Vulvitis Symptoms, Causes, Diagnosis, Treatment, and Prevention

Vulvitis is irritation or inflammation of the vulva, the skin right outside the vagina. It can be caused by dryness, skin abrasion, an allergy, infection, or injury. Usually, vulvitis is not serious, though it may cause persistent discomfort or pain. Sometimes, vulvitis is a symptom of an underlying condition that requires treatment, such as a sexually transmitted infection or a fungal infection. If you have persistent irritation for several days, you should see your doctor. Treatment depends on the cause of your vulvitis.

Vulvitis can be caused by anything that irritates the vulva. The most common causes of vulvitis include:

• Infections: Vaginal infections, such as vaginitis, genital herpes, and fungal infections, often cause vulvitis.
• Irritants: Products made with irritating materials or that contain added dyes or perfumes can cause vulvitis without an infection. For example, soaps, powders, sanitary napkins, underwear, pantyhose, and massage oils can all irritate the skin or cause an allergic reaction.
• Medication: Some medications, such as hormone supplements and anti-anxiety medicines can cause vaginal dryness, increasing susceptibility to vulvitis. Oral or intravenous antibiotics increase the risk of a vaginal or vulvar fungal infection, which can cause vulvitis.
• Vaginal Douches: Douches change the fluid in and around the vulva, and can cause dryness and irritation. They also alter the normal bacteria of the vaginal area, potentially causing a vulvar infection.
• Hygiene Habits: Not changing a pad or underwear, prolonged moisture around the vulva, and not wiping or drying properly can all lead to vulvitis.

Women who are perimenopausal or who have gone through menopause are susceptible because decreased amounts of estrogen associated with these transitions make the vulva thinner, less lubricated, and more delicate. Similarly, young girls who have not yet reached puberty are also at risk because they don't make adult levels of estrogen yet.

The symptoms of vulvitis vary depending on the cause and how long it has been affecting you.

Common symptoms include:

• Itching
• Redness
• Swelling
• Soreness
• Pain with sex
• Increased sensitivity when wiping with toilet paper

Some infections or allergies that cause vulvitis produce other symptoms as well, including:

• Thickened or whitish patches
• Fluid-filled, clear blisters that break open and form a crust
• Scaly appearance
• Bumps or warts
• Vaginal discharge

You may already suspect the cause of your vulvitis; perhaps symptoms started after you switched laundry detergents, for example. But sometimes, the cause may not be obvious. Either way, getting a doctor to weigh in is a good idea.

Your doctor can usually diagnose vulvitis with a pelvic examination. Several diagnostic tools, such as urinalysis, testing for sexually transmitted diseases (STDs), and Pap smears, can help your doctor diagnose the cause of vulvitis if you haven't used a product that directly irritated your skin.

The underlying cause of your vulvitis will dictate the treatment.

Your doctor's recommendations may involve these self-care strategies to reduce irritation and inflammation:

• Discontinue the use of soaps, lotions, bubble bath, and other products that cause or aggravate your vulvitis.
• Try not to scratch because this can lead to further irritation, as well as cause bleeding or an infection. 
• Wash the area only once daily with warm water. Over-washing can lead to further irritation.

These may be used alone or in conjunction with medication:

• Low-dose hydrocortisone creams may be prescribed for an allergic reaction.
• Anti-fungal creams or antibacterial creams may be needed for an infection.
• Topical estrogen may relieve inflammation and symptoms for post-menopausal women.

While they won't resolve the condition, other strategies may be used to ease the discomfort you're experiencing as your vulvitis is addressed:

• Taking warm baths, or using a sitz bath
• Applying hot boric acid compresses
• Applying calamine lotion (external areas only)
• Using a hypoallergenic lubricant, particularly before sex

As a general rule, keep your vaginal and vulvar area clean, dry, and cool, especially during menstrual periods and after bowel movements. Be sure to gently cleanse the vaginal and perianal areas, and avoid rubbing with washcloths or towels.

Other ways to prevent vulvitis include:

• Wearing white cotton underpants
• Avoiding excessively tight pants, pantyhose, or any clothes that are abrasive to the vulvar area or that don't allow for adequate air circulation
• Opting for unscented, white toilet paper and fragrance-free feminine products
• Using fragrance- and dye-free laundry detergent; passing on using fabric softener when washing underwear
• Avoiding vaginal sprays and powders
• Changing out of wet clothing promptly, such as after a swim or vigorous exercise
• Always using condoms during sexual activities to reduce your risk of vulvitis, STDs, and other vaginal infections (unless you're in a long-term, monogamous relationship)

Vulvitis is fairly common and usually resolves without complications. Lifestyle adjustments are typically effective unless it is caused by an infection, a medical condition, or a medication. Be sure to listen to your body and don't ignore itching, tenderness, or discomfort of the vulvar area. Vulvitis typically does not go away on its own.