Vulvitis

Definition
Vulvitis is inflammation of the external female genitalia (vulva).

Causes, incidence, and risk factors

Vulvitis can be caused by a number of conditions. These include chronic dermatitis, seborrhea or eczema, and allergies, particularly to soaps, colored toilet paper, vaginal sprays, laundry detergents, bubble bath, or fragrances. It can also be caused by infections such as fungal and bacterial infections, pediculosis, or scabies.

Vulvitis can affect women of all ages. In young girls and postmenopausal women, the condition may be caused by low estrogen levels.

Symptoms

• Redness and swelling of the vulvar skin
  
• Burning or itching of the vulvar skin
  
• Thickening of the vulvar skin
  
• Possible small cracks in the vulvar skin
  
• Possible vaginal discharge

A pelvic examination often reveals redness and thickening and may reveal cracks or skin lesions on the vulva.

If there is any vaginal discharge, a wet prep inspection may reveal vaginal infection such as vulvovaginitis or vaginitis as the source.

Treatment

Self-care options may be initiated if no vaginal discharge is present. These include discontinuing the use of any potential irritants, and following the recommendations for preventing vulvitis (see Prevention section).

An over-the-counter cortisone cream may be used 2 or 3 times a day on the affected area for up to 1 week. If these measures do not alleviate symptoms, see your physician.

If discharge from a vaginal infection is the cause of vulvitis, the source of the vaginal infection should be treated and concurrent topical cortisone cream may be used to decrease vulvar itching.

Note: If the infection is transmitted sexually, it is very important that your partner(s) receive treatment also, even if they have no symptoms. Many organisms can be harbored without producing symptoms. Failure of the partner(s) to accept treatment can cause continual reinfection that may eventually lead to more extensive problems, possibly limiting your ability to have children and affecting overall health.

If treatment of vulvitis is not very effective, further evaluation may include biopsy of the skin to rule out the potential of vulvar dystrophy (a chronic vulvar skin condition) or vulvar dysplasia, a precancerous condition. A biopsy may also be necessary if any skin lesions are present.

Expectations (prognosis)

The scratch-and-itch cycle of vulvitis may be difficult to halt, but with adequate identification of the causative factors, it can usually be alleviated over several weeks.

Complications

Itching of the vulva may be a sign of genital warts (HPV - human papilloma virus), vulvar dystrophy, or vulvar dysplasia (a precancerous condition).

Sexually transmitted diseases, which can cause vulvitis, may eventually lead to more extensive problems, possibly causing reduced reproductive ability, total sterility, or problems with general health if they are not treated appropriately.

Calling your health care provider

Call for an appointment with your health care provider if symptoms occur and do not respond to self care measures, or if vaginal discharge accompanies the symptoms. Also call if skin lesions are noted on the vulva.

Prevention

Since one of the main causes of vulvitis is exposure of the vulva to chemicals (bubble bath, douches, detergents, fabric softeners, perfumes, etc.), or other irritating materials (wool, fibrous, or “itchy” materials), daily cleansing with mild soap, adequate rinsing, and thorough drying of the genital area is one of the best ways to avoid it. Also, avoid using feminine hygiene sprays, fragrances, or powders in the genital area.

Avoid wearing extremely tight-fitting pants or shorts, which may cause irritation by constantly rubbing against the skin and by holding in heat and restricting air circulation. Underwear made of silk or nylon is not very absorbant and also restricts air circulation. This can increase sweating in the genital area, which can cause irritation and may provide a more welcoming environment for infectious organisms.

Wearing cotton underwear or pantyhose that have a cotton crotch allow better air circulation and can decrease the amount of moisture in the area. For the above-mentioned reasons, you should also avoid wearing sweaty exercise clothing for prolonged periods. Not wearing underwear while sleeping will also allow more air circulation.

Those infections that may be spread by intimate or sexual contact may be prevented or minimized by practicing abstinence or using safer sexual behaviors, especially condom use.

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