Vulvovaginitis

Common causes in adults

Other causes include lichen sclerosus (white, itchy, thin skin), herpes, and retained tampons.

Vulvovaginitis in children

Before puberty, the vulvar and vaginal skin is thin and lacks the protective effects of estrogen, so it is easily irritated. Common causes:

• bubble baths, scented soaps, shampoo in bath water
• tight clothing, nylon underwear, wet swimsuits
• wiping back to front, or incomplete wiping
• pinworms: intense itching at night
• bacteria such as group A strep (bright red, painful area, sometimes after a sore throat) or shigella
• a foreign body such as toilet paper (persistent, foul-smelling, sometimes bloody discharge)
• skin conditions such as eczema or lichen sclerosus

Yeast infections are uncommon in girls who are out of diapers and have not reached puberty, unless they have diabetes or recent antibiotics.

Sexually transmitted infections in a child raise concern for abuse and need specialist evaluation.

Symptoms

• itching, burning or soreness of the vulva
• redness and swelling
• changes in vaginal discharge: amount, color, consistency or smell
• pain or burning when urinating, as urine touches inflamed skin
• pain or discomfort during sex
• light spotting

Diagnosis

Symptoms alone are not reliable for identifying the cause. A clinician may:

• examine the vulva and vagina
• check vaginal pH (raised in bacterial vaginosis and trichomoniasis)
• look at discharge under a microscope
• perform tests for yeast, trichomonas and bacterial vaginosis
• test for chlamydia and gonorrhea
• in girls, examine gently and take a swab if discharge is present

Treatment

• bacterial vaginosis: metronidazole or clindamycin (tablets or vaginal gel or cream)
• yeast infection: antifungal vaginal creams or suppositories (such as clotrimazole or miconazole, available over the counter) or oral fluconazole. Recurrent infections may need longer suppressive treatment
• trichomoniasis: metronidazole or tinidazole; sexual partners must be treated
• atrophic vaginitis: vaginal moisturizers, lubricants, and low-dose vaginal estrogen
• irritant dermatitis: stop the irritant; plain water washing; a bland emollient; sometimes a short course of mild steroid cream
• girls: hygiene measures, sitz baths in plain warm water, loose cotton underwear, and specific treatment for pinworms or bacterial infection

Prevention

• wash the vulva with plain water or a gentle, unscented cleanser; avoid douching
• avoid scented products, bubble baths and feminine sprays
• wear breathable cotton underwear and change out of wet swimwear promptly
• wipe from front to back
• use condoms to reduce STIs and bacterial vaginosis
• control blood sugar if you have diabetes

Frequently asked questions

What is vulvovaginitis?

It is inflammation of the vulva and vagina, causing itching, burning, redness and changes in discharge. It can be caused by infections such as yeast, bacterial vaginosis or trichomoniasis, by irritants, or by low estrogen after menopause.

What causes vulvovaginitis in children?

In young girls, it is usually caused by irritation from soaps and bubble baths, tight or damp clothing, or hygiene factors, rather than infection. Pinworms, strep bacteria and foreign bodies are other causes.

How is vulvovaginitis treated?

Treatment depends on the cause: antifungals for yeast, antibiotics for bacterial vaginosis or trichomoniasis, vaginal estrogen for atrophy, and avoiding irritants for contact dermatitis. Getting the right diagnosis first avoids repeated ineffective treatment.

Is vulvovaginitis contagious?

Some causes are. Trichomoniasis and other STIs are passed through sexual contact, and partners need treatment. Yeast infections and bacterial vaginosis are not usually considered sexually transmitted, and irritant causes are not contagious.