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The Female Body
Signs of vulvitis: Inflammation
and red swollen skin.
|What Is Vulvitis?
It is an inflammation of the vulva area - that is the fleshy tissue that covers the entrance to the vagina. It is not a condition in itself but rather a symptom of a number of other diseases, infections, allergies or external irritants. Bad diet, tiredness, stress and poor hygiene can increase a woman's risk of vulvitis. Except in rare cases not associated with vulva cancer, vulvitis is not a serious condition but it can be agonizingly uncomfortable. It is often difficult to pinpoint a cause which makes treatment frustratingly difficult.
What Are The Symptoms?
The following are signs of vulvitis (you may experience all or some symptoms):
• Red, swollen skin.
• Excruciating itching (pruritus) around the labia and other parts of the vulva.
• Small cracks in the skin.
• Possible vaginal discharge.
• Clear fluid filled blisters that eventually burst and crust over.
• If the condition is chronic the skin becomes thickened and develops white patches.
• If associated with diabetes the skin often looks deep red.
• Leads to painful intercourse.
What Are The Causes?
The following are a list of the most common causes:
• Diabetes (type 1 and 2).
• Vulva cancer (see, symptoms of vulva cancer).
• Lichen scleroses, a condition that causes patchy white areas of skin. More common in postmenopausal women.
• Genital herpes
• Genital warts
• Vaginitis (inc. thrush/yeast infections). May also be referred to as vulvovaginitis.
• Pubic lice.
Vulvitis may be caused by contact dermatitis - that is where there is itching and burning but no infection. This occurs when the skin becomes inflamed by contact with irritants such as female hygiene products, soaps and bubble baths. Note: there is a difference between being ‘irritated’ by a product and being allergic. If you are allergic to something the symptoms may not be apparent for 24 to 48 hours after contact. With an irritant, the symptoms are immediately apparent. Common irritants or allergens include:
• Condoms and spermicides.
• Soaps or bubble baths.
• Laundry detergents.
• Scented toilet paper.
• Vaginal douches, deodorants and sprays.
• Sanitary napkins or tampons.
• Stress (read about the effects of stress).
• Bad diet, lack of good nutrition.
• Poor hygiene.
• Wearing a wet bathing suit for a long time.
• Not having enough rest.
• Physical trauma to the vulva (from a bicycle seat or horseback riding for example).
Who Is Most At Risk?
Women who have gone through menopause (postmenopausal) and young girls who have not had their first period (menarche) appear to be most vulnerable to vulva inflammation and itching. The reason for this is not clear but it is possibly due to lower estrogen levels (read about the effects of estrogen in women).
How Is It Diagnosed?
You should consult a doctor if vulvitis does not clear with self treatment or if it is accompanied by a strong smelling discharge. A pelvic examination will reveal if the vulva is inflamed. The doctor's real task however is to try and locate a cause. To do this, he may:
• Ask questions to find out if you are using any new products that may be irritating the skin.
• Perform some urine tests.
• Test for sexually transmitted diseases (STDs).
• A glucose test may be performed to test for diabetes.
• Perform a vaginal wet mount test on vaginal discharge for signs of infection (see, vaginitis diagnosis).
If there are lesions on the vulva, or the woman is over 50 and has persistent inflammation that is not relieved by vaginal creams, a biopsy of the vulva may be done to check for precancerous or malignant cells. For more on this, see vulva cancer diagnosis. The biopsy can be done with local anesthesia.
How Is It Treated?
Self Help Remedies
Sometimes vulvitis is cured through self help remedies:
1. Look for an obvious irritant and stop using it - check any new products you have been using - soaps, laundry powder, bubble baths, even shampoo for your hair which can wash down to the vulva area when showering. If it acts as an irritant you will feel vulva sensitivity almost immediately. If it is an allergic reaction, watch for symptoms which appear within 48 hours. Test one product at a time. To do this, eliminate all suspect products and reintroduce one at a time. This trial process may take a few weeks.
2. Sitz baths with Aveeno colloidal oatmeal or baking soda can help in the meantime to relieve symptoms.
3. Boric acid compresses applied to the vulva can help reduce inflammation. It also comes in a capsule form which is inserted in the vagina as a suppository (daily for 2 weeks).
4. Triamcinolone ointment (0.1%) applied twice a day, can help with irritant contact dermatitis.
5. Hydrocortisone creams are available without prescription and can relieve itching, particularly when symptoms are caused by allergic contact dermatitis. Hydrocortisone should not be used longer a month without talking to your doctor because long-term use can lead to atrophy - that is thinning of the vulva tissue which leads to increased sensitivity and inflammation.
6. Keep the area clean and dry. Wash with gentle unscented soap and dry immediately.
If vulvitis does not clear within 3 weeks of trying self-help remedies, or if there is a foul-smelling discharge, talk to your doctor. He will perform some of the tests mentioned above - if an underlying cause is found, such as bacterial vaginosis or an STD, this will need to be appropriately treated. Or, he may prescribe a stronger hydrocortisone cream or antihistamine to reduce inflammation. Women who are past menopause and suffering chronic inflammation may want to consider estrogen replacement therapy as a longer term solution.
Can It Be Prevented?
Not all cases of vulvitis can be prevented, particularly if there is an underlying disease. However, in general it can be prevented in much the same was as vaginitis is prevented. That is, by practicing good hygiene, always wiping from back to front after a bowel movement to prevent the spreading of bacteria and not using other people’s towels. Avoid using scented toilet paper, wearing pantyhose and tight jeans and only wear cotton underwear or underwear where the crotch is made of cotton. Avoid using irritating vaginal products (maybe even tampons) and avoid sexual intercourse during a flare up. Ensuring you get plenty of sleep and good food will also help.