Vulvovaginitis

Background

Labeled vulva, showing external and internal views.
Pelvic anatomy including organs of the female reproductive system.
  • Definition: inflammation of the vulva and vagina
  • Candida Vaginitis and Contact Vulvovaginitis may occur in pre-pubertal and non-sexually active people
  • Atrophic vaginitis may occur in postmenopausal women

Vulvovaginitis

Clinical Features

  • Nonspecific
    • Discharge
    • Itching
    • Erythema or rash
    • Dysuria
    • Odor
    • Pain with intercourse

Differential Diagnosis

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

Genitourinary

Gastrointestinal

Musculoskeletal

Vascular

Evaluation

Workup

  • History and GU exam are required, and a chaperone should accompany the provider
  • Evaluate for infectious causes with cultures, wet mount, and trichomonas NAAT (or molecular vaginitis panel)
  • Consider O&P
    • Pinworms may cause vulvovaginitis in children [2]

Diagnosis

Management

  • Treat infectious etiologies based on wet mount, PCR, and culture results as indicated
  • Hygienic measures for non-specific vulvovaginitis particularly in pre-pubertal females
  • OTC Vaginal lubrication products for post-menopausal women with vulvovaginal atrophy symptoms [3]
  • Consider hormone replacement therapy in post-menopausal women
    • Best provided by a primary care provider

Treatment for Test-Positive Patients based on Organism and Symptomatology

Positive Organism Symptomatic Asymptomatic
BV Treat Do not treat
Vaginal candidiasis Treat Do not treat
Trichomoniasis Treat Treat

Disposition

  • Virtually all patients can be discharges with PCP or Gyn follow up
  • Any test sent should be followed for results

See Also

External Links

  • ACOG patient information for vaginitis [1]

References

  1. Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  2. Loveless M, Myint O. Vulvovaginitis- presentation of more common problems in pediatric and adolescent gynecology. Best Pract Res Clin Obstet Gynaecol. 2018 Apr;48:14-27. doi: 10.1016/j.bpobgyn.2017.08.014. Epub 2017 Sep 5. PMID: 28927766.
  3. Alvisi S, Gava G, Orsili I, Giacomelli G, Baldassarre M, Seracchioli R, Meriggiola MC. Vaginal Health in Menopausal Women. Medicina (Kaunas). 2019 Sep 20;55(10):615. doi: 10.3390/medicina55100615. PMID: 31547180; PMCID: PMC6843679.