoms alone. Testing – whether that is in-clinic checks or a comprehensive microbiome test – is the reliable way to know what you are dealing with before you treat it.
Is bacterial vaginosis a sexually transmitted infection?
BV is not classed as an STI, but it is linked to sexual activity, and the balance of the vaginal microbiome can shift with a new partner.
It is worth ruling out STIs separately if there is any chance of one, since those need their own testing and treatment.
Can vaginosis lead to vaginitis?
It can. A long-standing imbalance can leave tissue more vulnerable, and disruption to the protective bacteria can make inflamed conditions more likely. Looking after the underlying microbiome is part of keeping both at bay.
What to do next
If your symptoms are mild and new, it is reasonable to keep things simple for a few days – skip soaps and washes, wear breathable cotton, and let irritated tissue settle.
If nothing improves, or anything on the red-flag list above applies, get it properly checked rather than guessing.
For recurring or stubborn symptoms, a comprehensive test takes the guesswork out, and working out why the balance tipped is what stops the cycle.
You can ask Aunt Vadge’s Assistant, the chat widget in the bottom-left of your screen, or book an appointment to work through it with one of our practitioners.
This is general information, not a substitute for personalised medical advice.
- Paladine HL, Desai UA. Vaginitis: Diagnosis and Treatment. Am Fam Physician. 2018;97(5):321–329.
- Ravel J, Gajer P, Abdo Z, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011;108(Suppl 1):4680–4687.
- Amabebe E, Anumba DOC. The vaginal microenvironment: the physiologic role of lactobacilli. Front Med (Lausanne). 2018;5:181.
- Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG. 2002;109(1):34–43.
- van de Wijgert J, Verwijs MC. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review. BJOG. 2020;127(2):287–299.
