Vulvovaginitis

VULVOVAGINITIS

Vulvovaginitis is an inflammation or infection of the vulva and vagina. It's a common condition that affects women and girls of all ages. It has a variety of causes. Other names for this condition are vulvitis and vaginitis.

Bacterial Vulvovaginitis affects a lot of women during their lifetime. It's the most common cause of vaginal symptoms. Studies indicate that vaginal candidiasis (yeast infection) is the second most prevalent vaginal infection.

Vaginitis is the infectious or noninfectious inflammation of the vaginal mucosa, sometimes with inflammation of the vulva. Symptoms include vaginal discharge, irritation, pruritus, and erythema. Diagnosis is usually by testing of vaginal secretions. Treatment is directed at the cause and at any severe symptoms.

TYPES AND CAUSES

Vaginitis occurs when the normal amount of yeast and bacteria in the vagina goes out of balance. This could happen for several reasons, including infection, hormonal changes, or use of antibiotics. It could also be because of the body's reaction to something that comes into contact with the vulva or vagina.

There are three common types of vaginal infections that cause vaginitis.

• Trichomoniasis - This type comes from a tiny, one-celled parasite called Trichomonas vaginalis. It is passed on through sex with someone who's infected. Men who have the parasite don't usually have any symptoms.
• Yeast infection - Sometimes too much of a fungus called C. albicans, or any of several species of candida could be the cause. There is always some candida in the vagina, but an overgrowth causes yeast infections and symptoms of vaginitis.
• Bacterial vaginosis - A healthy vagina naturally has several types of bacteria living in it. Some good and some are bad, but they balance each other out. When the bad bacteria start to outnumber the good bacteria, then bacterial vaginosis occurs.

Those three are usually the culprits behind most cases of vaginitis, however, one can also get it from:

• Allergic reactions to lubricants, lotions, detergent, etc.
• Sexually transmitted diseases
• Viruses, including herpes and human papillomavirus (HPV)
• A decrease in hormones, usually during menopause or after childbirth

Commonly, the causes of vaginitis vary by patient age. Vulvitis and Vulvovaginitis have some of the same causes.

Pediatric

In children, vaginitis usually involves infection with gastrointestinal tract flora (nonspecific Vulvovaginitis).

A common contributing factor among girls aged 2 to 6 years is poor hygiene in the area between the anus and vulva (perineal hygiene). Examples may be wiping from back to front after bowel movements; not washing hands after bowel movements; fingering, particularly in response to itch (pruritus).

• Chemicals in bubble baths or soaps may cause inflammation.
• Sexual abuse can result in sexually transmitted diseases, including Trichomonal vaginitis, in children.
• Foreign bodies (e.g., tissue paper) may cause nonspecific vaginitis with a bloody discharge.
• Sometimes childhood Vulvovaginitis is due to infection from specific pathogens (e.g., streptococci, staphylococci, and Candida species; occasionally, pinworm).

Women of reproductive age

In women of reproductive age, Vulvovaginitis is usually infectious. The most common types are;

• Candidal vaginitis
• Bacterial vaginosis
• Trichomonal vaginitis (sexually transmitted)

In women of reproductive age, Lactobacillus sp is normally the predominant component of normal vaginal flora. Colonization by this bacteria keeps vaginal pH in the normal range, thereby preventing the overgrowth of pathogenic bacteria.

Factors that pre-disposes a person to overgrowth of bacterial vaginal pathogens may include the following:

• Frequent douching
• Poor hygiene
• An alkaline vaginal acidity which may be due to menstrual blood, semen, or a decrease in lactobacilli.

Vaginitis may also result from foreign bodies (e.g., forgotten tampons). Inflammatory vaginitis, which is non-infectious, is not common.

Postmenopausal women

In postmenopausal women, a marked decrease in estrogen usually causes vaginal thinning, increasing the vulnerability to infection and inflammation. Decreased estrogen predisposes one to inflammatory vaginitis.

Hormonal changes during menopause can result in a more alkaline vaginal condition, which can predispose to overgrowth of vaginal pathogenic bacteria.

Poor hygiene especially in patients who are incontinent or bedridden, can lead to chronic vulvar inflammation due to chemical irritation from urine or feces or due to nonspecific infection.

What does odor and discharge say about the cause?

Discharge and odor distinguish the three causes of Vulvovaginitis.

• Trichomoniasis discharge may also have a fishy odor. The color of the discharge is a yellow-green color, and it appears foam-like.
• Discharge with yeast infections is generally white and cottage cheese-like, but it normally does not have an odor. Yeast infections also cause itching.
• Bacterial Vaginosis discharge is more substantial and may appear as a grey or green color. Its fishy smelling odor can distinguish BV.

SYMPTOMS

Typically, the symptoms you get from vaginitis all happen in your vagina or just outside it, on your vulva. What you'll feel will depend on what's causing your vaginitis. It's possible to have more than one type of vaginitis at a time.

Symptoms of vaginitis include

• Itching – An irritating sensation that makes you want to scratch the skin
• Irritation - Uncontrollable sensation that makes you want to scratch to relieve the feeling
• Burning - The two most common infections behind a burning feeling are yeast infections and bacterial vaginosis, or BV, which throws off the vaginal pH and can create a burning feeling
• Redness - Skin redness is often harmless, but can sometimes be a symptom of another condition. Possible causes of red skin include burns, infections
• Swelling - Occurs whenever the organs, skin, or other parts of the body enlarge
• Dryness - Vaginal dryness occurs when the tissues of the vagina are not well lubricated and healthy. It can occur at any age but is more common in older women
• Rash, blisters or bumps - Most causes of vaginal rash aren't medically serious and can be cured. But sometimes an underlying condition is serious or incurable.

You may also notice:

• Pain during sex
• Discharge and odor
• Discomfort when urinating
• Light bleeding or spotting

Abnormal discharge is one of the most common symptoms of vaginitis. It may give the doctor clues to what's causing the vaginitis.

PEDIATRIC VULVOVAGINITIS

In childhood, the infection usually begins in the vulva, with a secondary spread to the vagina. In adolescence, particularly after the onset of sexual intercourse, vaginal involvement is primary. Vulvovaginal candidiasis (yeast infection) is very rare in children unless the child is immune-compromised or on antibiotics.

Young girls are particularly susceptible to Vulvovaginitis. Because the genital area is close to the rectum, bacteria and sometimes parasites spread easily. In addition, children can spread bacterial respiratory infections from their nose and mouth to the vulva. Infection with sexually transmitted pathogens would suggest sexual abuse.

In addition, the vulvar skin is thin and sensitive to trauma from scratching, rubbing from tight-fitting clothing, or exposure to irritants like harsh soaps or bubble baths.

Yeast Vulvovaginitis

A fungus called candida, which is typically found in the intestines, mouth, skin and the tissues around the genital areas, is found in every human being. When, candida grows out of control, it causes a yeast infection, and candida flourishes in warm, dark areas, such as the vagina or armpit.

The different types of Pediatric Vulvovaginitis

Nonspecific Vulvovaginitis

Vulvovaginitis is an inflammation of the vulva and vaginal tissues. This is a common problem in prepubertal girls. It is typically not caused by a specific pathogen and is not treated with antibiotics. It can also be caused by infection, irritation, a foreign body, allergy, or systemic disease.

Yeast Vulvovaginitis

Pediatric yeast infection - A general term that describes when a naturally occurring fungus grows in excess and causes irritation.

Toddler (1 to 3 years) yeast infection – This infection creates a rash in the armpit, diaper area, mouth and neck.

Vaginal yeast infection – This is the most common type of yeast infection. Approximately 75 percent of all women will have at least one during their lifetime. Yeast infections are not common in normal prepubertal girls, so treatment is usually avoided in these girls.

Signs and symptoms of Pediatric Vulvovaginitis

Nonspecific Vulvovaginitis

• Burning sensation during urination
• Redness of vulvar
• Abnormal odor
• Discharge
• Discomfort, pain, or itching
• Vulvar irritation

Yeast Vulvovaginitis

• White, thick coating on tongue
• Vaginal swelling
• Itching and irritation
• Pain during urination
• Rashes

RISK FACTORS

Factors that increase your risk of developing Vulvovaginitis include:

Hormonal changes, such as those associated with pregnancy, birth control pills or menopause

• Douching
• Use of spermicides for birth control
• Sexual activity
• Having a sexually transmitted infection
• Medications, such as antibiotics and steroids
• Uncontrolled diabetes
• Use of hygiene products such as bubble bath, vaginal spray or vaginal deodorant
• Wearing damp or tightfitting clothing
• Use of an intrauterine device (IUD) for birth control

WHEN TO SEE A DOCTOR

Although it is generally not a severe condition, Vulvovaginitis can be serious if not treated. Seeing a doctor is the best way to determine what is happening and to get the right treatments because of the many different causes, including sexual contact.

A doctor will make a diagnosis of Vulvovaginitis based on symptoms and analysis of any vaginal discharge. A pelvic exam can also help with diagnosis. Pelvic exams involve physical and visual examination of the reproductive organs, including the vulva and vagina.

A doctor may test vaginal discharge with a wet prep test, also called a vaginal wet mount. They may test vaginal pH as well, as raised pH levels can indicate BV or Trichomoniasis. A doctor will apply a pH testing stick to the vaginal walls to check pH levels.

Once a doctor has determined the bacteria, yeast, or parasite source of the Vulvovaginitis, they will diagnose the type of Vulvovaginitis, and treatment can begin.

DIAGNOSING VAGINITIS

If one notices changes in their discharge, or other symptoms, the doctor can check things out to see how best to treat the infection.

She'll ask about medical history, including sexual history. She'll also want to know if you've been using anything that may be causing the vaginitis, like new detergent or spermicide.

The doctor will also take a sample of the discharge so it can be examined under a microscope to see what kind of vaginitis the patient has.

In cases which the patient had vaginitis before and can recognize the symptoms, she may be able to treat the problem herself without seeing any doctor.

Diagnosing Pediatric Vulvovaginitis

If a child develops skin irritation in the vaginal area, develops an odor in the area or has discharge from the vagina, they should be made to see their doctor. Depending on the problem and how severe the symptoms are, the doctor may refer them to a gynecology clinic.

The gynecologist will ask questions about the child's general health and do a physical examination. The doctor will want to ensure that there is no infection or skin problem that needs treatment. Sometimes, a small vaginal swab will be taken to look for infection and if there has been any bleeding, the doctor may need to examine further.

The doctor will also ask questions and examine the child just to make sure that they have not been subjected to any sexual abuse. The parent will need to tell the child what the examination is about, with words which they can understand. The aim is to let the child feel comfortable with the examination and make sure they do not have a painful or frightening experience.

After the examination, the doctor will tell you what the best treatment would be. Whatever treatment is recommended, there will be some things that you can do to help at home.

TREATMENT

The correct treatment for Vulvovaginitis depends on the type of infection and the causal organism.

It's possible to treat some types of Vulvovaginitis on your own. But people must be sure to speak with their doctor before initiating any home treatment.

Home Remedies

If the person had a yeast infection in the past, she may be able to treat Vulvovaginitis using over-the-counter products available at any pharmacy, including:

• Oral pills
• Vaginal creams
• Suppositories
• Topical ointments

Crushed garlic and coconut oil, both known for their antibacterial properties, may also help treat the condition at home.

You may be able to relieve some of the symptoms of Vulvovaginitis by sitting in a warm, shallow bath that only covers the hip area (sitz bath). Adding tea tree oil or a trace amount of vinegar or sea salt to the bath may help kill some bacteria, if that's the cause of the symptoms.

Be careful not to sit in the bath for too long. Use a towel to dry the affected area completely after your bath.

Prescribed medications

After the doctor identifies the type of organism that is causing the Vulvovaginitis, he will most likely prescribe medication.

Medications for this condition may include:

• Oral antibiotics
• Oral antifungal pills
• Estrogen creams
• Antibiotic creams (to be applied directly to the skin)
• Antibacterial creams (to be applied directly to the skin)
• Antifungal creams (to be applied directly to the skin)
• Oral antihistamines, (if an allergic reaction is a possible cause)

The doctor may also recommend a personal hygiene routine to help heal the infection and prevent it from recurring. This could include taking sitz baths and wiping properly after using the toilet.

Other suggestions will include wearing loose clothing and cotton underwear to allow for air circulation and to reduce moisture in the area. Removing underwear at bedtime may also help prevent Vulvovaginitis.

Proper cleansing is important and may help prevent irritation. This is especially true if the infection is bacterial. Avoid using bubble baths, perfumed soaps, douches, and washing powders. Instead, opt for sitz baths or sensitive-skin versions of products.

A cold compress may also relieve pain on swollen or tender areas.

Sexual health

It's important for the woman to tell her sexual partner(s) if the Vulvovaginitis is the result of an STI. All sexual partners should receive treatment for the condition, even if they're currently not showing symptoms.

Pediatric Vulvovaginitis Treatment

In many cases, Vulvovaginitis does not need to be treated with anything more than improved hygiene and vulvar care.

This includes:

• Taking sitz baths in lukewarm water to soothe inflammation
• Patting the vulvar area dry after bathing, or allowing it to air dry
• Making sure daughter wipes from front to back after using the bathroom
• Using toilet paper without perfumes or dyes
• Avoiding the use of harsh or perfumed soaps and bubble baths, which can irritate the vulva
• Avoiding tight-fitting, non-breathable clothing and underwear
• Washing clothes in a mild detergent with no rinse or dryer additives
• Discouraging the child from touching the area when sick

Barrier emollients such as Vaseline, Aquaphor ointment, Desitin, or coconut oil can be applied to the vulva to decrease the itching

In some cases, the doctor may prescribe a low-dose topical steroid to reduce itching and inflammation. If these methods don't work, and Vulvovaginitis is caused by infection, her doctor may prescribe antibiotics.

PREVENTION

Keep the genital area clean and dry when you have vaginitis.

• Avoid douching. Many women feel cleaner when they douche, but it may actually make symptoms worse because it removes healthy bacteria that line the vagina. These are bacteria that help protect against infection.
• Avoid soap rinse with just water to clean
• Soak in a warm, not hot, bath to help the symptoms. Dry thoroughly afterward.

Other tips are:

• Refrain from using hygiene sprays, fragrances, or powders in the genital area.
• Use pads instead of tampons while you have an infection.
• If patient has diabetes, keep the blood sugar level in good control.

Allow more air to reach the genital area.

This can be done by:

• Wearing loose-fitting clothes and not wearing panty hose.
• Wearing cotton underwear (instead of synthetic fabrics) or underwear that has a cotton lining in the crotch. Cotton allows normal evaporation of moisture so that moisture buildup is reduced.
• Not wearing underwear at night when you sleep.

Girls and women should also:

• Know how to properly clean their genital area while bathing or showering.
• Wipe properly after using the toilet. Always wipe from front to back.
• Wash thoroughly before and after using the toilet.
• Always practice safe sex. Use condoms to avoid catching or spreading infections.