Inflammation of the vagina

Alternative names
Vaginitis; Vaginal inflammation; Vulvovaginitis

Definition
Vulvovaginitis is characterized by inflammation (swelling, redness, and irritation caused by the presence of extra immune cells) or infection of the vulva and 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 diseases 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.

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.

A sexually transmitted disease called Trichomonas vaginalis 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.

Nonspecific vulvovaginitis (where no causative organism or irritant can 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 children with unusual infections and recurrent episodes of unexplained vulvovaginitis. Neisseria gonorrhoeae, the organism that causes gonorrhea, produces gonococcal vulvovaginitis in young girls. Since gonococcal vaginitis is considered a sexually transmitted disease, young girls with culture-proved gonococcal vaginitis should be evaluated for sexual abuse.

Symptoms

     
  • irritation and/or itching of the genital area  
  • inflammation (irritation, redness, and swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area  
  • vaginal discharge  
  • foul vaginal odor  
  • discomfort or burning when urinating

Signs and tests

A pelvic examination may reveal red, tender vulvar or vaginal skin. Any lesions or sores should be inspected. 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.

Trying to diagnose the condition by symptoms alone is very inaccurate in determining the cause of vulvoginitis. Furthermore, self-diagnosis and treatment with over-the-counter medications (such as yeast infection creams) is unwise and may lead to incorrect and ineffective use of these products. For this reason, vulvovaginitis should be diagnosed by a health care provider.

Treatment
The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed.

Improved perineal hygiene is necessary to help healing and to prevent future reinfection for those whose infections are 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. Wearing cotton underwear (rather than nylon) or underwear that has a cotton lining in the crotch area allows greater air flow and decreases the amount of moisture in the area. Removing underwear at bedtime may also help.

Note: If a sexually transmitted disease is diagnosed, it is very important that your partner(s) receive treatment also, even if there are no symptoms. Many organisms don’t produce noticeable symptoms. Failure of the partner(s) to accept treatment can cause continual reinfection, which may eventually (if not taken care of) lead to more extensive problems, possibly limiting fertility and affecting overall health.

Expectations (prognosis)
Proper treatment of an infection is usually very effective.

Complications

     
  • persistent discomfort  
  • superficial skin infection (from scratching)  
  • complications of the causative condition (such as gonorrhea and candida infection)

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 non-infectious 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.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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