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Vulvovaginitis

Definition

Vulvovaginitis is inflammation or infection of the vulva and vagina.

Alternative Names

Vaginitis; Vaginal inflammation; Inflammation of the vagina

Causes, incidence, and risk factors

Vulvovaginitis can affect women of all ages and is extremely common. It can be caused by bacteria, yeasts, viruses, and other parasites. Some sexually transmitted infections (STIs) can also cause vulvovaginitis, as can various chemicals found in bubble baths, soaps, and perfumes. Environmental factors such as poor hygiene and allergens may also cause this condition.

Candida albicans, which causes yeast infections, is one of the most common causes of vulvovaginitis in women of all ages. Antibiotic use can lead to yeast infections by killing the normal antifungal bacteria that live in the vagina. Yeast infections typically cause genital itching and a thick, white vaginal discharge, and other symptoms. For more information see: Vaginal yeast infection

Another cause of vulvovaginitis is bacterial vaginosis, an overgrowth of certain types of bacteria in the vagina. Bacterial vaginosis may cause a thin, grey vaginal discharge and a fishy odor.

An STI called trichomonas vaginitis infection is another common cause. This infection leads to genital itching, a vaginal odor, and a heavy vaginal discharge, which may be yellow-grey or green in color.

Bubble baths, soaps, vaginal contraceptives, feminine sprays, and perfumes can cause irritating itchy rashes in the genital area, while tight-fitting or nonabsorbent clothing sometimes cause heat rashes.

Irritated tissue is more susceptible to infection than normal tissue, and many infection-causing organisms thrive in environments that are warm, damp, and dark. Not only can these factors contribute to the cause of vulvovaginitis, they frequently prolong the recovery period.

A lack of estrogen in postmenopausal women can result in vaginal dryness and thinning of vaginal and vulvar skin, which may also lead to or worsen genital itching and burning.

Some skin conditions can cause itching and chronic irritation of the vulvar area. Foreign bodies, such as lost tampons, can also cause vulvar irritation and itching and strong smelling discharge.

Nonspecific vulvovaginitis (where specific cause cannot be identified) can be seen in all age groups, but it occurs most commonly in young girls before puberty. Once puberty begins, the vagina becomes more acidic, which tends to help prevent infections.

Nonspecific vulvovaginitis can occur in girls with poor genital hygiene and is characterized by a foul-smelling, brownish-green discharge and irritation of the labia and vaginal opening. This condition is often associated with an overgrowth of a type of bacteria that is typically found in the stool. These bacteria are sometimes spread from the rectum to the vaginal area by wiping from back to front after using the bathroom.

Sexual abuse should be considered in girls with unusual infections and recurrent episodes of unexplained vulvovaginitis. Neisseria gonorrhoeae, the organism that causes gonorrhea, produces gonococcal vulvovaginitis in young girls who have sexual exposure. Gonorrhea-related vaginitis is considered a sexually transmitted illness. If lab tests confirm this diagnosis, young girls should be evaluated for sexual abuse.

Symptoms

  • Irritation and itching of the genital area
  • Inflammation (irritation, redness, and swelling) of the labia majora, labia minora, or perineal area
  • Vaginal discharge
  • Foul vaginal odor
  • Discomfort or burning when urinating

Signs and tests

If you have been diagnosed with a yeast infection in the past, you can try treatment with over-the-counter products. However, if your symptoms do not completely disappear in about a week, contact your health care provider. Many other infections have similar symptoms.

The health care provider will perform a pelvic examination. This may show red, tender areas on the vulva or vagina.

A wet prep (microscopic evaluation of vaginal discharge) is usually done to identify a vaginal infection or overgrowth of yeast or bacteria. In some cases, a culture of the vaginal discharge may identify the organism causing the infection.

A biopsy of the irritated area on the vulva may be recommended if there are no signs of infection.

Treatment

Treatment depends on what is causing the infection. Treatment may include:

  • Antibiotics taken by mouth or applied to the skin
  • Antifungal cream
  • Antibacterial cream
  • Cortisone cream
  • Antihistamine, if the irritation is due to an allergic reaction
  • Estrogen cream, if the irritation and inflammation is due to low levels of estrogen

Proper cleansing is important and may help prevent irritation, particularly in those with infections caused by bacteria normally found in stool. Sitz baths may be recommended.

It is often helpful to allow more air to reach the genital area. Here are some tips:

  • Wear cotton underwear (rather than nylon) or underwear that has a cotton lining in the crotch area. This increases air flow and decreases moisture.
  • Do not wear pantyhose.
  • Wear loose-fitting clothing.
  • Remove underwear at bedtime.

Note: If a sexually transmitted infection is diagnosed, it is very important that any other sexual partners receive treatment, even if they do not have symptoms. If your sexual partner is infected but not treated, you risk becoming infected over and over again.

Expectations (prognosis)

Proper treatment of an infection is usually very effective.

Complications

  • Discomfort that does not go away
  • Skin infection (from scratching)
  • Increased risk of getting HIV if you come into contact with the virus when you have a vaginal infection or irritation

Calling your health care provider

Call your health care provider if vulvovaginitis symptoms are present or if known vulvovaginitis does not respond to treatment.

Prevention

Use of a condom during sexual intercourse can prevent most sexually transmitted vaginal infections. Proper fitting and adequately absorbent clothing, combined with good hygiene of the genital area, also prevents many cases of noninfectious vulvovaginitis.

Children should be taught how to properly clean the genital area while bathing or showering. Proper wiping after using the toilet will also help (girls should always wipe from the front to the back to avoid introducing bacteria from the rectum to the vaginal area).

Hands should be washed thoroughly before and after using the bathroom.

References

Eckert LO, Lentz GM. Infections of the lower genital tract:vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 23.

Merritt DF. Vulvovaginitis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 543.

McCormack WM. Vulvovaginitis and cervicitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 107.


Review Date: 5/31/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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