Vulvitis

Vulvitis an inflammation of the vulva, the soft folds of skin outside the vagina. It is a symptom of a host of diseases, infections, injuries, allergies and other irritants.

Diagnosing and treating this symptom can be frustrating because it is often difficult to determine the specific cause of the irritation.

Any person can develop vulvitis, including those who have not yet reached puberty.

Symptoms of vulvitis can vary and each individual may experience symptoms differently. Common symptoms may include:

• Redness and swelling on the labia and other parts of the vulva
• Extreme and constant itching or burning
• Clear, fluid-filled blisters
• Sore, scaly, thickened, or whitish patches on the vulva
• Cracks in the skin of the vulva

The symptoms of vulvitis can resemble other conditions or medical problems so it’s important to consult a healthcare provider if symptoms last for more than a few days.

Vulvitis may be caused by one or more of the following:

• Scented or colored toilet paper
• Perfumed soaps or bubble baths
• Shampoos and hair conditioners
• Laundry detergents (especially enzyme-activated “cold water” formulas)
• Vaginal sprays, deodorants and powders
• Spermicides
• Douching
• Water in a hot tub and swimming pool
• Synthetic undergarments without a cotton crotch
• Rubbing against a bicycle seat
• Wearing a wet bathing suit for a long period of time
• Horseback riding
• Infections such as pubic lice (pediculosis) or mites (scabies)
• Skin conditions such as eczema or dermatitis
• Herpes

Adolescents with signs and symptoms of vulvitis should be referred to clinicians who have expertise in adolescent medicine. At Children’s Hospital of Philadelphia (CHOP), these young people are evaluated by our Adolescent Medicine specialists.

At CHOP, diagnosis of vulvitis begins with a series of questions about the patient’s overall medical history, menstrual cycle, symptoms and any sexual activity. A physical examination follows, which may include a pelvic examination. We welcome parents and caregivers as key partners in supporting a young person’s care during and after treatment of vulvitis.

To help young people develop the skills needed to be responsible for their own health, clinicians typically ask to spend time alone with patients during each visit. This helps young people become comfortable talking with their healthcare providers about their concerns and allows patients to ask questions that may be more difficult to say in front of their parents and caregivers. We respect the privacy and confidentiality of our young patients, while ensuring that young people are safe and connected to the appropriate services and resources they need.

To confirm a diagnosis of vulvitis — as well as rule out more serious causes for the vaginal irritation — clinicians may perform the following tests:

• Urinalysis
• Tests for sexually transmitted diseases (STDs)
• Bloodwork or other tests to evaluate for other medical causes of symptoms

Treatment for vulvitis may require a coordinated approach. At Children’s Hospital of Philadelphia, Adolescent Medicine specialists work closely with specialists from gynecology, dermatology, gastroenterology and surgery if needed to accurately diagnose and treat vulvar problems.

Treatment for vulvitis will be determined by your adolescent’s healthcare provider based on:

• The age, overall health and medical history of the affected adolescent
• Cause of the irritation and severity of the symptoms
• The adolescent’s tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment may include:

• Avoiding irritants or activities known to bring on symptoms or make them worse
• Wearing loose fitting clothes and cotton undergarments
• Taking sitz baths with soothing compounds
• Applying topical steroids
• Applying estrogen cream