How are vaginal infections diagnosed?

Dr. Kevin W. Windom, MD
OBGYN (Obstetrician & Gynecologist)

A vaginal yeast infection is usually diagnosed by the patient when she notices a thick, cottage cheese discharge and significant itching. Most yeast infections are treated with over-the-counter medications, and the patient never seeks medical attention. When the patient seeks medical attention and I examine the patient, I look for the same signs and symptoms. If the diagnosis is somewhat confusing, then vaginal cultures are necessary to help diagnose this problem.

Your doctor can tell a lot about your vaginal infection by asking about your symptoms and looking at your health history. A pelvic exam may be done. A sample of the vaginal discharge can be analyzed microscopically to confirm the diagnosis. If a sexually transmitted infection is suspected, tests may be done to confirm this.

Here is how each type of vulvovaginitis is diagnosed:

Estrogen deficient vulvovaginitis
Doctors must be careful when diagnosing a case of estrogen deficient vulvovaginitis, both because of its similarity to other vulvovaginitis types and the possible fragility of the vaginal tissue it causes. Your doctor may perform a pelvic exam, in which your vagina will be checked for symptoms of estrogen deficient vulvovaginitis, including inflammation, loss of pubic hair, and cracks or sores in your vaginal wall. Serum hormonal tests can also be performed, in which your doctor examines your hormone levels to rule out other causes of vulvovaginitis. A Pap smear can also check vaginal pH levels and if yours is higher than 5, estrogen deficient vulvovaginitis will be suspected. Finally, your doctor can perform an ultrasound to check the thickness of your uterine walls. The lack of estrogen in atrophic vulvovaginitis causes the uterine walls to shrink, which can be a good indication of this type of vulvovaginitis.

Bacterial vulvovaginitis
In order to diagnose bacterial vulvovaginitis, a doctor may start with a pelvic exam to check for symptoms such as inflammation or a vaginal discharge. Doctors often take a sample of the discharge to test for bacterial imbalances and vaginal pH. If the pH of the vaginal discharge is at least 4.5 and it has a fishy odor, the doctor can diagnose bacterial vulvovaginitis. However, more common gynecological tests such as a cervical Pap smear are not responsive enough to detect the minute bacterial imbalances in bacterial vulvovaginitis.

Nonspecific vulvovaginitis
Your doctor will perform a pelvic exam to check for symptoms such as inflammation, swelling or redness. You may also be asked about specific hygiene habits or certain products you use. Your doctor may also take a vaginal discharge sample to check for the presence of bacteria, as well as checking your vaginal pH. This process is called a wet prep. If your vaginal pH measures at least 4.5 and there are no signs of a bacterial or yeast infection, a diagnosis of nonspecific vulvovaginitis can be made.

Trichomonal vulvovaginitis
In order to diagnose a case of trichomonal vulvovaginitis, doctors will do a physical examination and test a sample of fluid from either the vagina or penis. In the physical examination, your doctor will check for symptoms of trichomonal vulvovaginitis, such as a heavy vaginal discharge, vaginal redness or even sores on the walls of your vagina. Doctors can also take a sample of either vaginal or penile fluid and examine it under a microscope. From there, they can easily detect the presence of the protozoa Trichomonas vaginalis.

If you have previously been diagnosed with vulvovaginitis and recognize your specific symptoms, it may be enough to administer over the counter medication yourself. However, if you are unsure in any way what could be causing your symptoms or if symptoms persist for at least a week after self-treatment, consult your doctor or gynecologist as soon as possible.


Continue Learning about Vulvovaginitis



Vulvovaginitis refers to numerous types of infections that can affect the vulva and vaginal area. Causes of vulvovaginitis include yeast, bacteria, parasites STDs and other viruses. If you have symptoms of vulvovaginitis like odor...

, discharge, itching, rash or pain in the vagina, you should call your doctor. You will want to make sure that you are treated for this condition, as it does not always go away on its own.

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.