Vulvitis: Irritation of the Vulva

Vulvitis is irritation or inflammation of the vulva, the skin folds right outside the vagina. It's not usually serious but may cause persistent discomfort, itchiness, or pain.

While vulvitis may be a symptom of a yeast infection or sexually transmitted infection (STI), it can also be caused by dryness, hormones, skin abrasion, an allergy, or injury.

Once the cause is diagnosed, it can usually be treated quickly with over-the-counter remedies to relieve symptoms or prescription medication to treat the underlying cause. If vulvitis persists for more than a few days, see your healthcare provider.

What Are the Signs and Symptoms of Vulvitis?

Vulvitis is not a medical condition on its own but a sign of a disease or medical issue.

Vulvitis is characterized by the following issues, which are symptoms of an allergy, infection, or irritation that should be checked by a healthcare provider:

• Itching
• Redness
• Swelling
• Soreness
• Pain with sexual activity
• Increased sensitivity when wiping with toilet paper
  

Vulvitis Causes

Vulvitis can be caused by anything that irritates the vulva. The most common causes of vulvitis include:

• Infections: Vagina infections, such as bacterial vaginosis, yeast infections, and STIs like genital herpes, can often cause vulvitis.
• Irritants: Products made with irritating materials or added dyes or perfumes can cause vulvitis without an infection. For example, soaps, powders, sanitary napkins, underwear, pantyhose, and massage oils can all irritate the skin or cause an allergic reaction.
• Medication: Some medications, such as hormone supplements and anti-anxiety medicines, can cause vaginal dryness, increasing the likelihood of vulvitis. Oral or intravenous (IV) antibiotics increase the risk of a vaginal or vulvar fungal infection, which can cause vulvitis.
• Vaginal douches: Douches change the fluid in and around the vulva, and can cause dryness and irritation. They also alter the normal bacteria in the vaginal area, potentially causing a vulvar infection.
• Hygiene habits: Not changing a pad or underwear, prolonged moisture around the vulva, and wiping or drying improperly can all lead to vulvitis.

Risk Factors

Anyone with a vulva can develop vulvitis. However, those who are allergy-prone, have sensitive skin, or have a weakened immune system may be particularly at risk.

Specific risk factors include:

• Diabetes: People who have diabetes also have an increased risk of developing vulvitis because high blood sugar content increases susceptibility to infections.
• Menopause: Those who are perimenopausal (the phase leading up to menopause) or have gone through menopause are susceptible to vulvitis due to lower estrogen levels that make the vulva thinner, less lubricated, and more delicate.
• Pregnancy: Changes in hormone levels can make you vulnerable as well.
• Pre-pubescence: Female children who haven't reached puberty are also at risk because they don't make adult levels of estrogen yet.
• Weakened immune system: People with HIV or those taking immunosuppressants or undergoing corticosteroid therapy may develop vulvitis due to lower immunity.

When to See a Healthcare Provider for Vulvitis

If vulvitis persists for several days and does not resolve with over-the-counter treatments, see your healthcare provider.

Vulvitis can be caused by infections or allergies that may require prescription medication. See your healthcare provider for vulvitis accompanied by the following symptoms:

• Thickened or whitish patches
• Fluid-filled, clear blisters that break open and form a crust
• Scaly appearance
• Bumps or warts
• Vaginal discharge
  

How Vulvitis Is Diagnosed

You may already suspect the cause of your vulvitis. Perhaps symptoms started after you switched laundry detergents or soaps, for example. But sometimes, the cause may not be obvious.

Your healthcare provider can usually diagnose vulvitis by examining your vulva or performing a pelvic examination. Several diagnostic tools may also be used. These include urinalysis (urine test) and testing for sexually transmitted infections (STIs).

These can help narrow down a diagnosis if you haven't used a product that directly irritated your skin.

Treatment for Vulvitis

Vulvitis will often go away on its own in a few days if it's due to irritants such as soap products or related to other non-infectious causes. You can often manage these symptoms with home remedies.

However, vulvitis from an infection requires medical treatment. Untreated infections can lead to pelvic inflammatory disease (PID), pain, scarring, and inflammation.

Home Remedies

The following at-home strategies can help to relieve the itching, irritation, and inflammation of vulvitis:

• Discontinue the use of soaps, lotions, bubble baths, and other products that may have caused or aggravated your vulvitis.
• Apply a cool compress or ice pack wrapped in a washcloth to the vulva to ease pain and itching.
• Take lukewarm baths or sitz baths with baking soda to relieve itching and irritation.
• Try not to scratch or rub the area because this can lead to further irritation, as well as cause bleeding or an infection. 
  
• Wash the area only once daily with warm water. Overwashing can lead to further irritation.
  

Medications

Prescription and over-the-counter (OTC) medications that may be used to treat vulvitis include:

• Antibiotics or antibacterial creams are prescribed to treat bacterial infections.
• Antifungal medications are used to treat yeast infections, including OTC creams and prescription oral medications.
• Low-dose hydrocortisone creams, with OTC or prescription, may be used to treat an allergic reaction.
• Oral antihistamines, like Benedryl (diphenhydramine), may help relieve itching.
  
• Topical estrogen or hormone replacement therapy may be prescribed for post-menopausal vulvitis.
  

Preventing Vulvitis

As a general rule, keep your vaginal and vulvar area clean, dry, and cool, especially during menstrual periods and after bowel movements.

Be sure to gently cleanse the vaginal area. Avoid harsh rubbing with washcloths or towels.

Other ways to prevent vulvitis include:

• Wearing cotton underpants
• Avoiding excessively tight pants, pantyhose, or any clothes that are abrasive to the vulvar area or that don't allow for adequate air circulation
• Opting for unscented, white toilet paper and fragrance-free feminine products
• Using fragrance- and dye-free laundry detergent
• Avoiding fabric softener when washing underwear
• Avoiding vaginal sprays and powders
• Changing out of wet clothing promptly, such as after a swim or vigorous exercise
• Using external or internal condoms during sexual activities to reduce your risk of vulvitis, STIs, and other vaginal infections

Summary

Vulvitis is irritation around the vulva that leads to itchiness, redness, and pain. It can be caused by a number of things, including vaginal infections, medications, and products with dyes and perfumes.

Your healthcare provider can usually diagnose vulvitis with a pelvic exam. They may use other tests, like those for STIs, to help you find the cause. If it's caused by a fungus or bacteria, your doctor may prescribe a cream to treat the condition.

To prevent vulvitis, keep the area around your vagina clean and dry. Don't use soap or bubble baths with irritants like dyes and perfumes. Use condoms during sexual activities to help avoid infection.