What happens to the vaginal pH in irritant vaginitis?

From the Guidelines

In irritant vaginitis, the vaginal pH typically remains normal (3.8-4.5) unlike other vaginal conditions. This is because irritant vaginitis is caused by chemical irritants rather than infectious agents that alter the vaginal microbiome. Common irritants include soaps, douches, spermicides, and feminine hygiene products which damage the vaginal mucosa but don't necessarily disrupt the lactobacilli that maintain normal acidity. The preservation of normal pH distinguishes irritant vaginitis from bacterial vaginosis (where pH rises above 4.5) and helps clinicians make an accurate diagnosis. Treatment focuses on identifying and removing the offending irritant while allowing the vaginal tissues to heal, rather than addressing pH imbalances. Patients should avoid potential irritants and may benefit from temporary use of bland emollients or corticosteroid creams to reduce inflammation while the vaginal epithelium recovers. Although studies such as 1 and 1 discuss the diagnosis and treatment of Candida vaginitis, they do not directly address irritant vaginitis, but they do support the idea that a normal vaginal pH is less than or equal to 4.5. It's worth noting that the provided studies 1 are older and do not specifically address irritant vaginitis, however, the general principle of maintaining normal vaginal pH applies. In clinical practice, it's crucial to prioritize the patient's symptoms and medical history when making a diagnosis and developing a treatment plan for irritant vaginitis. Some key points to consider when diagnosing and treating irritant vaginitis include:

• Identifying and removing the offending irritant
• Avoiding potential irritants
• Using bland emollients or corticosteroid creams to reduce inflammation
• Maintaining a normal vaginal pH (3.8-4.5) to prevent further irritation and promote healing.

From the Research

Vaginal pH in Irritant Vaginitis

• The vaginal pH can be affected by various types of vaginitis, including irritant vaginitis 2.
• However, there is limited information available on the specific effects of irritant vaginitis on vaginal pH.
• Studies have shown that bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis can alter the vaginal pH, with bacterial vaginosis and trichomoniasis typically causing an increase in pH 3, 2.
• In contrast, vulvovaginal candidiasis usually has a normal vaginal pH of 4.0 to 4.5 2.
• Aerobic vaginitis, another type of vaginitis, can also cause an increase in pH, leading to symptoms such as vaginal dryness, itching, and irritation 4.
• A study on the association of pH change in the vaginal environment with the presence of Enterococcus faecalis in bacterial vaginosis found that a pH value above 4.0 can indicate a decrease in lactobacillus bacteria and an increase in other microorganisms 5.
• Another study found that a vaginal pH of 6.0 or higher is strongly predictive of infection and may be more useful than the type of discharge in suggesting a need for confirmatory microbiological tests 6.
• While these studies provide information on the effects of various types of vaginitis on vaginal pH, there is no specific information available on the effects of irritant vaginitis on vaginal pH.