An Overview of Vulvitis

Vulvitis is irritation or inflammation of the vulva (the skin right outside the vagina). It can be caused by dryness, skin abrasion, an allergy, an infection, or an injury. Usually, vulvitis is not serious, but 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 because the treatment depends on the cause of your vulvitis.

The symptoms of vulvitis vary, depending on the cause and how long you have had irritation of the vulva.

Common symptoms include:

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

Accompanying symptoms

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

Vulvitis can be caused by anything that irritates the vulva. Any woman who is allergy-prone or has sensitive skin can develop vulvitis.

Women who are perimenopausal or who have had menopause are susceptible because the decreased amounts of estrogen 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. And women who have diabetes also have an increased risk of developing vulvitis because a high blood sugar content increases susceptibility to infections.

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. Soaps, powders, sanitary napkins, underwear, pantyhose, and massage oil can all irritate the skin or cause an allergic reaction.
• Medication: Some medications, such as hormone supplements and antianxiety 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 and 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.

Your doctor can usually diagnose vulvitis with a pelvic examination. You may already know the cause if it is an irritant that you recently started using. But sometimes, the cause may not be obvious.

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

It's important that you try not to scratch because this can lead to further irritation, and it can cause bleeding or an infection. Over-washing the affected area can lead to further irritation so it's best to wash just once a day with warm water.

Treatment of vulvitis varies according to the cause.

• Discontinuing use of soaps, lotions, or other products that cause or aggravate your vulvitis is an important step in relieving the problem.
• 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.

Comfort

There are treatments that can ease the discomfort you're experiencing as your vulvitis resolves, including baths, hot boric acid compresses, calamine lotion, or a hypo-allergenic 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 and avoiding excessively tight pants or any clothes that are abrasive to the vulvar area. Vaginal sprays and powders should also be avoided, Unless you're in a long-term monogamous relationship, always use condoms during sexual activities to reduce your risk of vulvitis, STDs, and other vaginal infections.

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 by medication. Be sure to listen to your body, and don't ignore itching, tenderness, or discomfort of the vulvar area. While it does go away with treatment and avoidance of irritants, vulvitis typically does not go away unless some changes are made.