What is Vulvovaginitis?
Vulvovaginitis is described as a collection of a variety of conditions that affect the external genitalia of a female, most commonly the vulva and vagina. These conditions are mainly characterized by inflammation and infection of the vulva and the vagina. Vulvovaginitis is extremely common and can be easily treated with medications. The primary causes of Vulvovaginitis include bacterial and yeast infections. Certain parasitic infections also at times cause Vulvovaginitis. In majority of the cases, both the vagina and vulva get affected by this condition; however, the symptoms that a female experiences tend to be variable [2].
In a study around 200 females of reproductive age with known diagnosis of Vulvovaginitis who presented to the emergency department with vaginal discharge, pain, and redness were analyzed. The most common cause for the condition in the participants was believed to be parasites or infections. Sexual abuse as a causative factor was also studied in the subjects but there was no evidence found of any sexually transmitted infection or injury. Urinary tract infections were also studied as a possible cause but it was noted only in 20 participants of the study [1].
Treatment of the parasitic infection and improving personal hygiene were good enough to provide symptom relief in all the participants. The urinary symptoms that were seen in some participants were believed to be caused due to irritation of the genital area with no active evidence of infection. Thus, researchers believe that before treatment is started with antibiotics that a urine culture be done to confirm the diagnosis of infection [1].
In case if a patient presents with recurrent episodes of Vulvovaginitis despite successful treatment then the possibility of sexual abuse should be considered and the patient should be sent for psychological counseling if required. This article explains some of the causes of Vulvovaginitis and different treatment options for the condition [1].
What Causes Vulvovaginitis?
Some of the causes for Vulvovaginitis include:
Bacterial Vaginosis: This is by far the most common cause of Vulvovaginitis and the primary cause for this condition is the domination of bad bacteria over good bacteria in the vagina where these bacteria are naturally present. There is no evidence to suggest that sexual activity has a role to play in the bacterial imbalance seen in cases of bacterial vaginosis but definitely has the potential [2].
Studies suggest that about 30% of females between the ages of 15 and 50 in the United States have bacterial vaginosis. This data is according to the Center for Disease Control. In majority of the cases, bacterial vaginosis is asymptomatic [2].
Yeast Infections: This is yet another cause of Vulvovaginitis. The most common yeast infection that causes Vulvovaginitis is candida infection. When both the vagina and the vulva get affected then it is termed as vulvovaginal candidiasis. It should be noted here that yeast infections are not sexually transmitted. Studies suggest that 75% of females develop yeast infection at some point or the other [2].
This infection also has the tendency to recur even after successful treatment. This is seen in people who are immune compromised such as people above the age of 65 or people who have autoimmune disorders. Diabetics and people with SLE also are at increased risk for developing yeast infections affecting the vulva and vagina [2].
Trichomonas Infection: This infection in most cases is caused due to unprotected sex with multiple partners even though there have been some cases where it has not been transmitted sexually. In the United States only around 3% of females in the reproductive age have Trichomonas infection which makes this quite a rare entity. Again, this data is released by the Center for Disease Control [2].
Some of the other causes of Vulvovaginitis include allergies due to certain types of soaps, lotions, and shampoos. In some cases, if a female wears tight undergarments in a hot environment causing heat rash may also result in inflammation in the vagina and vulva. People with certain types of dermatological disorders also are at an increased risk for developing Vulvovaginitis [2].
Depleted levels of estrogen in the body such as seen after reaching menopause or after delivery of a child can also at times cause Vulvovaginitis. Females who do not practice good personal hygiene also are at increased risk of having Vulvovaginitis. This is mostly seen in young girls under the age of 10. These little girls generally do not practice or are not aware of the correct hygienic practices which can lead to Vulvovaginitis [2].
How is Vulvovaginitis Treated?
Even though Vulvovaginitis can be treated easily if it remains untreated it can cause certain serious complications. If a female has symptoms that point towards a bacterial or parasitic infection then it is best to consult with a physician who will then identify a diagnosis and formulate a treatment plan. Based on the symptoms and tests conducted, a diagnosis of Vulvovaginitis will be confirmed [2].
In some cases, the physician may also do a detailed pelvic examination to confirm the diagnosis of Vulvovaginitis. To rule out Trichomonas and bacterial vaginosis, a vaginal pH test may also be done [2].
Coming to the treatment options for Vulvovaginitis, the cause determines the course of treatment. For cases of bacterial vaginosis as a cause for Vulvovaginitis, treatment options include medications and topical ointments which can be directly applied to the vagina or the vulva. Metronidazole is the most preferred medication to treat cases of bacterial vaginosis which will be prescribed by the physician. For treating yeast infections, over-the-counter antifungal medications can easily get rid of the condition.
Miconazole is the most preferred medication for this purpose [2].
For severe cases of yeast infection, the physician may prescribe stronger antifungal medications like fluconazole. For treatment of sexually transmitted diseases like Trichomoniasis, the Center for Disease Control recommends metronidazole which is extremely successful in treating this condition. Just a single dose of this medication is enough to treat Trichomoniasis [2].
However, once treated the patient should avoid any sexual contact for at least a week to prevent any recurrence of the condition. In case if the symptoms return after successful treatment then the patient should be reevaluated again for diagnosis and to rule out other conditions causing the symptoms [2].
In conclusion, Vulvovaginitis is a collection of disorders that cause inflammation and infection of the vagina and the vulva. It is quite a common condition and can be cured easily by medications. However, if it is left untreated then it has the potential to cause significant complications. Bacterial and parasitic infections are the most common causes of Vulvovaginitis. Bacterial infections are caused when the bad bacteria starts dominating over the good bacteria present on the vagina. Poor hygiene practices often increase the risk of a female developing bacterial vaginosis [1, 2].
In some cases, wearing tight undergarments on a hot day resulting in heat rash also at times can cause bacterial vaginosis as the damp and hot environment provides the best environment for bacterial infection. It is also essential to get involved in sexual activity with full protection to prevent Trichomonas from infiltrating the body and causing inflammation of the vagina and vulva. Using antifungals can easily treat this infection. Some of the other causes of Vulvovaginitis include depleted estrogen levels or allergies [1, 2].
Vulvovaginitis can be prevented by practicing good hygiene, have safe sex, and wearing loose fitting undergarments especially on a hot and humid day. In case if a female experiences symptoms suggestive of Vulvovaginitis, then it is better to consult with a physician and start treatment to prevent any unwarranted complications [1, 2].
