Vulvitis – Causes, Symptoms, Diagnosis, Treatment

Vulvitis is inflammation of the vulva, the external female mammalian genitalia that includes the labia majora, labia minora, clitoris, and introitus (the entrance to the vagina). It may co-occur as vulvovaginitis with vaginitis, inflammation of the vagina, and may have infectious or non-infectious causes. The warm and moist conditions of the vulva make it easily affected. Vulvitis is prone to occur in any female especially those who have certain sensitivities, infections, allergies, or diseases that make them likely to have vulvitis. Postmenopausal women and prepubescent girls are more prone to be affected by it, as compared to women in their menstruation period.[rx] It is so because they have low estrogen levels which makes their vulvar tissue-thin and dry. Women having diabetes are also prone to be affected by vulvitis due to the high sugar content in their cells, increasing their vulnerability. Vulvitis is not a disease, it is just an inflammation caused by an infection, allergy, or injury. Vulvitis may also be a symptom of any sexually transmitted disease or fungal infection.

Vulvitis, inflammation, and infection of the vulva—the external genitalia of the female. The external organs of the vulva include the labia majora and minora (folds of skin), the clitoris, and the vestibular glands. The basic symptoms of vulvitis are superficial red, swollen, and moisture-laden lesions on the skin of the vulva. Itching sensations are a particularly prominent and consistent symptom. The areas of affected vulvar skin may turn white, crack, or develop fluid-filled blisters that break open, ooze, and crust over.

Types of Vulvitis

  • Candida vulvitis – A yeast infection of female external genitals (the vulva).
  • Chronic vulvitis – A chronic inflammatory skin condition that affects external female genitals (the vulva).

Causes of Vulvitis

Vulvitis may be caused by the following reasons:

  • Allergies or sensitivities towards certain products like – colored or perfumed toilet papers, vaginal sprays or douches, shampoos and hair conditioners, laundry detergents, creams or medications.
  • Reactions to – bubble baths or soaps used on genital area, spermicides, sanitary napkins.
  • Irritations caused by – a yeast infection, chlorinated water in swimming pools or hot tubs, synthetic underwear or nylon pantyhose without a breathable cotton crotch, wearing a wet bathing suit for a long time, bike or horseback riding, douching, poor personal hygiene, incontinence, by urine or stool if it remains in contact with the vulva (as may occur in women who have incontinence or are confined to bed), contact with urine and stool sometimes cause ongoing (chronic) vulvitis.
  • Infections such as – vaginitis, genital herpes, a viral and fungal infection.
  • Factors such as – Diabetes, scabies or pubic lice, eczema or dermatitis, oral sex.[rx]
  • The use of colored or perfumed toilet paper
  • An allergic reaction to bubble bath or soap used to clean the genital area
  • Use of vaginal sprays or douches
  • Irritation by a chlorinated swimming pool or hot tub water
  • Allergic reaction to spermicide
  • Allergic reaction to sanitary napkins
  • Wearing synthetic underwear or nylon pantyhose without a breathable cotton crotch
  • Wearing a wet bathing suit for extended periods of time
  • Bike or horseback riding
  • Fungal or bacterial infections including scabies or pubic lice
  • Herpes
  • Skin conditions such as eczema or dermatitis

Postmenopausal women can be particularly susceptible to vulvitis. As estrogen levels drop, the vulvar tissues become thinner, drier, and less elastic. This makes women more vulnerable to irritation and infection.

Symptoms of Vulvitis

The symptoms of vulvitis are

  • Extreme and constant itching
  • A burning sensation in the vulvar area
  • Vaginal discharge
  • Small cracks on the skin of the vulva
  • Redness and swelling on the vulva and labia (lips of the vagina)
  • Clear fluid-filled Blisters on the vulva
  • Scaly, thick, whitish patches on the vulva
  • Bumps or warts
  • Soreness
  • Pain with sex
  • Increased sensitivity when wiping with toilet paper
  • Blisters on the vulva
  • Scaly, thick, whitish patches on the vulva

Symptoms of vulvitis may also be an indication of other diseases or disorders. A doctor should be consulted when one is having any of these symptoms. The symptoms may vary on depending on the cause and the time period it has been infected for.

Diagnosis of Vulvitis

Adolescents with signs and symptoms of vulvitis should be referred to clinicians who have expertise in adolescent medicine. At Children’s Hospital of Philadelphia (CHOP), these young people are evaluated by our Adolescent Medicine specialists.

At CHOP, diagnosis of vulvitis begins with a series of questions about the patient’s overall medical history, menstrual cycle, symptoms, and any sexual activity. A physical examination follows, which may include a pelvic examination. We welcome parents and caregivers as key partners in supporting a young person’s care during and after treatment of vulvitis.

To help young people develop the skills needed to be responsible for their own health, clinicians typically ask to spend time alone with patients during each visit. This helps young people become comfortable talking with their healthcare providers about their concerns and allows patients to ask questions that may be more difficult to say in front of their parents and caregivers. We respect the privacy and confidentiality of our young patients while ensuring that young people are safe and connected to the appropriate services and resources they need.

To confirm a diagnosis of vulvitis — as well as rule out more serious causes for the vaginal irritation — clinicians may perform the following tests:

  • Urinalysis
  • Tests for sexually transmitted diseases (STDs)
  • Bloodwork or other tests to evaluate for other medical causes of symptoms
  • Urine tests
  • Tests for sexually transmitted infections (STIs)
  • Pap test. This test involves a microscopic exam of cells collected from the cervix. It’s used to find changes that may be cancer or may lead to cancer. It also shows other conditions, such as infection or inflammation.

Treatment of Vulvitis

The treatment of inflammation of the vulva (vulvitis) depends on the underlying cause.

Prescribed medications

After your doctor identifies the type of organism causing your vulvovaginitis, they’ll likely prescribe medication.

Medications for this condition may include:

  • oral antibiotics
  • antibiotic creams (applied directly to the skin)
  • antibacterial creams (applied directly to the skin)
  • antifungal creams (applied directly to the skin)
  • oral antifungal pills
  • oral antihistamines, if an allergic reaction is a possible cause
  • estrogen creams

It is usually recommended that you do not use soap or fragranced products to wash your vulva. In addition, you should avoid contact with your vulval skin with bubble bath, shampoo, personal deodorants, wet wipes, detergents, textile dyes, fabric conditioners, and sanitary wear. These can all worsen the irritation.

You should just wash this area once a day with warm water. Ideally, you should wear cotton underwear that is not too tight. Your doctor may recommend an emollient which you can use instead of soap and this can be very soothing for many women. Emollient creams can also be very soothing to use, as they work to moisturize the skin. If the itching is particularly bad then your doctor may recommend you take an antihistamine tablet which will reduce the itching.

If you are using contraception, it is recommended that your partner should avoid using spermicidal lubricated condoms. Some women find using lubricating gels useful during sex (intercourse).

Steroid creams are often given which are usually used for short periods. These work by reducing the inflammation and also the irritation and can be really effective for many women. There are different strengths of steroid cream and usually, the weakest strength is given first. However, if this does not work effectively then stronger steroid creams are usually given.

If the underlying cause is an infection then an antifungal or antibiotic treatment may be given.

Sometimes a cream, pessary, or vaginal tablet containing the female chemical (hormone) called estrogen is prescribed if the cause of your vulvitis is low estrogen levels.

Local anesthetic creams, some medications, and surgery are some treatments for women with burning, stinging but often unexplained pain affecting the skin around the vagina or vulva (vulvodynia).

Diffuse vestibulitis should be managed as outlined earlier for vulvitis, with oral antifungal treatment for candidiasis if the yeast cultures are positive, avoidance of possible allergens, and use of topical corticosteroids. Vulvar vestibulitis is initially treated symptomatically. Vulvar burning may respond to tap water or baking soda douches to temporarily reduce vaginal acidity. Tepid baths may also provide transient relief. The dyspareunia usually improves with the use of precoital lubricants and topical anesthetic agents. Many patients obtain satisfactory relief of symptoms with these nonoperative measures. For women who do not achieve a satisfactory response, surgical treatment (vestibulopathy) provides good results in about 75% of patients.

Prevention of vulvitis

Your treatment and prevention options depend on your age, health history, lifestyle, and personal risk factors. Your doctor may discuss prevention strategies with you such as:

  • Wearing underwear with a breathable cotton lining
  • Avoiding soaps and hygiene products with added colors or fragrances
  • Changing out of wet clothing as soon as possible
  • Washing the genital area with mild soap and water daily, and drying thoroughly before dressing
  • Avoiding tight-fitting pants and underwear

Treatment will depend on the severity of the irritation. Mild cases of vulvitis, or vulvar itching, may not require medical attention. Simple self-care measures, including avoidance of irritating substances and sitting in warm water, can ease discomfort and promote healing.

If your vulvitis symptoms do not improve within a day or so, visit your doctor at Dignity Health. Your doctor can help determine the cause of vulvar irritation and prescribe appropriate treatment. Medical treatment of vulvitis may include:

  • Topical creams or ointments, including hydrocortisone ointment or estrogen cream
  • Medication to treat infection, if an infection is causing your symptoms, to eliminate the underlying condition

With appropriate diagnosis and treatment, most cases of vulvitis go away within a few weeks, and possibly sooner.

Tips for vulvar hygiene

  • Removal of irritants – no baby wipes; nylons or tight-fitting clothing; wet bathing suits; bathtubs filled with soap, shampoo, or bubble bath; scented detergents; washing powders; or dryer sheets. Sleep in nightgowns or long T-shirts without underwear. All underwear should be dye-free.
  • Cleaning –  Soak the area in warm water for 10–15 minutes per day. Never scrub. Gently wipe front to back with hypoallergenic soap. Stand up in the bath to be soaped, shampooed, and rinsed. Let air-dry or gently pat dry.
  • Toileting – Lean forward when voiding to prevent pooling of urine in the lower vagina and always wipe front to back.
  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down the questions you want to be answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Home remedies

If you’ve had a yeast infection in the past, you may be able to treat vulvovaginitis using over-the-counter products available at any pharmacy, including:

  • vaginal creams
  • suppositories
  • topical ointments
  • oral pills

A pharmacist can likely advise you on the best product for your symptoms and how to apply the product.

Crushed garlic and coconut oil, both known for their antibacterial properties, may also help treat the condition.

You may be able to relieve some of the symptoms of your vulvovaginitis by sitting in a sitz bath — a warm, shallow bath that only covers your hip area. Adding tea tree oil or a trace amount of vinegar or sea salt to the bath may help kill some bacteria if that’s the cause of your symptoms.

Be careful not to sit in the bath for too long. Use a towel to dry the affected area completely after your bath.

Consult your doctor if the inflammation or discharge doesn’t improve after a week of home treatment.

Shop for vulvovaginitis home remedies online:

  • vaginal creams
  • suppositories
  • topical ointments
  • coconut oil
  • sitz baths
  • tea tree oil


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