Vulvitis • Symptoms & Treatment of Inflammation!

The outer sexual organs of women (vulva) include the hairy pubic mountain, large and small labia, clitoris, vaginal vestibule and the two Bartholin glands. The vaginal vestibule is bounded by the labia minora and contains the urethral orifice, the vaginal entrance and the mouth of the Bartholin's glands.

Every woman gets vulvitis at least once in her life

The Bartholin glands are to the side of the vaginal entrance and moisten the vaginal vestibule with their secretions. The dam separates the vulva from the anal area towards the rear.

A distinction is made between infectious and non-infectious vulvitis. Pathogens trigger infectious vulvitis, while non-infectious vulvitis is usually due to a hypersensitivity reaction of the vulva.

These symptoms suggest vulvitis

Inflammation of the external genital organs of women is usually noticeable as pronounced itching and burning in the genital area. Because the vulvar area is very sensitive, many women experience pain that can affect walking, sitting, and sexual intercourse.

Occasionally, swollen lymph nodes in the groin are also noticed. Fever is rather rare, but can occur especially with the very painful initial infection with herpes viruses.

If the inflammation has spread to the urethra and bladder, the women affected also report pain when urinating. A vaginal discharge that has changed in smell, color or texture indicates a simultaneous infection of the vagina (vaginitis).

The relatively frequent infection with human papilloma viruses can go hand in hand with no symptoms. In addition to the typical symptoms of vulvitis, there may also be a sensation of wetness and bleeding after sexual intercourse.

Vulvitis: what are the causes?

Numerous factors can trigger or favor vulvitis.

• Hypersensitivity reaction to substances such as soaps, detergents (also indirectly via clothing), synthetic materials, intimate sprays and certain medications
• Bacteria such as staphylococci, streptococci, coli (intestinal bacteria), anaerobes, rarely gonococci
• Viruses like genital herpes or human papilloma viruses
• Yeast like Candida albicans (vaginal yeast infection)
• Flagellates such as trichomonads
• Parasites such as pubic lice, itch mites, and worms
• Lack of estrogen
• Diabetes mellitus (diabetes)
• Defensive immune system, for example in AIDS / HIV or a tumor disease
• Skin diseases such as skin lichen (lichen) or psoriasis (psoriasis)
• Urinary tract infections
• Bladder weakness ()
• excessive or neglected intimate hygiene
• minor injuries, for example from shaving the genital area or from scratching when itchy

Inflammatory skin disease also in the vulva area

The various skin lichen and psoriasis are inflammatory skin diseases that can also show up in the vulva area. Urine leakage occurs unintentionally when the bladder is weak. In addition to the direct irritation of the skin through the urine, this creates a constant moist and warm environment in the vulva area in which pathogens can multiply more easily. People with diabetes mellitus excrete sugar in their urine, which creates favorable conditions for the growth of fungi (Candida albicans). Excessive intimate hygiene can also damage the skin and promote infections.

Transmission of the pathogen

Due to its proximity to the anus, the urethra and the vagina, the vulva is particularly exposed to pathogens. For example, intestinal bacteria can get into the vulva area through incorrect toilet hygiene (cleaning the anus from back to front). Infections in adjacent areas such as the vagina (Vaginitis) extend to the vulva. Many pathogens such as gonococci, genital herpes or human papilloma viruses are mainly transmitted from person to person through sexual intercourse. Another source of infection, for example for itch mites and pubic lice, can be sharing underwear, bed linen and towels. Swimming pools, saunas and whirlpools are also common sources of infection.

Vulvitis diagnosis: what happens to the doctor?

The doctor gains initial indications of vulvitis from detailed questioning of the patient's medical history and current symptoms (anamnesis). A gynecological examination follows. Because the vagina is often inflamed at the same time, it and the cervix are also examined. Depending on the pathogen, the anal area is also checked.

Even when looking at (inspecting) the vulvar region, the doctor notices swelling and reddening of the usually very moist mucous membrane. Abscesses, small nodules or inflamed hair follicles can also become visible. Due to the swollen mucous membrane, the mouth of the Bartholin glands can be blocked. Due to the now obstructed discharge of secretion, the gland can swell and form a visible cyst. An indication of a herpes infection is provided by vesicles standing in groups that form small ulcers and heal without scars after a few days. Certain human papillomaviruses can cause benign, cauliflower-like tissue growths called genital warts. Pubic lice and their eggs (nits) can be seen with the naked eye in good lighting.

Clarification of the reason for the vulvitis

To determine the cause of the vulvitis, the doctor takes a swab from the vulvar area and examines it under a microscope. If the pathogen cannot be identified, it is grown (culture). Viral infections may also require DNA detection of the virus.

Especially with recurring inflammation of the external genital organs, it is advisable to rule out a hormone deficiency or diabetes mellitus. If the disease is chronic, a malignant tumor of the vulva must also be excluded.

Vulvitis therapy: how does the treatment work?

The therapy depends on the cause of the vulvitis: antibiotics are used against bacteria and trichomonads, so-called antimycotics against fungal infections and antihelminthics against worms.

An infestation with pubic lice or itch mites can only be combated externally with a substance called lindane. While infections caused by human papilloma viruses often heal without therapy, the herpes infection cannot be cured to this day. Only the symptoms are treated with so-called antivirals.

Depending on the pathogen and the course of the vulvitis, the drugs are applied as a cream or taken in tablet form. In the case of sexually transmitted infections, it makes sense to treat your partner as well. Vulvitis should be treated for a long enough time to prevent relapses.

Abscesses are opened surgically under local anesthesia

The Bartholin cyst requires what is known as marsupialization, during which the doctor opens the cyst and sutures it to the outer skin. The new, larger gland outlet prevents the affected Bartholin gland from becoming blocked again. Genital warts are initially only observed because they often regress on their own. If this does not happen, substances such as podophyllotoxin or trichloroacetic acid can be dabbed on. Another option is to remove the warts using a laser, knife or electric loop.

Chamomile hip baths are suitable for treating non-infectious vulvitis

They can also be useful in the follow-up treatment of infectious vulvitis. Since vulvitis is often associated with pain, pain relievers and anti-inflammatory drugs are also often used. It is also advisable to adhere to some hygiene rules, such as changing towels and underwear every day. Some pathogens, such as the itch mite, also require clothing and bed linen to be cooked.

Course: Vulvitis usually easy to treat

Often the vulvitis can be treated without any problems, so that severe courses are rather rare. Infections with Herpes viruses cannot be cured. While acute vulvitis can be treated, the viruses that cause it remain in the body and can trigger renewed vulvitis, for example in the event of stress or menstruation. If an expectant mother becomes infected with the herpes virus shortly before birth, there is a great risk for the child to become infected during the birth. Since neonatal herpes is associated with a high mortality rate, the infection must go through a Caesarean section be bypassed.

Genital warts should be operated on

Genital warts very rarely grow together to form large clusters (Condylomata gigantea), which can make a caesarean section necessary. Infection of the newborn with human is also rare Papilloma viruses (HPV) during childbirth. As a result, genital warts and rarely benign tumors in the larynx can develop in the child. To avoid this, the genital warts should be eliminated before birth.

Risk of cancer from humans Papilloma viruses

An infection with another group of humans Papilloma viruses carries the risk of developing cervical cancer years later. They also seem to be at least involved in the development of cancer in the vulvar area.

This is how women prevent vulvitis

In order to prevent vulvitis, excessive use of intimate cosmetics such as intimate deodorants or soaps should be avoided as well as negligent intimate hygiene.

After a bowel movement, the anus should always be cleaned from front to back, i.e. away from the vulva. In swimming pools and saunas, it is advisable to only use your own towel and to swap a wet bathing suit for a dry one. Instead of tight-fitting, synthetic underwear, breathable cotton briefs should be preferred.

Condoms offer some protection against sexually transmitted diseases and are therefore unreservedly recommended. However, since they only cover parts of the genitals, the introduction of pathogens into the vulva area is still possible.

A vaccine against certain human papilloma viruses is now available and, according to current knowledge, offers very good protection against infection.