Vulvitis

Medically reviewed by The Dermatologists and written by Dr. Alexander Börve

Last updated on March 11, 2025

What is Vulvitis

Vulvitis is not a disease, but an inflammation of the vulva caused by an infection, allergy or injury. The vulva is the area of skin outside of the female genitalia, and is prone to irritation because of its moistness and warmth.

vulvitis: a condition involving inflammation of the vulva, characterized by symptoms such as redness, swelling, and irritation.

Some irritants that cause vulvitis are vaginal sprays, fungal infection, and dermatitis. Stress, poor nutrition, and poor hygiene can also increase susceptibility.

Any woman of any age can be affected by vulvitis, especially those who have not yet reached puberty or are post-menopausal.

This susceptibility is largely due to lower estrogen levels in these groups, which result in thinner, dryer vulvar tissues, increasing the risk of irritation and inflammation.

Who’s at Risk?

While vulvitis can affect women of any age, it’s more prevalent among,

• Prepubescent girls: Due to lower estrogen levels, the vulvar tissues are thinner and more prone to irritation.
• Post-menopausal women: Similar to prepubescent girls, decreased estrogen levels lead to increased vulnerability.

Why Does Vulvar Itching Occur?

The vulvar area has thinner, sensitive skin, making it prone to irritation and itching. Common underlying factors include:

• Skin Barrier Issues: Conditions like eczema or psoriasis weaken skin defenses.
• Hormonal Changes: Fluctuations in estrogen levels (puberty, pregnancy, menopause) affect skin health and susceptibility.
• Nerve Sensitivity: Sometimes, nerve dysfunction can trigger itching without visible skin changes.
• Vaginal Health: Imbalanced vaginal bacteria can also contribute to vulvar itching.

Difference between vulvitis and vaginitis

Vulvitis specifically refers to inflammation of the vulva, the external genital organs, while vaginitis is the inflammation inside the vagina. When both conditions occur together, it is known as vulvovaginitis, encompassing a broader area of inflammation.

Symptoms of Vulvitis

Symptoms of vulvitis may include:

Intense itching is the most common symptom, often described as extreme and constant. Changes in skin appearance such as,

• Small Cracks on the Skin: The appearance of tiny fissures or cracks on the skin of the vulva.
• Sores and Blisters: Formation of sores or blisters, which may burst and ooze.
• Scaly and Thick Whitish Patches: Development of thick, whitish patches on the skin of the vulva that feel scaly to the touch.
• Redness and Swelling: Redness and swelling affecting both the vulva and labia (the lips of the vagina).
• Vaginal Discharge: Presence of vaginal discharge, which can vary in consistency and color.
• Burning Sensation: A burning sensation in the affected area, contributing to discomfort.

It’s important to note that symptoms can vary depending on age and hormone levels. Some skin changes may appear white or patchy, depending on underlying conditions. Vulvitis symptoms can resemble those of other conditions, including STIs. If your symptoms don’t improve or worsen, it’s crucial to seek medical attention.

Common Causes and Triggers

Vulvitis, characterized by the inflammation of the vulva, is a complex condition with a multitude of potential causes. Understanding these triggers is essential for effective management and prevention.

1. Infections

• Fungal – Vulvovaginal Candidiasis

Candida albicans remains the predominant fungal culprit, particularly in adult women.Factors such as elevated estrogen levels (pregnancy, hormonal therapies), antibiotic usage, and compromised immune systems (diabetes, HIV, corticosteroid use) significantly increase susceptibility.Recurrent episodes may indicate underlying genetic predispositions.Clinical presentations vary, but itching and burning are consistent symptoms.

• Bacterial

In prepubertal females, Group A beta-hemolytic streptococcus (GABHS) infections manifest as distinct, red, edematous plaques, causing itchiness and pain.Adult women are less prone to GABHS-mediated vulvitis.Other bacterial agents like Staphylococcus aureus, Haemophilus, and Shigella are less frequent but notable causes.

• Viral and Parasitic

Genital herpes, a viral infection, can induce significant vulvar inflammation and discomfort.Pinworm infestation is also a cause of vulvar itching.

2. Irritants and Allergens

• Chemical Sensitivities

Everyday products like perfumed toilet paper, soaps, shampoos, and laundry detergents can act as potent irritants.Feminine hygiene products, including sprays, deodorants, powders, and spermicides, are common triggers.Even topical treatments, such as steroids and antifungal agents, can paradoxically induce irritation.

• Physical and Environmental Triggers

Tight-fitting clothing, synthetic fabrics, and prolonged exposure to moisture (wet bathing suits) create environments conducive to irritation.Activities like cycling and horseback riding can cause mechanical irritation.Exposure to hot tub and swimming pool chemicals can also provoke vulvitis.

• Allergic Reactions

Fragrances and preservatives are frequent allergens.Rubber products (condoms, diaphragms) and clothing dyes can also elicit allergic responses. Patch testing is very helpful to find the allergen.

3. Hormonal Influences

• Estrogen’s Role

Estrogen fluctuations across life stages (puberty, pregnancy, menopause) significantly impact vulvar epithelium.These changes influence vaginal pH and microbial balance, affecting vulvar susceptibility.Hormonal therapies, including contraceptives and replacement therapies, can also alter vulvar conditions.

• pH Dynamics

Vulvar pH, like vaginal pH, varies with hormonal status.Alkaline pH can enhance the activity of proteases, potentially triggering neuronal itch receptors.Hormonal shifts can disrupt the balance between proteases and their inhibitors, contributing to inflammation and itch.

4. Other Dermatological Conditions

• Eczema on Vulva (Vulvar Dermatitis)

  Eczema on the vulva, also known as vulvar dermatitis, is a common cause of vulvar itching and inflammation. It manifests as intense, persistent itching, redness, swelling, and sometimes scaly, cracked, or thickened skin. Vulvar eczema is frequently triggered by irritants or allergens such as soaps, detergents, and hygiene products. Women with a history of atopic dermatitis (eczema) elsewhere on the body are particularly at risk. Treatment typically involves topical corticosteroids and careful management of irritants, under medical supervision.

• Other Eczematous Processes

Atopic dermatitis, irritant contact dermatitis, and allergic contact dermatitis are leading causes of vulvar itch.Seborrheic dermatitis, though less common, can also manifest on the vulva.

• Other Inflammatory Dermatoses

Lichen planus, lichen sclerosus, and psoriasis can cause significant vulvar discomfort.

• Neoplasms

Although rare, vulvar cancer (squamous cell carcinoma, Paget’s disease, VIN) can present with persistent vulvar pruritus.It is crucial to consider malignancy in cases of refractory vulvar symptoms.

What can I do?

Stop using the products that may be causing the inflammation in the vulva. Over-the counter cortisone creams may help reduce the irritation and itching.

To prevent inflammation in the vulva, you can use gentle, unscented cleaning products. Make sure to dry the genital area thoroughly after bathing. Maintaining genital hygiene and wearing loose, breathable clothing can also help. Long-term dermatitis or infections, such as pubic lice or mites (scabies), can also lead to vulvitis.

Avoid the following products/activities, which may cause vulvitis:

• Toilet paper with perfume or dye
• Soaps or bubble baths with perfume
• Shampoos and hair conditioners
• Laundry detergents
• Vaginal sprays, deodorants, and powders
• Spermicides
• Douching
• Hot tub and swimming pool water
• Underwear made of synthetic material without a cotton crotch
• Rubbing against a bike seat
• Wearing a wet bathing suit for a long period
• Injury from activities like cycling or horseback riding.

Beyond external irritants, vulvitis can be triggered by fungal or bacterial infections, viral conditions like genital herpes, and skin conditions such as eczema or dermatitis.

Should I seek medical care?

The symptoms of vulvitis can also suggest other disorders or diseases of the genitals. Contact a healthcare provider for more medical advice if you experience the symptoms of vulvitis.

A physician can then perform a full pelvic exam and check for vagina discharge for any infections. A urine sample is usually taken to rule out more serious causes of genital irritation (e.g. vulvar cancer) and sexually transmitted infections (STIs).

A comprehensive diagnostic approach may include a review of your medical history, a detailed physical examination, and specific tests such as urine and blood tests, STI screenings, and a Pap smear to accurately identify the cause of inflammation.

Diagnosis of Vulvitis

• Medical history and physical exam – A healthcare provider will review your symptoms and conduct a pelvic exam.
• Testing –
  • Urine tests: To rule out other conditions.
  • Vaginal swabs: To check for infections.
  • Biopsy: In some cases, a small tissue sample may be taken for further examination.

Treatment Options for Vulvitis

The treatment for vulvitis varies based on the underlying cause, and your healthcare provider will recommend the best approach for your situation:

1. Topical Treatments for Inflammation and Itching:

• Hydrocortisone and antifungal creams: Common initial treatments to soothe inflammation and itching.
• Topical corticosteroids: Your doctor will prescribe the appropriate strength and duration to control itching. Always apply exactly as instructed to prevent skin thinning.
• Emollients (Moisturizers): Apply generously and frequently, particularly after bathing or using the restroom. Wait at least 20-30 minutes after applying steroids before using emollients to avoid dilution.
• Prescription Sitz Baths: May include soothing agents to alleviate irritation and provide comfort.

2. Non-Steroid Treatments

• Topical calcineurin inhibitors: These are steroid-free anti-inflammatory treatments suitable for long-term management, reducing the risk of steroid-related side effects.
• Other topical treatments: Special creams containing ingredients such as capsaicin or doxepin can relieve persistent itching. Your doctor will guide you on their safe use.

3. Treating Infections

• Fungal Infections (e.g., Yeast infections): Antifungal creams or tablets usually clear these quickly. Difficult cases might need stronger treatments like vaginal boric acid.
• Bacterial Infections: Antibiotics, either topical or oral, will be prescribed based on the specific bacterial infection.
• Parasitic Infestations (e.g., Scabies, Pubic lice): Permethrin creams or lotions effectively clear these. If you have pinworms, all household members must be treated simultaneously.
• Viral infections (e.g., Herpes, HPV): Antiviral medications such as acyclovir help manage herpes outbreaks. HPV-related warts can be treated with topical medications or procedures like freezing.

4. Managing Persistent Itching and Pain

• Oral medications: Neuropathic medications like gabapentin or topical numbing creams (lidocaine) might be recommended if vulvar itching is intense and chronic.
• Antidepressants: Certain antidepressants (tricyclic antidepressants, SSRIs) can sometimes help reduce chronic itching by calming irritated nerves.

5. Hormone-Based Therapies

• For post-menopausal women, topical estrogen treatments help relieve symptoms related to hormonal changes like dryness, thinning skin, and persistent itching.

Important: Always seek medical guidance before attempting self-treatment, as OTC remedies might contain irritating or allergenic ingredients. Your healthcare provider is your best partner in identifying the exact cause of vulvitis and providing effective treatment.

Prognosis and Follow-Up

The prognosis for vulvitis is generally excellent, with most individuals seeing significant improvement within a few weeks of starting treatment. Living with vulvitis involves ongoing vulvar care and regular consultations with your healthcare provider to manage symptoms and prevent recurrences.

Frequently Asked Questions (FAQs)

1. Is vulvitis contagious?
Vulvitis itself isn’t contagious, as it’s inflammation—not an infection. However, some underlying causes (like yeast infections or herpes) can be contagious. See a healthcare provider to identify the exact cause of your symptoms.

2. How can I tell if I have vulvitis or an STI like herpes?
Vulvitis and certain STIs, such as herpes, share symptoms like itching, redness, and sores. However, herpes often causes painful blisters, while other STIs might cause unusual discharge or specific symptoms. Due to symptom overlap, it’s essential to seek professional evaluation and testing for accurate diagnosis.

3. What if antifungal cream doesn’t help?
If antifungal creams don’t relieve your symptoms, the vulvitis might have another cause, such as irritants, allergens, bacterial infections, or underlying skin conditions (like eczema). Consult a healthcare provider, who can perform an examination and recommend appropriate tests and treatments.

4. Can vulvitis cause permanent damage or scarring?
With prompt and proper treatment, vulvitis rarely leads to permanent damage or scarring. However, chronic or severe inflammation—especially if there’s repeated scratching—may cause skin thickening or texture changes. Early medical treatment helps prevent these complications.

5. Should I stop having sex until my symptoms clear up?
It’s generally advised to avoid sexual activity until your symptoms resolve, as sex can worsen irritation and discomfort. Also, if an infection causes your vulvitis, it could potentially spread to your partner.

6. How can I relieve itching at night?
To ease nighttime itching, you can:

• Apply cool compresses to soothe the area.
• Use fragrance-free moisturizers before bedtime.
• Consider a sedating antihistamine if recommended by your healthcare provider.
• Keep fingernails short to reduce skin damage.
• Wear loose, breathable cotton clothing.

If nighttime itching persists, consult your healthcare provider for further evaluation.