Vulvitis

What causes vulvitis?

Infections

Infections are caused by germs such as bacteria, viruses and fungi. Vaginal infections are common and can also affect your vulva. The following infections may cause vulvitis:

• Thrush.

• Genital herpes infection.

• Genital warts.

• Other infections: these include scabies and pubic lice.

Skin conditions

Inflammation of the skin of the vulva can be due to an allergy, similar to an allergy affecting other areas of your skin. This is called an allergic or contact dermatitis. Any skin conditions that affect the skin can also affect the skin of your vulva - for example, psoriasis, lichen sclerosus or lichen planus.

Irritation

There are many different products that can cause irritation to the vulval area which then leads to vulvitis. Examples of these include:

• Scented toilet paper.

• Perfumed soaps or bubble baths.

• Spermicides.

• Swimming pool water or hot tub water.

• Horse riding or cycling.

• Synthetic underwear.

Low oestrogen levels

Levels of the female chemical (hormone) called oestrogen are reduced during the menopause. Some women develop vulvitis as a result of their low oestrogen levels. This is usually associated with atrophic vaginitis which causes your vagina to become quite dry and sore.

Young girls who have not yet started puberty can also experience soreness, irritation, redness and sometimes a vaginal discharge due to lack of oestrogen in the vaginal tissues. Thrush is rare in this age group.

Vulval cancer

Vulval cancer is an uncommon cancer and usually affects women aged over 60 years. Vulval cancer can start as a sore or lump in the vulva.

Note: if you have noticed any new changes (however minor) in your vulval area then you should see your doctor.

Vulvodynia

Vulvodynia is a burning, stinging but often unexplained pain affecting the skin around your vagina or vulva. The skin of your vulva is usually normal but some women have some swelling or inflammation.

Symptoms vary greatly between women, and the symptoms often depend upon what is causing the inflammation of your vulva (vulvitis).

The most common symptoms are:

• Itching (this can often be worse at night).

• Soreness.

It is really important to try not to scratch, as this can lead to further irritation and sometimes an infection developing.

It can be common to develop redness and/or swelling of your vulval area. You may notice thickened or whitish patches around your vulval area. Some women develop clear, fluid-filled blisters.

Vulvitis is diagnosed from your symptoms and a physical examination by a doctor or nurse.

The treatment of vulvitis (inflammation of the vulva)depends on the underlying cause. However, it may be recommended that you:

• Avoid using soap or fragranced products to wash your vulva.

• Avoid direct vulval skin contact with bubble bath, deodorants, wet wipes, detergents, textile dyes, fabric conditioners and sanitary products.

• Wash your vulva once a day with warm water.

• Wear cotton underwear that is not too tight.

• Use emollient creams to help soothe the skin.

• Avoid using spermicidally lubricated condoms.

• Have a sitz bath.

Steroid creams

Steroid creams are often given which are usually used for short periods of time. These work by reducing the inflammation and also the irritation and can be really effective for many women. There are different strengths of steroid cream and usually the weakest strength is given first. However, if this does not work effectively then stronger steroid creams are usually given.

Vaginal treatments

Sometimes a cream, pessary or vaginal tablet containing the female chemical (hormone) called oestrogen is prescribed if the cause of your vulvitis is low oestrogen levels.

Other treatments

Local anaesthetic creams, some medications and surgery are some treatments for women with burning, stinging but often unexplained pain affecting the skin around the vagina or vulva (vulvodynia).

If the underlying cause is an infection then an antifungal or antibiotic treatment may be given.

Vulvitis can be prevented by avoiding irritants, such as soap/bubble bath, perfume, panty liners/sanitary towels. It is best to wash the area using only water, and showers are better than baths. It is important to rinse well then pat the vulval area gently but thoroughly dry with a towel after a bath or shower. Wear loose-fitting cotton underwear. Using an emollient can help protect the skin barrier.