What Is Vulvitis

Overview

Vulvitis is an inflammation of the outer part of the vagina, the vulva. It is an especially warm and moist part of the body, making it prone to infections and irritation.

The vulva includes the folds of the skin that are surrounding the vagina, labia majora (outer folds), labia minora (vaginal lips) and the clitoris. The vulva can become irritated and inflamed because of infections, injuries and allergic reactions.^{1,2, 4}

Importance of understanding vulvitis

Any female can experience vulvitis in their life, but it is more common in children and in females who are going through menopause. This is because females who have not reached puberty will have lower estrogen levels than the ones who have their menstruation cycle. Postmenopausal females will also have a lower estrogen level, which can lead to dryer, thinner vulvar tissues. This then increases the chance of injuries and inflammation.³

Common causes and risk factors

Allergies, infections, injuries and irritants can all cause irritation and inflammation in your vulva. The following can cause vulvitis:^2,3

• Perfumes or dyed toilet paper
• Scented pads, tampons, pantyliners
• Scented bubble bath soaps, vaginal sprays
• Douches
• Tight, wet or sweaty clothing worn for long periods of time
• Spermicide
• Allergies to detergents
• Synthetic underwear that does not have a cotton crotch lining
• Injuries during horse riding and cycling
• Poor hygiene

Different  conditions can also cause vulvitis, including:

• Bacterial vaginosis
• Skin conditions such as eczema and psoriasis
• Lichen sclerosis
• Yeast infections
• Lichen planus
• Vaginal atrophy during menopause

Types of vulvitis

Infectious vulvitis

•  Bacterial Vulvitis - a condition caused by the Gardnella spss; a bacteria commonly found in the vagina. The overgrowth of the bacteria caused the imbalance of the pH levels, causing irritation and inflammation of the vulva ³
•  Fungal Vulvitis (Candidal Vulvitis) - a condition that is caused when Candida sps., a naturally occurring fungus, overgrows and causes the vulva to be itchy and irritated. It is caused when the balance of the microorganisms and the pH levels of the vagina are changed, so the fungi multiply due to the changes in the environment of the gastrointestinal tract and the vagina ⁶
• Viral Vulvitis (Herpes Vulvitis) - It is a painful rash, ulcer or blister that is present on both sides of the vulva. These ulcers can then start to crust. It can also be caused by sexually transmitted diseases. ⁷

Non-infectious vulvitis

• Allergic Vulvitis - This happens when, for instance, you are allergic to the laundry detergent that you wash clothes with, causing irritation on the vulva.³ 
• Chemical Irritant Vulvitis - When a certain scent or dye is present on the pad and tampon or toilet paper, it can cause the skin of the vulva to be irritated.³
• Atrophic Vulvitis - A condition that causes inflammation because of low estrogen levels. It is commonly found in women who are postmenopausal, but premenopausal women can experience it as well. ⁵

Symptoms 

There are various symptoms that can cause vulvitis; however, different symptoms can help to differentiate one from another.^{2,3, 5,6,7}

Common symptoms:

• Itching
• Burning
• Redness and swelling in the inner labia or in the vulva
• Discomfort urinating

Specific symptoms for different types:

• Strong-smelling vaginal discharge, coloured green, white or yellow - bacterial vulvitis
• Blisters releasing clear fluid, forming ulcers filled with greyish fluid; painful urination - herpes vulvitis
• Increased vaginal discharge, painful sexual intercourse, soreness - candidal vulvitis

Diagnosis 

Medical history and physical examination

The healthcare professional would first review and look at your medical history and ask you about the symptoms that you are experiencing and any habits you may have for personal hygiene. A physical exam and a pelvic exam are then done. They would look at any skin changes, such as redness, blisters, or lesions on the skin. They can also look at your vaginal discharge if an infection is involved. ²

Laboratory tests

Are there any tests that are done to make sure and to diagnose the type of vulvitis you may have?³

• Urine tests - can help to detect any of the bacteria causing the condition, such as chlamydia, gonorrhoea and trichomoniasis and check for UTIs
• Blood tests- These help to detect syphilis and HIV presence in the bloodstream
• Sexually transmitted infections (STI) tests - these tests can help to narrow down the cause of the condition 
• Pap smear tests - They would take cell samples from your cervix to check its health. 

Differential diagnosis

Different swab tests can be done in different areas of your vulva for further testing, such as for bacteria, yeast or viruses like herpes vulvitis. A white blood cell test can test for syphilis and HIV, which are infections that are sexually transmitted. ¹ 

Treatment and management

Treatment for vulvitis will be dependent on the cause of the inflammation. Most of the time, protecting the vulva from irritants and practising appropriate vulva hygiene and care can help alleviate vulvitis. Your GP can recommend:^2,3,4

Treatment approaches for infectious vulvitis:

• Antibiotics - can help to treat bacterial infections. Given in conjunction with other treatments for a proper treatment plan.
• Topical low-dose steroids/ hormones - given in conjunction with antibiotics to treat vulvitis. Some examples include Estrace, Advantan and Betnovate.

Management of non-infectious vulvitis:

• Over-the-counter medications - such as painkillers and topical creams, can help to alleviate any discomfort.
• Sitz baths - shallow and warm lower body baths to help itch in your vulva.

Prevention 

While vulvitis is very treatable when given the proper care and treatment, there are many things and options you can take to help prevent and to better take care of your vulva:³

• Avoiding irritation - stop using products that can irritate your vulva. These include hygiene products, soaps and detergents. It is better to use loose-fitting, breathable cotton underwear to help the air in the vulva and in the vagina. 
• Changing out from the sweaty and wet bottoms as soon as you can
• Washing the vulva with care and not the vagina
• Do not steam or douche the vagina
• Practicing safe sex is very important to avoid STIs and other sexually transmitted diseases

Complications

There are a few complications which vulvitis can have if left untreated and how it can impact your sexual life. 

Potential complications of untreated vulvitis

If vulvitis is left untreated, then any rashes, lesions or blisters can become infected, worsen over time and even spread towards your anus. The vulva is where bacteria and fungi love to grow, so an early treatment is highly advisable.^2,3

Impact on sexual health

Practising safe measures when it comes to your sexual health is wise, as any itchiness and irritation can be passed to your partner. Even having sexual intercourse can cause worsening of the irritation of the vulva, so it is best to not have any sex during the time you have vulvitis. ⁸ 

When to seek medical attention

It is important to seek advice from your local GP when you experience any of the symptoms, as changes in the environment will change the natural flora around the vulva and the vagina. So, it is essential to be aware of the changes in your body. It is good to look out for any red flags that may be present, such as discomfort, irritation, and lesions. Your body will tell you when something is not quite right, so it is important to listen to it!

Summary

Vulvitis is a condition caused by inflammation and irritation in the vulva. Mostly found in females who are in prepuberty and after menopause, experiencing symptoms like itching, burning and discomfort. It can easily be treated and managed when spoken with your local GP, so it is important to communicate that if left untreated, the symptoms may worsen over time and potentially cause unwanted fungi and bacteria to grow.