Vaginitis and vulvovaginitis

Vaginitis can be caused by many things, and simply refers to ‘inflammation’ (itis) of the vulva and/or vagina.

Vulvovaginitis is where the inflammation also affects the vulva, which is the external genitalia like your labia, as opposed to your vagina, which is the canal that leads to your uterus on the inside of your body.

Vaginitis is inflammation of the vaginal tissue (mucosa), and can be caused by an infection or another irritant. It is important that you get to a clinic to be tested to find the cause, and treat it because you don’t want an infection lingering.

It can be very hard to tell what the cause of vaginitis is without an investigation, though sometimes your irritation will clear up on its own. This is particularly true if it was being caused by something you were doing (like douching) and you stop the irritating activity.

Your vagina will try to get itself back to balance unless something is preventing this from happening like an irritant or microbe.

Symptoms of vaginitis or vulvovaginitis

• Abnormal vaginal discharge
• Irritation of the vulva or vagina
• Itchy vulva and/or vagina
• Redness of the vulva – labia, vaginal entrance
• Burning sensation
• Pain
• Bleeding from the outer vulva or the vagina
• Discomfort wearing underwear or tight clothes
• Urethral syndrome (feels like a UTI but a test comes back negative)
• Painful urination (dysuria)
• Painful sex (dyspareunia)

Vaginitis is very common, since it doesn’t take much to get the vulva and vagina inflamed – the mucous membranes are quite delicate and necessarily sensitive.

When vaginitis involves the vagina and vulva, it is called vulvovaginitis, but when it only affects the vulva, it is called vulvitis.

Vulvovaginitis, vulvitis or vaginitis in children

If the vaginitis is in children, see our article specifically for vulvovaginitis in children. Typically children have a foreign object inside the vagina or are wiping incorrectly, transferring bacteria and causing an infection. Kids don’t have protective lactobacilli, so can get vulvovaginal infections more easily.

Vulvovaginitis, vulvitis or vaginitis in fertile-age people

In fertile-aged people, the most common cause of vaginitis is bacterial vaginosis or aerobic vaginitis, a yeast infection or a sexually transmitted infection like trichomoniasis.

Vulvovaginitis can also be caused by poor hygiene and problems like forgotten tampons or other foreign objects left inside the vagina for too long.

Microbes can overgrow if given an appropriate medium on which to feed and reproduce. Vaginitis is most often caused by a bacterial problem (infection or imbalance).

Inflammatory vaginitis without a microbial problem is rare, but does happen. There is a condition called desquamative inflammatory vaginitis (DIV), which is a mysterious, persistent vaginitis.

Vulvovaginitis, vulvitis or vaginitis in menopausal women

In postmenopausal women, decreased oestrogen levels cause thinning vaginal skin and greater susceptibility to atrophic vaginitis. Atrophic vaginitis – now named as part of the genitourinary symptoms of menopause (GSM) – can be remedied with oestrogen cream, some diet modifications, and more frequent sexual activity.

Sexual activity keeps cells juicy, even if you do it to yourself. Vulvovaginal infections are less common in menopausal women despite this group of women having few lactobacilli, much like their prepubertal counterparts. This is due to lowered oestrogen levels.

Vulvovaginitis, vulvitis or vaginitis in bed-bound or those with incontinence

If the vaginitis is in a bed-bound person or someone who suffers from incontinence, hygiene challenges are likely the cause, and can lead to chronic vulvar inflammation.

Risk factors for vulvovaginitis in compromised women include:

• Fistulas between the intestine and vagina/genital tract that allows intestinal bacteria into the vagina
• Pelvic radiation or tumours

Causes of non-infectious vaginitis or vulvovaginitis

You can develop non-infectious vaginitis due to a sensitivity that you have developed or already had to an irritant such as:

• perfume
• sprays
• pads
• tampons
• laundry detergent
• bleach
• fabric softeners
• dyes
• synthetic fibres
• bathing additives
• shower wash
• toilet paper (especially cheap or printed toilet paper)
• spermicide
• lubricant
• vaginal creams
• latex condoms
• contraceptive rings
• diaphragms

If you have changed something as slight as toilet paper brand recently, change back and see what happens. These types of sensitivities can be unique to just you, and be caused by something as minor as dyed toilet paper, or an ingredient in your shower gel.

You may also have developed a semen allergy. If you have recently started having sex with a new partner, their body (saliva, semen) may be causing you an issue.

Diagnosis of vaginitis or vulvovaginitis

You will have a clinical evaluation and examination where the physician will inspect your vagina using a speculum, and possibly take swabs to check for infections.

The pH of your vagina will be tested, and a wet mount taken. Kids are treated a bit more cautiously, and this requires a gynaecological paediatrician who can very carefully question and if necessary, remove items.

If a child has a foreign object inside her vagina, she may need to be sedated to avoid distress while it is removed.

What if it’s not vaginitis or vulvovaginitis?

You could have symptoms of cervicitis or pelvic inflammatory disease (PID), which can look like vaginitis. PID can be a result of cancers and STIs, so it’s important that you get checked out.

You may also have a skin disorder like psoriasis, or another fungus like tinea.

Treatment of vaginitis and vulvovaginitis

If you and/or your doctor have correctly determined the problem, treatment is straightforward – remove the irritant, treat infection. If your vulvovaginitis due to poor hygiene, get advice on what you’re doing wrong and remedy it.

Keep the vulva clean, and don’t use anything on it that is going to cause extra irritation. This means using products that are basic, pH balanced for skin, and hypoallergenic, and using warm water to clean yourself, but no drying irritating soaps.

Don’t douche, but you can use a sitz bath with baking soda to soothe redness, soreness or itching. If you have an infection, your doctor will probably prescribe antibiotics specific to the infection.

For some problems, cortisone cream may be recommended for the vulva, but not inside the vagina.