Vulvovaginitis - overview
Vulvovaginitis or vaginitis is swelling or infection of the vulva and vagina.
Vaginitis is a common problem that can affect women and girls of all ages.
Vaginitis; Vaginal inflammation; Inflammation of the vagina; Nonspecific vaginitis
Yeast infections are one of the most common causes of vulvovaginitis in women.
- Yeast infections are most often due to the fungus Candida albicans.
Candida and the many other germs that normally live in the vagina keep each other in balance. However, sometimes the number of candida increases, leading to a yeast infection.
- Yeast infections often cause genital itching, a thick white vaginal discharge, and other symptoms.
The vagina normally contains both healthy bacteria and unhealthy bacteria. Bacterial vaginosis (BV) occurs when more unhealthy bacteria than healthy bacteria grow. BV may cause a thin, gray vaginal discharge and a fishy odor.
A less common type of vaginitis is spread by sexual contact. It is called trichomonias. Symptoms in women include genital itching, vaginal odor, and a heavy vaginal discharge that may be yellow-gray or green in color.
Chemicals can cause itchy rashes in the genital area.
- Spermicides and vaginal sponges, which are over-the-counter birth control methods
- Feminine sprays and perfumes
- Bubble baths and soaps
Low estrogen levels in women after menopause can cause vaginal dryness and thinning of the skin of the vagina and vulva. These factors may lead to or worsen genital itching and burning.
Other causes include:
- Tight-fitting or nonabsorbent clothing, which leads to heat rashes
- Skin conditions
- Objects such as a lost tampon can also cause irritation, itching, and strong-smelling discharge.
Sometimes, the exact cause cannot be found. This is called nonspecific vulvovaginitis.
- It occurs in all age groups, but is most common in young girls before puberty, especially girls with poor genital hygiene.
- It causes a foul-smelling, brownish-green discharge and irritation of the labia and vaginal opening.
- This condition is often linked with excess growth of bacteria that are 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 toilet.
Irritated tissue is more likely to become infected than healthy tissue. Many germs that cause infection thrive in a warm, damp, and dark environment, which can also lead to a longer recovery.
Sexual abuse should be considered in young girls with unusual infections and repeated episodes of unexplained vulvovaginitis.
- Irritation and itching of the genital area
- Inflammation (irritation, redness, and swelling) of the genital area
- Vaginal discharge
- Foul vaginal odor
- Discomfort or burning when urinating
Exams and Tests
If you have been diagnosed with a yeast infection in the past and know the symptoms, 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 provider will perform a pelvic examination. This exam may show red, tender areas on the vulva or vagina.
A wet prep (examining vaginal discharge under a microscope) 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 germ that is causing the infection.
A biopsy (a test of the tissue) of the irritated area on the vulva may be recommended if there are no signs of infection.
Creams or suppositories are used to treat yeast infections in the vagina. You can buy most of them without a prescription at drugstores, some grocery stores, and other stores. Follow the directions that came with the medicine you are using.
There are many treatments for vaginal dryness. Before treating your symptoms on your own, see a doctor who can find the cause of the problem.
If you have BV or trichomoniasis, your provider may prescribe:
- Antibiotic pills that you swallow
- Antibiotic creams that you insert into your vagina
Other medicines that may help include:
- Cortisone cream
- Antihistamine pills to help with itching
Be sure to use the medicine exactly as prescribed and follow the instructions on the label.
Proper treatment of an infection is most often very effective.
When to Contact a Medical Professional
Call your provider if you have symptoms of vulvovaginitis, or if treatment you receive for vulvovaginitis does not relieve your symptoms.
Keep your genital area clean and dry when you have vaginitis.
- Avoid soap. Just rinse with water to clean yourself.
- Soak in a warm, not hot, bath to help your symptoms. Dry thoroughly afterward.
Avoid douching. Many women feel cleaner when they douche, but it may actually make symptoms worse because it removes healthy bacteria that line the vagina. These bacteria help protect against infection.
Other tips are:
- Avoid using hygiene sprays, fragrances, or powders in the genital area.
- Use pads instead of tampons while you have an infection.
- If you have diabetes, keep your blood sugar level in good control.
Allow more air to reach your genital area. You can do this by:
- Wearing loose-fitting clothes and not wearing panty hose.
- Wearing cotton underwear (instead of synthetic fabrics) or underwear that has a cotton lining in the crotch. Cotton increases air flow and decreases moisture buildup.
- Not wearing underwear at night when you sleep.
Girls and women should also:
- Know how to properly clean their genital area while bathing or showering.
- Wipe properly after using the toilet -- always wipe from front to back.
- Wash thoroughly before and after using the toilet.
Always practice safe sex, and use condoms to avoid catching or spreading infections.
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: Elsevier Mosby; 2012:chap 23.
Hoefgen HR, Meritt DF. Vulvovaginitis. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 549.
McCormack WM, Augenbraun MH. Vulvovaginitis and cervicitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 110.
Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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