Vulvovaginitis

Alternative names:

inflamed vulvae

Definition:

Inflammation of the vulva and vaginal areas.

Causes, incidence, and risk factors:

Vulvovaginitis can afflict women of all ages, however it is most commonly seen in prepubertal (before puberty) girls. Once puberty begins, the vagina becomes more acidic which tends to help prevent infections. Vulvovaginitis can be caused by various chemicals found in bubble baths, soaps, and perfumes, environmental factors such as poor hygiene and allergens, and organisms including bacteria, yeasts, viruses, and parasites. Candida albicans, which causes a yeast infection, is one of the most common causes. Sexually-transmitted diseases can also cause vulvovaginitis.

Nonspecific vulvovaginitis (that is, no causative organism or irritant is identified) can occur in girls with poor genital hygiene and is characterized by a foul-smelling, brownish green discharge and irritation of the labia and vaginal opening. This condition is often associated with an overgrowth of a type of bacteria that is typically found in the stool. These bacteria are sometimes spread from the rectum to the vaginal area by wiping from back to front after using the bathroom. Pinworms can cause itching in the rectal area, where scratching may cause bacterial spread to the vagina. Strep or staph bacteria, which may be found in the nose and transferred on the fingers, are also associated with some cases.

Neisseria gonorrheae, the organism that causes gonorrhea, produces a form of vulvovaginitis in young girls. Young girls with culture-proved gonococcal vaginitis should be evaluated for sexual abuse because gonococcal vaginitis is considered a sexually-transmitted disease. Gardnerella vaginalis is a common cause of vulvovaginitis in children, and Candida albicans (yeast), which can also cause vulvovaginitis and is frequently associated with itching, effects women of all ages. A yeast infection may arise following a course of antibiotics, especially tetracycline. The antibiotics produce an environment within the vagina that destroys the anti-fungal bacteria that are normally present, allowing C. albicans to thrive.

Bubble baths, feminine sprays, perfumes, and harsh soaps can cause irritating itchy rashes in the genital area, while tight fitting or irritating clothing, and non-absorbent clothing sometimes cause heat rashes. Irritated tissue is more susceptible to infection than normal tissue, and many infection causing organisms thrive in environments that are warm, damp, and dark. Not only can these factors contribute to the cause of vulvovaginitis, they frequently prolong the recovery period.

Note: Sexual abuse should be considered in children with unusual infections and recurrent episodes of unexplained vulvovaginitis.