Vulvovaginitis can affect women of all ages and is extremely common. It can be caused by bacteria, yeasts, viruses, and other parasites. Some sexually transmitted infections (STIs) can also cause vulvovaginitis, as can various chemicals found in bubble baths, soaps, and perfumes. Environmental factors such as poor hygiene and allergens may also cause this condition.
Candida albicans, which causes yeast infections, is one of the most common causes of vulvovaginitis in women of all ages. Antibiotic use can lead to yeast infections by killing the normal antifungal bacteria that live in the vagina. Yeast infections typically cause genital itching and a thick, white vaginal discharge, and other symptoms.
Another cause of vulvovaginitis is bacterial vaginosis, an overgrowth of certain types of bacteria in the vagina. Bacterial vaginosis may cause a thin, grey vaginal discharge and a fishy odor.
An STI called trichomonas vaginitis infection is another common cause. This infection leads to genital itching, a vaginal odor, and a heavy vaginal discharge, which may be yellow-grey or green in color.
Bubble baths, soaps, vaginal contraceptives, feminine sprays, and perfumes can cause irritating itchy rashes in the genital area, while tight-fitting or nonabsorbent clothing sometimes cause heat rashes.
Irritated tissue is more susceptible to infection than normal tissue, and many infection-causing organisms thrive in environments that are warm, damp, and dark. Not only can these factors contribute to the cause of vulvovaginitis, they frequently prolong the recovery period.
A lack of estrogen in postmenopausal women can result in vaginal dryness and thinning of vaginal and vulvar skin, which may also lead to or worsen genital itching and burning.
Some skin conditions can cause itching and chronic irritation of the vulvar area. Foreign bodies, such as lost tampons, can also cause vulvar irritation and itching and strong smelling discharge.
Nonspecific vulvovaginitis (where specific cause cannot be identified) can be seen in all age groups, but it occurs most commonly in young girls before puberty. Once puberty begins, the vagina becomes more acidic, which tends to help prevent infections.
Nonspecific vulvovaginitis can occur in girls with poor genital hygiene and is characterized by a foul-smelling, brownish-green discharge and irritation of the labia and vaginal opening. This condition is often associated with an overgrowth of a type of bacteria that is 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 bathroom.
Sexual abuse should be considered in girls with unusual infections and recurrent episodes of unexplained vulvovaginitis. Neisseria gonorrhoeae, the organism that causes gonorrhea, produces gonococcal vulvovaginitis in young girls who have sexual exposure. Gonorrhea-related vaginitis is considered a sexually transmitted illness. If lab tests confirm this diagnosis, young girls should be evaluated for sexual abuse.
If you have been diagnosed with a yeast infection in the past, you can try treatment with over-the-counter products. However, if your symptoms do not completely disappear in about a week, contact your health care provider. Many other infections have similar symptoms.
The health care provider will perform a pelvic examination. This may show red, tender areas on the vulva or vagina.
A wet prep (microscopic evaluation of vaginal discharge) is usually done to identify a vaginal infection or overgrowth of yeast or bacteria. In some cases, a culture of the vaginal discharge may identify the organism causing the infection.
A biopsy of the irritated area on the vulva may be recommended if there are no signs of infection.
Antihistamine, if the irritation is due to an allergic reaction
Estrogen cream, if the irritation and inflammation is due to low levels of estrogen
Proper cleansing is important and may help prevent irritation, particularly in those with infections caused by bacteria normally found in stool. Sitz baths may be recommended.
It is often helpful to allow more air to reach the genital area. Here are some tips:
Wear cotton underwear (rather than nylon) or underwear that has a cotton lining in the crotch area. This increases air flow and decreases moisture.
Do not wear pantyhose.
Wear loose-fitting clothing.
Remove underwear at bedtime.
Note: If a sexually transmitted infection is diagnosed, it is very important that any other sexual partners receive treatment, even if they do not have symptoms. If your sexual partner is infected but not treated, you risk becoming infected over and over again.
Use of a condom during sexual intercourse can prevent most sexually transmitted vaginal infections. Proper fitting and adequately absorbent clothing, combined with good hygiene of the genital area, also prevents many cases of noninfectious vulvovaginitis.
Children should be taught how to properly clean the genital area while bathing or showering. Proper wiping after using the toilet will also help (girls should always wipe from the front to the back to avoid introducing bacteria from the rectum to the vaginal area).
Hands should be washed thoroughly before and after using the bathroom.
Vulvar cancer is a rare type of cancer. It forms in a woman's external genitals, called the vulva. The cancer usually grows slowly over several years. First, precancerous cells grow on vulvar skin. This is called vulvar intraepithelial neoplasia (VIN), or dysplasia. Not all VIN cases turn into cancer, but it is best to treat it early.
Often, vulvar cancer doesn't cause symptoms at first. However, see your doctor for testing if you notice
A lump in the vulva
Vulvar itching or tenderness
Bleeding that is not your period
Changes in the vulvar skin, such as color changes or growths that look like a wart or ulcer
You are at greater risk if you've had a human papillomavirus (HPV) infection or have a history of genital warts. Your health care provider diagnoses vulvar cancer with a physica1 exam and a biopsy. Treatment varies, depending on your overall health and how advanced the cancer is. It might include surgery, radiation therapy, chemotherapy, or biologic therapy. Biologic therapy boosts your body's own ability to fight cancer.
Uterine fibroids are common. As many as 1 in 5 women may have fibroids during their childbearing years. Half of all women have fibroids by age 50.
Fibroids are rare in women under age 20. They are more common in African-Americans than Caucasians.
No one knows exactly what causes fibroids. They are thought to be caused by:
Hormones in the body
Genes (may run in families)
Fibroids can be so tiny that you need a microscope to see them. They can also grow very large. They may fill the entire uterus and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there are more than one.
Fibroids can grow:
In the muscle wall of the uterus (myometrial)
Just under the surface of the uterine lining (submucosal)
Just under the outside lining of the uterus (subserosal)
On a long stalk on the outside the uterus or inside the uterus (pedunculated)
Heavy bleeding during your period, sometimes with blood clots
Periods that may last longer than normal
Needing to urinate more often
Pelvic cramping or pain with periods
Feeling fullness or pressure in your lower belly
Pain during intercourse
Often, you can have fibroids and not have any symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause. A recent study also showed that some small fibroids shrink in premenopausal women.
Treatment for the symptoms of fibroids may include:
Birth control pills to help control heavy periods
Intrauterine devices (IUDs) that release hormones to help reduce heavy bleeding and pain
Iron supplements to prevent or treat anemia due to heavy periods
Pain relievers such as ibuprofen or naprosyn for cramps or pain
Hormone therapy shots to help shrink fibroids (done only for a short time)
Watchful waiting: You may have pelvic exams or ultrasounds every once in a while to check the fibroid's growth
Surgery and procedures used to treat fibroids include:
Hysteroscopy. This procedure can remove fibroids growing inside the uterus.
Uterine artery embolization.This procedure stops the blood supply to the fibroid, causing it to shrink and die. This may be a good option if you want to have children in the future.
Myomectomy. This surgery removes the fibroids from the uterus. This also may be a good choice if you want to have children. It won't prevent fibroids from growing again.
Hysterectomy. This surgery removes the uterus completely. It may be an option if you don't want children, medicines do not work, and you cannot have any other procedures.
If you have fibroids without symptoms, you may not need treatment.
If you have fibroids, they may grow if you become pregnant. This is due to the increased blood flow and higher estrogen levels. The fibroids usually return to their original size after your baby is born.
