Vulvovaginitis: Treatment, Symptoms, Causes

Vulvovaginitis is a term used to describe various disorders that share some uncomfortable symptoms: discharge, itching, and pain in or around the vagina.

It’s one of the most common gynecological complaints presented by both children and adults. Because there are many possible causes of vulvovaginitis, it’s important to speak to a medical professional to determine the cause, and decide the correct testing and treatment for your symptoms.

In this article, I’ll describe the symptoms of vulvovaginitis and the different potential causes. I’ll discuss its occurrences in adults and children, and how vulvovaginitis is diagnosed.

I’ll also cover the prescription and over-the-counter (OTC) treatments available, as well as some home remedies used in the prevention and treatment of vulvovaginitis. Finally, I’ll describe when it’s important to contact your healthcare provider to determine which treatment course may be right for you.

What is Vulvovaginitis?

Vulvovaginitis, sometimes referred to as vaginitis or vulvitis, is an inflammation or irritation of the vagina and/or vulva that can cause discharge, itching, and pain inside the vagina or outside the vagina on the vulva, including the labia, clitoris, and bladder and vaginal openings.

What Causes Vulvovaginitis?

There are multiple possible causes of vulvovaginitis, including:

Yeast infection

Vaginal yeast infections, also called vulvovaginal candidiasis, affect up to 75% of women at some point in their lives. Many women will experience more than one yeast infection. 

A yeast infection occurs when something disturbs the balance of naturally occurring yeast and bacteria in the vagina.

This leads to an overgrowth of yeast (most often the fungus candida albicans), which causes irritation, redness, discharge, and itching.

It can be caused by recent antibiotic use, wet or sweaty clothes, recent sexual activity, stress, or may happen with no clear cause. 

In addition to vaginal itching, the most common symptoms of a yeast infection include:

• Vulvar and vaginal Irritation
• Burning sensations (particularly during urination and sex)
• A red, swollen vulva
• Pain and soreness in the vaginal area
• Vaginal rash
• Thick, white, odorless discharge with a cottage cheese-like appearance, or watery discharge

In most cases, medication prescribed or recommended by your provider will effectively treat a yeast infection.

If you think you might have a yeast infection, talk with your healthcare provider to determine which over-the-counter (OTC) or prescription medication is best for you. 

Bacteria

Bacterial vaginosis is a common cause of vulvovaginitis triggered by a change or imbalance of the normal bacteria found in the vagina, leading to an overgrowth of a bacteria called gardnerella vaginalis, which can cause allow other bacteria to grow—and cause symptoms.

These symptoms can be similar to those of a yeast infection, which is why it’s important to speak to your healthcare provider to determine the exact cause of your vulvovaginitis. Symptoms of bacterial vaginosis include:

• Thin, white or gray vaginal discharge
• Foul-smelling, or fishy-smelling vaginal odor
• Vaginal itching
• Burning during urination

Though not considered a sexually transmitted infection, bacterial vaginosis more commonly occurs in sexually active women.

Sexually Transmitted Infections (STIs)

Some sexually transmitted infections (STIs) can cause vulvovaginitis. In some cases, additional symptoms may be present. 

STIs that can cause vaginal itching include:

• Trichomoniasis
• Chlamydia
• Genital warts
• Genital herpes

Additional symptoms you may experience are:

• Abnormal growths
• Green or yellow vaginal discharge
• Pain during urination

If you think you may have an STI, reach out to a healthcare provider to arrange for a test.

Environmental Causes

Irritants and chemicals found in soaps, sprays, and some contraceptives can trigger an allergic reaction, which can cause vulvovaginitis. 

Common irritants that can cause inflammation of the vagina or vulva can be found in:

• Soap or bubble baths
• Detergents and fabric softeners
• Feminine sprays
• Douches
• Topical contraceptives
• Creams and ointments
• Scented toilet paper
• Spermicides
• Forgotten tampons
• Sanitary napkins

Lifestyle

Some lifestyle factors, like wearing damp or tightfitting clothing, or using an intrauterine device (IUD) for birth control, can trigger vulvovaginitis.

Other possible lifestyle causes include:

• Uncontrolled diabetes
• Antibiotic or steroid use
• Sexual activity

Skin diseases

Some skin diseases, including eczema (atopic dermatitis), can cause redness and itching in the vagina or vulva.

If you have red or scaly rashes or patches that accompany your itchiness, talk to your doctor to determine if one of these skin conditions may be the cause.

Injury

An injury to the vagina or vulva can also cause vulvovaginitis.

Common injuries that can cause the symptoms of vulvovaginitis include bike or horseback riding.

Menopause & Pregnancy

Hormonal changes associated with menopause, pregnancy, and even birth control use can cause vulvovaginitis.

Reduced estrogen levels after menopause or surgical removal of the ovaries can cause the vaginal lining to become thin, leading to irritation, itching, burning, and vaginal dryness.

Some women also experience pain during sexual intercourse.

Parasites

There are two parasitic infections which can also cause vulvovaginitis: Pubic lice and scabies.

Public lice, also known as crabs, are small insects that can cause extreme vaginal itching when found in the genital area.

Though most commonly transmitted through sexual activity, they can also be spread through infested sheets, clothing, blankets, or towels.

Scabies is a skin condition caused by small bugs called mites that burrow underneath the skin and cause itching and irritation.

Though anyone can get scabies, they most commonly spread between people who live in close proximity to one another, including family members and the elderly who live in assisted living facilities.

Your healthcare provider can confirm a diagnosis of pubic lice or scabies with a thorough examination of your genital area. If the prescribed lotion or shampoos don’t work to kill them, your provider may prescribe stronger oral or topical treatments.

Vulvar cancer

In rare cases, symptoms of vulvovaginitis may be a sign of vulvar cancer. Additional symptoms of vulvar cancer include: 

• Persistent itching, burning, or bleeding on the vulva
• Changes in the color of the skin of your vulva
• Rashes or warts on your vulva
• Pain, especially during sex or urination
• Persistent sores, lumps, or ulcers on your vulva

If you experience any of the above symptoms, speak with a medical professional as soon as possible. 

Symptoms

There are no one-size-fits-all symptoms of vulvovaginitis.

Some people may only experience a mild itch, while others may experience more severe symptoms. 

With vulvovaginitis, you may experience one or several of the following symptoms:

• A change in the regular color, odor, or amount of vaginal discharge
• Vaginal itching or irritation
• A burning sensation in the vulva or vagina
• Small cracks on the skin of the vulva
• Redness or swelling
• Blisters on the vulva
• Scaly, thick, whitish patches on the vulva
• Pain during intercourse (dyspareunia)
• Painful urination
• Light vaginal bleeding or spotting

Vulvovaginitis in Children

Pediatric vulvovaginitis is common in girls of all ages, though the causes can vary depending on the child’s age.

Before puberty, the lining of the vagina and skin of the vulva is very thin, which can make it more susceptible to irritation caused by chemicals in soaps and detergents, as well as fungal and bacterial growth. 

Post-pubescent girls can also get vulvovaginitis triggered by irritation, or bacterial and fungal growth.

Hormonal changes experienced during this period can also be a possible cause, as can sexual activity.

Girls of all ages can also get vulvovaginitis caused by poor bathroom hygiene.

Wiping front to back can help keep the area clean from infection or irritation. Other common causes of vulvovaginitis in children include streptococcus (the same bacteria that causes strep throat) and pinworms, an intestinal infection caused by very small, parasitic worms.

Diagnosis

Most providers will diagnose vulvovaginitis based on your medical history and possibly an external or full pelvic exam.

In some cases, your provider may also want to collect a sample of your cervical or vaginal fluid or a sample of your urine to determine the possible cause of your vulvovaginitis.

Treatment

Treatment options for vulvovaginitis vary based on the cause of your symptoms identified by your provider.

In most cases, working with your doctor, gynecologist, or other medical professional is the best way to find the right treatment approach.

Medication

• Antifungal medications: If your provider identifies a yeast infection as the cause behind your symptoms, they may prescribe an antifungal medication such as fluconazole (Diflucan). There are also effective over-the-counter (OTC) antifungal medications that they might recommend, such as miconazole (Monistat) or clotrimazole.

• Antibiotic or anti-parasite medications: Medications such as metronidazole (Flagyl, MetroGel-Vaginal), clindamycin (Cleocin, Clindesse), or tinidazole (Tindamax), may be prescribed to treat bacterial vaginosis or some STIs.

• Antiviral medications: In the case of certain STIs like genital herpes, your doctor may recommend an antiviral medication.

• Corticosteroid creams and ointments: If your provider identifies a skin condition like dermatitis as the cause behind your vulvovaginitis, they may prescribe a corticosteroid cream or ointment. 

• Hormone therapy or estrogen cream: If menopause or low estrogen is the cause of your uncomfortable symptoms, treatment may involve hormone therapy, estrogen creams, tablets, or a vaginal ring insert.

• Supportive care: Vaginal itching due to the environment, an irritant or allergy should resolve on its own or once the chemical irritant or stressor is removed or managed. OTC vaginal itch creams may be used for symptoms until they resolve.

Home remedies

Though there are some things you can do at home to help soothe your vulvovaginitis, it’s important to speak with your provider first to determine whether or not testing or prescription medication is needed to determine and treat the root cause of your symptoms.

Once the cause and correct course of treatment has been identified, there are a few things you can do at home to supplement your treatment:

• Cold compress: Apply a cold compress to the labial area. Avoid anything scented, and use only cool water.

• Sitz bath: Sit in a tub of plain—not soapy—cool or lukewarm water for 10-15 minutes, several times per day. Afterwards, be sure to pat the vaginal area dry with a clean towel.

• Avoid tight-fitting clothing and irritating chemicals: Avoid thong underwear and tight pants, and stick with loose cotton, breathable underwear and clothes when possible. Change out of wet and sweaty clothes right away. Avoid douching, and avoid any highly fragranced bath and shower products.

Prevention

There are some things you can do to help prevent vulvovaginitis.

Some of the most effective preventive methods include:

• Avoiding scented lotions, soaps, sprays, and douches on your genital area
• Changing out of wet clothing right after swimming or exercising
• Wearing cotton underwear or underwear with a breathable, cotton lining
• Taking probiotics or eating foods with live cultures
• Using condoms during sexual intercourse
• Wiping front to back after bowel movements
• Consider boric acid suppositories per package instructions to maintain a normal pH
• Urinating right after intercourse

If you experience persistent symptoms that don’t resolve on their own, or if you have additional symptoms, talk to a healthcare professional to determine the cause and correct course of treatment.

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