Vulvitis is an inflammation of the vulva (external female genital organs). It is characterized by the appearance of itching, burning, copious discharge, hyperemia and swelling of the labia, painful sensations after urination. The transition of infection to the internal genitalia is dangerous; in girls of early childhood, vulvitis can cause fusion of the labia minora. To diagnose vulvitis, a gynecologist’s consultation is necessary, a smear examination for flora, colposcopy. Treatment includes etiotropic therapy (antibiotics, antimycotics, hormones), local and physiotherapy procedures.
The inflammatory process of the external genital area in women (vulvitis) develops due to a number of local and general reasons. With vulvitis, infection of the clitoris, labia minora and labia majora, the vestibule of the vagina and its glands, the hymen occurs. The causative agents of vulvitis are most often conditionally pathogenic microorganisms (E. coli, streptococci, staphylococci, yeast fungi), less often pathogenic pathogens of STDs (gonococci, trichomonas, chlamydia, viruses, etc.). Sometimes the development of vulvitis is provoked by pathogens of tuberculosis, diphtheria. Conditions for the development of infection are created as a result of a violation of the integrity of the skin and the mucous membrane of the vulva and a decrease in local immunity.
The reasons for vulvitis may be:
- non-compliance with personal hygiene rules (especially during menstruation);
- mechanical injury of the vulva mucosa when wearing tight and coarse clothing, prolonged use of sanitary pads, during sexual intercourse;
- irritation and maceration of the mucous membrane by secretions from the vagina, cervical canal with an existing infection of the genitals, urinary incontinence, chemicals;
- excessive use of medications (antibiotics), radiation therapy;
- hormonal and metabolic disorders in the body (ovarian hypofunction, obesity, diabetes mellitus, lack of vitamins and minerals), allergic reactions;
- the presence of pathological passages (fistulas) from the intestine, urinary tract;
- combing of the external genitals with vegetoneurosis, psoriasis, helminths, excessive sweating.
There is a primary vulvitis when the infection develops as a result of trauma or non-compliance with the cleanliness of the genitals, and secondary if the source of infection is other organs (vagina, uterus, tonsils, bladder, kidneys).
Primary vulvitis develops more often in girls and in postmenopausal women, which is associated with the peculiarities of the genitals in these age periods. In healthy adult women, the mucous epithelium of the vulva (due to the predominance of fermented milk microflora, acidic PH of the secretion, hormonal background) is more resistant to infection. Primary vulvitis is rare in them and occurs in the form of vulvovaginitis. Vulvitis can occur in acute and chronic form.
Primary vulvitis is more common in girls, as their skin and vulva mucosa are thin, tender, and easily injured. Coccoid forms predominate in the microflora of the genitals, there are no Doderlein sticks, the secreting medium is alkaline, local immunity is still imperfect. Also, the occurrence of vulvitis is facilitated by the presence of pinworms in the child – the mucous membrane of the external genitals is injured during combing, facilitating the penetration of infection. Sometimes newborn girls may have vaginal discharge provoked by maternal hormones-estrogens that got to them before childbirth. Usually these phenomena go away on their own.
During the postmenopause, with a decrease in the level of estrogens, the termination of the menstrual cycle, atrophic changes in the mucous membrane of the genitals occur. The amount of vaginal discharge decreases, the mucosa “dries out”, becomes thinner, is easily damaged and infected, which leads to the development of vulvitis. The development of secondary vulvitis occurs against the background of existing inflammatory diseases of the internal genital organs (colpitis, cervicitis, endocervicitis) of a specific and nonspecific nature.
The acute form of vulvitis is characterized by the following symptoms:
- severe swelling and redness of the labia, clitoris, ulcers and erosions may form, the inguinal folds and the inner surface of the thighs may be affected;
- itching and burning, soreness (increases when urinating, moving, touching);
- serous-purulent or succulent discharge. When infected with E. coli – watery white, yellow-green with a bad smell; staphylococcus – thick, yellowish; candida – “curd” white and plaque;
- sometimes – an increase in inguinal lymph nodes, fever
Girls with acute vulvitis have signs of nervous excitability, sleep disorders.
Vulvitis with untimely and improper treatment can turn into a chronic form with frequent relapses. The chronic form of vulvitis is characterized by moderate manifestations of edema, soreness and hyperemia in certain areas of the vulva mucosa, hypertrophy of the sebaceous glands, itching, burning, and scanty secretions. Sometimes with vulvitis, after the healing of erosions and ulcers, the genitals can deform, making it difficult to have sex in the future. Girls may have adhesions in the labia region – synechiae.
The examination of patients with signs of vulvitis is carried out by an obstetrician-gynecologist. A detailed anamnesis about the transferred or concomitant diseases is necessarily collected. If there is an indication of diabetes mellitus, an endocrinologist’s consultation is necessary. Sometimes the disease develops against the background of psoriasis, then a dermatologist’s examination is prescribed. The following methods are used in the diagnosis of vulvitis:
- Gynecological examination. The external genitals are hyperemic, swollen, and may be covered with a whitish coating. With bacterial nonspecific vulvitis, the plaque acquires a purulent character. There are traces of scratching, in severe cases – ulceration. The introduction of mirrors is painful. In combination with vaginitis, vaginal discharge and inflammation are noted.
- Bacterioscopic examination. In a smear from the vestibule of the vagina, a large number of leukocytes are detected, the composition of the microflora is changed. Cocci predominate, the number of sticks is reduced or they are completely absent. With candidiasis vulvitis, mycelium and fungal cells are detected.
- Bacteriological examination. Sowing on nutrient media allows you to determine the predominant type of microflora, to identify its sensitivity to antibiotics. With symptoms of candida vulvitis, but a negative smear, or its frequent relapses and ineffectiveness of treatment, the subspecies of candida and their sensitivity to antimycotics are determined.
- PCR diagnostics. The study makes it possible to identify the causative agents of sexual infections. With the help of PCR, the number of colony-forming units of pathogens is determined in real time. Herpes simplex viruses, HPV, which reduce local immunity, are often detected.
- Colposcopy. It is performed in combination with vaginitis for differential diagnosis of the causes of vulvitis and the prevalence of the disease. Inflammatory changes and erosion may be detected on the neck. With atrophic changes in the vulva, similar processes are found on the exocervix.
- Gynecological ultrasound. It is necessary for the diffdiagnosis of vulvovaginitis with inflammation of the appendages, endometrium. With salpingo-oophoritis, enlarged appendages, edematous fallopian tubes are determined, which allows us to consider vulvitis as a consequence of irritation of the mucous membrane of the vestibule of the vagina by secretions.
- Vulva biopsy. It is necessary in the presence of foci of atrophy, erosions or ulcers on the vulva to exclude the malignant process. Normally, with vulvitis, the structure of the epithelium is not changed, there is swelling of the stroma, expansion of capillaries.
Non-drug treatment of acute vulvitis includes a special diet. The use of spicy dishes, a large amount of salt is limited, alcohol is completely excluded as a factor provoking exacerbation. It is recommended to change underwear daily, switch to cotton fabrics, and abandon synthetics. Sexual rest is prescribed for the entire period of vulvitis treatment. When sexually transmitted infections are detected, treatment is carried out for both partners.
Drug therapy of vulvitis is carried out depending on the etiology of the disease. Preference is given to local funds. Patients with diabetes mellitus, psoriasis and other provoking diseases need correction of the underlying cause that provokes inflammation of the vulva. The following groups of medications are used:
- Antihistamines. Recommended for unbearable itching, allergic vulvitis. They help to alleviate the condition, reduce inflammation. They use a new generation of drugs that do not cause drowsiness.
- Antibiotic therapy. For nonspecific vulvitis, creams and candles with broad-spectrum antibiotics are used. When diagnosing sexually transmitted infections, systemic antibiotic therapy is prescribed, which is selected based on the type of pathogen.
- Antifungal agents. Candidiasis vulvitis is treated with local antifungal agents. Girls use a cream based on pimafucine, clotrimazole, nystatin ointment. Women are prescribed candles or fluconazole once.
- Anthelmintic drugs. In preschool–age girls, one of the most common causes of vulvitis is worm infestations. Anthelmintic suspensions are used, which are given twice: for the first time – after diagnosis, again – after 2-3 weeks to cause the death of young helminths, which were in the form of larvae during the first treatment.
- Hormone therapy. Local hormonal ointments with estrogens are necessary for atrophic vulvitis. They are prescribed to women with symptoms of approaching menopause. The dose is selected gradually, first the cream is applied daily, and after receiving the effect, they switch to a maintenance dosage.
To reduce unpleasant sensations, which are common symptoms of vulvitis, regardless of the cause of the disease, symptomatic treatment is prescribed. Treatment is carried out locally with the help of medications, methods of phytotherapy. Symptomatic treatment does not exclude etiological therapy, but complements it. The following tools are used:
- Sedentary baths. Baths with a decoction of chamomile, calendula, turn, chamomile help to reduce itching, irritation and swelling. Phytotherapy is used only in combination with the main treatment, as an independent method it is ineffective and leads to frequent relapses.
- Treatment with antiseptics. The toilet of the external genitals helps with a solution of furacilin, chlorhexidine, miramistin. This helps to reduce itching and burning, relieves swelling. Douching in girls is not carried out, and adult women are not recommended because of the leaching of normal microflora.
- Physical therapy. It acts non-specifically, improving blood flow, strengthening immune protection. Effectively UFO the vestibule of the vagina. In women, the vulva and vagina can be treated with ultrasound cavitated solutions. They help to separate the bacterial film, promote deep penetration of drugs, accelerate tissue regeneration.
The use of surgical methods of treatment is justified when purulent foci appear on the vulva, which do not respond to conservative therapy. Focal suppuration is opened, the wound is drained and treated with antiseptics. If necessary, vulva plastic surgery is performed. With vulvitis caused by a malignant tumor, radiation therapy may be required after surgical treatment.
Prognosis and prevention
Proper hygiene of girls is the key to their further female health. An untreated vulvitis in childhood can provoke serious gynecological problems in the future, the main of which is infertility. Prevention of the development of vulvitis implies: timely treatment of common diseases and the elimination of foci of chronic infection; compliance with the rules of personal hygiene (cleanliness of the genitals, wearing loose hygienic underwear); healthy lifestyle and strengthening immunity (quitting smoking, alcohol, lack of casual sexual relations, proper nutrition, sports).