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Vulvovaginitis is an inflammation of the vulva (vulvitis) and vagina (vaginitis) that may occur at any age and affects most females at some time. Because of the proximity of these two structures, inflammation of one usually precipitates inflammation of the other. The prognosis is good with treatment.


Vulvovaginitis is most often caused by a bacterial, fungal, or parasitic infection. Other microorganisms may cause vulvovaginitis, or it may be caused by allergic reaction, irritation, injury, low estrogen levels, and certain diseases.

Vulvovaginitis may be caused by

  • poor genital hygiene, such as wiping your bottom from back to front.
  • anti-yeasts to treat thrush.
  • various chemicals found in bubble baths, soaps, and perfumes.

Signs and Symptoms

Signs and symptoms may vary according to the infecting organism.

In trichomonal vaginitis, the patient may have vaginal irritation and itching along with urinary symptoms, such as burning and frequency. Inspection may reveal a vaginal discharge that is thin, bubbly, greentinged, and malodorous.

A patient with candidal vaginitis may report intense vaginal itching and a thick, white, cottage-cheese-like discharge. Red, edematous mucous membranes with white flecks may be seen on the vaginal wall.

In bacterial vaginosis, inspection may disclose a gray, foul, fishy-smelling discharge, although some patients may be asymptomatic.

Gonorrhea may produce no symptoms, or inspection may reveal a profuse, purulent discharge; the patient may complain of dysuria.

In acute vulvitis, the patient may complain of vulvar burning, pruritus, severe dysuria, and dyspareunia. Inspection may reveal vulvar edema and erythema.

In herpesvirus infection, you may note ulceration or vesicle formation on the perineum during the active phase; in chronic infection, severe edema that may involve the entire perineum.

Diagnostic tests

Diagnosis of vaginitis requires identification of the infectious organism during microscopic examination of vaginal exudate on a wet slide preparation (vaginal exudate applied to the slide is moistened by a drop of normal saline solution and then a drop of potassium solution).

In trichomonal infections, the presence of motile, flagellated trichomonads confirms the diagnosis.

In monilial vaginitis, 10% potassium hydroxide is added to the slide; diagnosis requires identification of C. albicans fungus.

In bacterial vaginosis, saline wet mount shows the presence of clue cells (epithelial cells with bacteria adherent to the cell wall), giving it a stippled appearance.

Gonorrhea requires a culture of vaginal exudate to confirm the diagnosis.

Diagnosis of vulvitis or a suspected sexually transmitted disease may require a complete blood count, urinalysis, cytology screening, biopsy of chronic lesions to rule out cancer, and culture of exudate from acute lesions.


Common therapeutic measures in vulvovaginitis include:

  • metronidazole given orally for the patient with trichomonal vaginitis and all sexual partners (if possible) because recurrence often results from reinfection by an infected, asymptomatic male
  • topical miconazole 2% or clotrimazole 1 % for candidal infection
  • metronidazole for bacterial vaginosis
  • systemic antibiotics for the patient with gonorrhea and all sexual partners
  • doxycycline or erythromycin (for a concurrent chlamydial infection).

Cold compresses or cool sitz baths may relieve pruritus in acute vulvitis; severe inflammation may require warm compresses. Other therapy includes avoiding drying soaps, wearing loose clothing to promote air circulation, and applying topical corticosteroids to reduce inflammation.

Chronic vulvitis may respond to topical hydrocortisone or antipruritics and good hygiene (especially in elderly or incontinent patients). Topical estrogen ointments may be used to treat atrophic vulvovaginitis. There is no cure for herpesvirus infections; however, oral and topical acyclovir decreases the duration and symptoms of active lesions.

Local treatment of genital warts usually consists of application of trichloroacetic acid.

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