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Vulvovaginitis

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Synonyms of Vulvovaginitis

Disorder Subdivisions

General Discussion

Vulvovaginitis is a common bacterial infection characterized by the simultaneous inflammation of the external parts of the female genital organs (vulva) and the canal that leads from the uterus to the external opening (vagina). It is one of the most common causes of genital symptoms in women. When only the vagina is inflamed, the disorder is called vaginitis. The symptoms and treatments of vulvovaginitis depend on the specific bacteria that caused the disorder.

The most common types of vulvovaginitis are genital candidiasis (also called yeast infection), trichomoniasis, and nonspecific vaginitis (also called haemophilus vaginalis vaginitis, bacterial vaginitis or gardnerella vaginalis vaginitis). Some types of vulvovaginitis are more rare than others.

Vulvovaginitis occurs when the normal acid/base balance of the vagina is disturbed. Yeast, fungi and other harmful organisms that are normally present in non-symptomatic concentrations may grow in excessive amounts causing infection of the vaginal walls.

Symptoms

The symptoms of genital candidiasis may include moderate to severe itching (pruritus) or burning of the vaginal area, difficult or painful urination (dysuria) and a thick discharge which may resemble cottage cheese. More rarely, there is a thin, watery discharge. Symptoms usually increase during the week before the menstrual period. Approximately 10% of the male sexual partners of infected women may develop symptoms such as abnormal redness and itching of the penis. (For more information, choose "Candidiasis" as your search term in the Rare Disease Database.)

Symptoms of trichomoniasis type of vulvovaginitis may include severe itching and a thin, frothy, offensive smelling discharge. There is usually inflammation of the vulva, and painful, difficult urination. Symptoms usually begin or become worse during or immediately after the menstrual period. Some women do not show symptoms for six months after infection has begun. Trichomoniasis bacteria can be isolated in 30% to 70% of the male sexual partners of infected women. Most men show no symptoms, but should be treated to stop transmission to their female sexual partners.

Women with nonspecific vaginitis usually have a light discharge which may contain bubbles and have a "fishy" odor. Initially, there is little inflammation of the vulva and three-quarters of infected women will show no symptoms. Symptoms of nonspecific vaginitis are not related to the stages of the menstrual cycle. Later symptoms may include inflammation of the vulva, itching or burning of the vaginal area, and painful or difficult sexual intercourse (dyspareunia).

Causes

Vulvovaginitis may occur as a result of a disturbance in the normal acid to base balance in the vagina. This allows bacteria, yeast or other harmful organisms to grow. Factors which may increase susceptibility to these infections are birth control pills, pregnancy, poor diet, antibiotics, frequent douching with chemical products, deodorant sprays, laundry soaps, fabric softeners and bath water additives. Tight, nonporous, nonabsorbent underclothing which does not provide adequate ventilation to the area, along with poor hygiene, may increase the growth of bacteria and fungi. Sensitivity to spermicides, sexual lubricants or latex on a diaphragm or condom may also cause irritation and disturb the natural balance.

Certain forms of vulvovaginitis may be transmitted sexually. More rarely, vaginal infection may be the result of foreign bodies, a viral infection such as herpes, pinworm or tumors of the reproductive tract.

Genital candidiasis (yeast infection) is caused by the fungus candida. Antibiotics taken for infection elsewhere in the body may reduce the normal bacterial content of the vagina, allowing yeasts to overgrow. Women on oral contraceptives are more susceptible to vaginal infections since hormonal changes may also upset the natural balance between bacteria and yeast in the vagina. Genital candidiasis is rarely transmitted by sexual relations. (For more information on this disorder, choose the term "Candidiasis" for your search term in the Rare Disease Database.)

Trichomoniasis is caused by the parasitic protozoa Trichomonas vaginalis, and is usually transmitted by sexual intercourse. Occasionally trichomoniasis may be transmitted nonsexually since trichomonas can survive for several hours on wet surfaces. Contact with infected moist objects such as towels, bathing suits, underwear, washcloths, toilet seats and locker room benches may result in this type of vulvovaginitis.

Nonspecific vaginitis can be caused by the bacteria Haemophilus vaginalis or Gardnerella vaginalis. Nonspecific vaginitis is commonly transmitted by sexual intercourse.

Affected Populations

Vulvovaginitis is very common and occurs most often in women during their reproductive years. Genital candidiasis occurs frequently in pregnant and diabetic women. Certain types of vulvovaginitis may be contracted through sexual intercourse and in turn spread to sexual partners.

Related Disorders

Atopic dermatitis is a chronic (long-lasting) disease that affects the skin. Dermatitis means inflammation of the skin and atopic refers to a group of diseases that are hereditary and often occur together. Some examples are asthma, allergies such as hay fever, and atopic dermatitis. In atopic dermatitis, the skin becomes extremely itchy and inflamed causing redness, swelling, cracking, weeping, crusting, and scaling. Atopic dermatitis most often affects infants and young children, but it can continue into adulthood or first show up later in life. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis will experience a permanent remission of the disease when they get older, although their skin often remains dry and easily irritated. Environmental factors can bring on symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.

Atopic dermatitis is often referred to as eczema, which is a general term for the many types of dermatitis. Atopic dermatitis is the most common of the many types of eczema.

Lichen simplex chronicus is a chronic inflammation of the skin (dermatitis) characterized by small, round itchy spots that thicken and become leathery as a result of scratching. Also termed neurodermatis, lichen simplex chronicus is the result of chronic skin irritation. It is common and occurs in roughly 5 out of every thousand people. A cycle beginning with initial irritation causes itching, and in turn, the itching causes scratching. Scratching leads to further irritation, which damages the skin. Further itching leads to more scratching and more skin damage. The possibility of infection is greatly increased when the outer layer of protective skin is broken. Skin usually repairs itself quickly. However, in the case of lichen simplex chronicus, healing skin causes more itching and more scratching causes a thickening of the skin (lichen).

Psoriasis is a common chronic skin disease that comes in different forms and with
varying levels of severity. Most researchers now conclude that it is related to the
immune system (psoriasis is often called an immune-mediated disorder). It is not contagious. In general, it is a condition that is frequently found on the knees, elbows, scalp, hands, feet or lower back. Many treatments are available to help manage its symptoms. More than 4.5 million adults in the United States have it.

Vulvodynia is a general term meaning pain in the vulva. It is not the name of a disease but a symptom, just like headache. The term vulvodynia is usually used to describe burning or stabbing pain that is felt more diffusely throughout the vulva. Vulvar vestibulitis is a syndrome in which there is pain at specific points in the vulvar vestibule (the portion surrounding the entrance to the vagina). The pain associated with vulvodynia and vulvar vestibulitis can be sharp and there may be small sores, bumps, or what feel like small grains of sand beneath the skin's surface in these areas. Many women have both vulvodynia and vulvar vestibulitis. In both cases, the skin usually feels extremely dry and tears easily, leaving tiny and painful fissures. Both cases may also involve pain that feels as though it travels from the vulva to the lower body (referred pain).

Standard Therapies

Diagnosis
A pelvic examination may reveal red, tender vulvar or vaginal skin. Any lesions or sores will be inspected. A microscopic evaluation of vaginal discharge (wet prep) is usually done to identify a vaginal infection or overgrowth of yeast or bacteria. In some cases, a culture of the vaginal discharge may identify the organism causing the infection.

Treatment
The cause of the infection determines the appropriate treatment. It may include oral or topical antibiotics and/or antifungal creams, antibacterial creams, or similar medications. A cream containing cortisone may also be used to relieve some of the irritation. If an allergic reaction is involved, an antihistamine may also be prescribed. For women who have irritation and inflammation caused by low levels of estrogen (postmenopausal), a topical estrogen cream might be prescribed.

Improved perineal hygiene is necessary to help healing and to prevent future reinfection for those whose infections are caused by bacteria normally found in stool. Sitz baths may be recommended. It is often helpful to allow more air to reach the genital area. Wearing cotton underwear (rather than nylon) or underwear that has a cotton lining in the crotch area allows greater air flow and decreases the amount of moisture in the area. Removing underwear at bedtime may also help.

If a sexually transmitted disease is diagnosed, it is very important that the partner(s) receive treatment, even if there are no symptoms. Many organisms don't produce noticeable symptoms. Failure of the partner(s) to accept treatment can cause continual reinfection, which may eventually, if not taken care of, lead to more extensive problems, possibly limiting fertility and affecting overall health.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com.

Organizations related to Vulvovaginitis

References

TEXTBOOKS
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:1948-51.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1375.

Larson DE, ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:136.

REVIEW ARTICLES
Sheeley A. Sorting out common causes of abnormal vaginal discharge. JAAPA. 2004;17:15-16, 18-20, 22.

Deligeoroglou E, Salakos N, Makrakis E, et al. Infections of the lower female genital tract during childhood and adolescence. Clin Exp Obstet Gynecol. 2004;31:175-78.

Ledger WJ, Monif GR. A growing concern: inability to diagnose vulvovaginal infections correctly. Obstet Gynecol. 2004;103:782-84.

Brook I. Microbiology and management of polymicrobial female genital tract infections in adolescents. J Pediatr Adolesc Gynecol. 2002;15:217-26.

Driver KA. Managing vulvar vestibulitis. Nurse Pract. 2002;27:24-35.

Wines N, Willsteed E. Menopause and the skin. Australas J Dermatol. 2001;42:149-58.

Ferrer J. Vaginal candidosis: epidemiological and etiological factors. Int J Gynaecol Obstet. 2000;71 Suppl 1:S21-27.

Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician. 2000;62:1095-104.

FROM THE INTERNET
Hecht BR. Medical Encyclopedia: Vulvovaginitis. MedlinePlus. Update Date: 7/8/2004. 3pp.
www.nlm.nih.gov/medlineplus/ency/article/000897.htm

Samra OM, Mancini DM. Vulvovaginitis. emedicine. Last Updated: December 1, 2004. 15pp.
www.emedicine.com/med/topic3369.htm

Report last updated: 2009/05/11 00:00:00 GMT+0