Vulvovaginitis

INFECTIONS

Yeast infections are one of the most common causes of vulvovaginitis in women.

• Yeast infections are most often due to the fungus Candida albicans.
• Candida and the many other germs that normally live in the vagina keep each other in balance. However, sometimes the number of candida organisms increase. This leads to a yeast infection.
• Yeast infections often cause genital itching, a thick white vaginal discharge, rash, and other symptoms.

The vagina normally contains both healthy bacteria and unhealthy bacteria. Bacterial vaginosis (BV) occurs when more unhealthy bacteria than healthy bacteria grow. BV may cause a thin, gray vaginal discharge, pelvic pain, and a fishy odor.

A less common type of vaginitis is spread by sexual contact. It is called trichomoniasis. Symptoms in women include genital itching, vaginal odor, and a heavy vaginal discharge that may be yellow-gray or green in color. Women may also experience vaginal spotting after intercourse.

OTHER CAUSES

Chemicals can cause itchy rashes in the genital area.

• Spermicides and vaginal sponges, which are over-the-counter birth control methods
• Feminine sprays and perfumes
• Bubble baths and soaps
• Body lotions

Low estrogen levels in women after menopause can cause vaginal dryness and thinning of the skin of the vagina and vulva. These factors may lead to or worsen genital itching and burning. This condition is called genitourinary syndrome of menopause (GSM), formerly known as atrophic vaginitis.

Other causes include:

• Tight-fitting or nonabsorbent clothing, which leads to heat rashes.
• Skin conditions.
• Objects such as a lost tampon in your vagina can also cause irritation, itching, and strong-smelling discharge.

Sometimes, the exact cause cannot be found. This is called nonspecific vulvovaginitis.

• It occurs in all age groups. However, it is most common in young girls before puberty, particularly girls with poor genital hygiene.
• It causes a foul-smelling, brownish-green discharge and irritation of the labia and vaginal opening.
• This condition is often linked with excess growth of bacteria that are 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 toilet.

Irritated tissue is more likely to become infected than healthy tissue. Many germs that cause infection thrive in a warm, damp, and dark environment. This can also lead to a longer recovery.

Sexual abuse should be considered in young girls with unusual infections and repeated episodes of unexplained vulvovaginitis.

Symptoms include:

• Irritation and itching of the genital area
• Inflammation (irritation, redness, and swelling) of the genital area
• Vaginal discharge
• Foul vaginal odor
• Discomfort or burning when urinating

If you have had a yeast infection in the past and know the symptoms, you can try treatment with over-the-counter products. However, if your symptoms do not completely go away in about a week, contact your health care provider. Many other infections have similar symptoms.

The provider will perform a pelvic examination. This exam may show red, tender areas on the vulva or vagina.

A wet prep is usually done to identify a vaginal infection or overgrowth of yeast or bacteria. This includes examining vaginal discharge under a microscope. In some cases, a culture of the vaginal discharge may help find out the germ that is causing the infection.

A biopsy (a test of the tissue) of the irritated area on the vulva may be done if there are no signs of infection.

Creams or suppositories are used to treat yeast infections in the vagina. You can buy most of them over-the-counter. Follow the directions that came with the medicine you are using.

There are many treatments for vaginal dryness. Before treating your symptoms on your own, see a provider who can find the cause of the problem.

If you have BV or trichomoniasis, your provider may prescribe:

• Antibiotic pills that you swallow
• Antibiotic creams that you insert into your vagina

Other medicines that may help include:

• Cortisone cream
• Antihistamine pills to help with itching

Be sure to use the medicine exactly as prescribed and follow the instructions on the label.

Proper treatment of an infection is effective in most cases.

Contact your provider if:

• You have symptoms of vulvovaginitis
• You do not get relief from the treatment you receive for vulvovaginitis

Keep your genital area clean and dry when you have vaginitis.

• Avoid soap. Just rinse with water to clean yourself.
• Soak in a warm, not hot, bath to help your symptoms. Dry thoroughly afterward.

Avoid douching. Many women feel cleaner when they douche, but it may actually make symptoms worse because it removes healthy bacteria that line the vagina. These bacteria help protect against infection.

Other tips are:

• Avoid using hygiene sprays, fragrances, or powders in the genital area.
• Use pads instead of tampons while you have an infection.
• If you have diabetes, keep your blood sugar level in good control.

Allow more air to reach your genital area. You can do this by:

• Wearing loose-fitting clothes and not wearing panty hose.
• Wearing cotton underwear (instead of synthetic fabrics) or underwear that has a cotton lining in the crotch. Cotton allows normal evaporation of moisture so that moisture buildup is reduced.
• Not wearing underwear at night when you sleep.

Girls and women should also:

• Know how to properly clean their genital area while bathing or showering.
• Wipe properly after using the toilet. Always wipe from front to back.
• Wash thoroughly before and after using the toilet.

Always practice safe sex. Use condoms to avoid catching or spreading infections.

Vaginitis; Vaginal inflammation; Inflammation of the vagina; Nonspecific vaginitis

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Braverman PK. Urethritis, vulvovaginitis, and cervicitis. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 51.

Gardella C, Eckert LO, Lentz GM. Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 23.

Oquendo Del Toro HM, Hoefgen HR. Vulvovaginitis. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 586.

Updated by: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.