Presentation
Psoriasis, atopic dermatitis and lichen sclerosus may cause chronic vulvar dermatosis Psoriasis presents as red, nonscaly, pruritic plaques, sometimes isolated to the vulva. [cmaj.ca]
A 15-year retrospective review of prepubertal girls presenting with recurrent vaginal discharge found that sexual abuse might have been involved in about 5% of cases. 2 Systemic diseases, such as eczema and psoriasis, may also present with gynecologic [mdedge.com]
Presentation to medical services will also be influenced by the level of parental concern. [adc.bmj.com]
If the presenting complaint is mainly dyspareunia, pelvic muscle tone may need to be assessed. [patient.info]
An 18-year-old woman presents with severe vaginal and vulvar itching and a thick white discharge. Figure 77-1 shows the appearance of her vulva with redness and excoriations. Note the satellite lesions near the borders of the inflamed areas. [obgynkey.com]
Entire Body System
- Candidiasis
Placebo in Subjects With Acute Vulvovaginal Candidiasis Recruiting NCT03734991 Phase 3 Ibrexafungerp;Placebo 17 A Study of Oral VT-1161 for the Treatment of Acute Vaginal Candidiasis (Yeast Infection) in Patients With Recurrent Vaginal Candidiasis Recruiting [malacards.org]
Studies have shown that the prevalence of a variant MLB gene is higher in women with recurrent vulvovaginal candidiasis than in controls without candidiasis. [emedicine.medscape.com]
Complicated VVC is characterized by recurrent (four or more episodes in 1 year) or severe VVC, non-albicans candidiasis, or the patient has uncontrolled diabetes, debilitation, or immunosuppression.1 Yeast vaginitis, yeast infection, candidiasis, moniliasis [obgynkey.com]
The most common infectious causes of vaginitis in symptomatic women include bacterial vaginosis (22% to 50%), candidiasis (17% to 39%), and trichomoniasis (4% to 35%). [accessmedicine.mhmedical.com]
Vulvovaginal candidiasis (VVC) is characterized by vulvovaginal itching, redness and discharge. [mdpi.com]
Gastrointestinal
- Diarrhea
[…] virus African swine fever Aujeszky's disease Blue eye disease Classical Swine Fever Encephalomyocarditis Foot-and-mouth disease Influenza Japanese B Encephalitis Nipah virus disease Porcine circovirosis Porcine cytomegalovirus infection Porcine epidemic diarrhea [pig333.com]
Side-effects are uncommon but can include headaches, diarrhea and a rash. Itraconazole is typically reserved for severe cases and is generally only available with a prescription from a doctor. [ada.com]
Shigella vaginitis is associated with mucopurulent bloody discharge and likewise, is not always accompanied by a history of diarrhea. [unboundmedicine.com]
Diarrhea is absent in most of the patients. Mucopurulent, malodorous, and bloody discharge occurs in 47% of cases. Yersinia More Details enterocolitica vulvovaginitis is rare. [jnsmonline.org]
- Abdominal Pain
This may or may not be associated with vaginal discomfort and/or abdominal pain. [accessmedicine.mhmedical.com]
Oral azoles occasionally cause nausea, abdominal pain, and headache. Therapy with the oral azoles has been associated rarely with abnormal elevations of liver enzymes. [cdc.gov]
Pelvic inflammatory disease (PID): Abdominal pain, cervical motion tenderness, or cervical inflammation suggests PID. [msdmanuals.com]
Vulvovaginitis was the most common presentation (18%), followed by labial adhesions in (14%) of girls, abdominal pain in (7%) of girls, and precocious puberty in (6%). [jnsmonline.org]
Musculoskeletal
- Osteoporosis
[…] vesicular disease Teschen disease Transmissible gastroenteritis Diseases caused by parasites Ascariasis Coccidiosis Mange Metastrongylosis Trichinellosis Trichuriasis Nutritional deficiencies Biotin deficiency Iron deficiency anemia Mulberry heart disease Osteoporosis [pig333.com]
Skin
- Pruritus
Generalised pruritus. Psychological problems. [patient.info]
The usual symptoms are discharge, discomfort, pain or pruritus, vulvar irritation, or burning on urination. [pedsinreview.aappublications.org]
[…] is the primary risk factor, but it is not considered an STD Other risk factors include intrauterine devices ( IUDs ), douching, and pregnancy Clinical features Commonly asymptomatic Increased vaginal discharge, usually gray or milky with fishy odor Pruritus [amboss.com]
Discharge due to vaginitis is accompanied by pruritus, erythema, and sometimes burning, pain, or mild bleeding. Pruritus may interfere with sleep. Dysuria or dyspareunia may occur. [msdmanuals.com]
Presents with pruritus, discharge and/or bleeding. It usually consists of pale atrophic patches on the labia and perineum. The patches can be confluence and extensive. If asymptomatic – no treatment required. [pch.health.wa.gov.au]
- Skin Lesion
Skin biopsy is usually required in cases of diagnostic difficulty (or for any skin lesion not responding to a six-week course of treatment). This is usually performed in secondary care or by a GP with special interest. [patient.info]
Neurologic
- Irritability
Bacteria from the bottom can irritate the sensitive genital area. What causes vulvovaginitis? Most commonly, vulvovaginitis is caused when the skin becomes irritated. [healthnavigator.org.nz]
</li><li>Dry winter air can be irritating to the skin.</li><li>Heat and humidity can also irritate the skin, especially if combined with wet bathing suits or tight clothing. [aboutkidshealth.ca]
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. [indiatoday.in]
Irritation of the genital area due to detergents, harsh soaps, chemicals such as chlorine, bubble baths, poor hygiene practices or tight clothing Infections, with bacteria or yeast Pinworm Contact irritants Skin diseases such as eczema A foreign body [cincinnatichildrens.org]
It can be caused by infection, irritation, a foreign body, allergy, or systemic disease. Yeast Vulvovaginitis Pediatric yeast infection is a general term that describes when a naturally occurring fungus grows in excess and causes irritation. [childrens.com]
Urogenital
- Dyspareunia
[…] or single-dose oral fluconazole References: [4] [5] [6] [7] [8] Trichomoniasis Pathogen : Trichomonas vaginalis Transmission : sexual Clinical features Foul-smelling, frothy, yellow-green, purulent discharge Vulvovaginal pruritus, burning sensation, dyspareunia [amboss.com]
Dysuria or dyspareunia may occur. In atrophic vaginitis, discharge is scant, dyspareunia is common, and vaginal tissue appears thin and dry. [msdmanuals.com]
Presenting symptoms include vulvar or vaginal pain and dyspareunia. Diagnosis. On physical examination, the vulva appears pale and atrophic, with narrowing of the introitus. [consultqd.clevelandclinic.org]
External dysuria and dyspareunia may also occur. [ijogr.com]
It may prevent sexual intercourse (apareunia) or result in painful or uncomfortable sexual intercourse ( dyspareunia ). What are the causes of vaginitis? Although most often due to infection, vaginitis may be due to one or more causes. [dermnetnz.org]
- Vaginal Bleeding
You notice vaginal bleeding. Your child has pain or burning when urinating, and is urinating more often. You have other concerns or questions. Symptoms return. [childrensmn.org]
vaginal discharge/vaginal bleeding was the most common symptom (49%). [jnsmonline.org]
Vaginitis may result in vaginal soreness, itching, discharge, malodour, fissuring and bleeding. It may hurt to pass urine ( dysuria ). [dermnetnz.org]
Exclusion criteria were the presence of vaginal bleeding, pregnancy, intercourse in the last 24 hours and the use of antibiotic or immunosuppressive drugs in the last month. [oatext.com]
Vaginal foreign bodies cause an intense inflammation, resulting in vaginal bleeding and foul smelling, blood stained vaginal discharge. These cases were not included in the study. [adc.bmj.com]
- Pruritus Vulvae
Clin Obstet Gynecol. 1997 ; 40 : 135 – 140 OpenUrl CrossRef PubMed Pruritus Vulvae in Prepubertal Children. Paek SC, Merritt DF, Mallory SB. [pedsinreview.aappublications.org]
Pruritus vulvae of unknown cause In the absence of a specific diagnosis, or whilst waiting for results, the following treatments can be tried. [patient.info]
[Sponsored content] Related information On DermNet NZ Pruritus vulvae (itchy vulva) Pruritus ani (itchy anus) Vulvodynia Vestibulodynia Vulval and vaginal problems in girls Genital skin problems Sexually transmitted infections Other websites Medscape [dermnetnz.org]
- Vulvar Edema
Signs include vulvar edema, fissures, excoriations, and thick curdy vaginal discharge. [cdc.gov]
Workup
Serum
- Estrogen Decreased
Some treatments (eg, oophorectomy, pelvic radiation, certain chemotherapy drugs) also result in loss of estrogen. Decreased estrogen predisposes to inflammatory (particularly atrophic) vaginitis. [msdmanuals.com]
Microbiology
- Chlamydia
Detection and differentiation of Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pneumoniae by DNA amplification. [ncbi.nlm.nih.gov]
Sexually active women 25 years or younger with STIs should be offered empiric treatment for gonorrhea and chlamydia in addition to counseling regarding safe sex and testing for syphilis, HIV, and viral hepatitis at the time of presentation and prior to [oxfordmedicine.com]
Vaginal discharge can be secondary to a wide variety of pathologies, including vaginitis due to bacterial vaginosis, candidiasis, or trichomoniasis, as well as cervicitis, salpingitis, or pelvic inflammatory disease due to Neisseria gonorrhoeae or Chlamydia [accessmedicine.mhmedical.com]
Candida Unusual (3%) in > 2 year old prepubertal girls Usually if recent antibiotic therapy, immunocompromised or wearing nappies Sexually Transmitted Infections Typically the result of sexual abuse with some exceptions All cases of Neisseria gonorrhoea, Chlamydia [pch.health.wa.gov.au]
Discovery of Chlamydia trachomatis, N. gonorrhea, Trichomonas, and Herpes simplex should raise the suspicion of sexual abuse. Some of these may be transmitted from the mother, other family members, and caretakers by non-sexual means. [pedclerk.bsd.uchicago.edu]
Treatment
Therefore, treatment is usually reserved for women with bothersome symptoms. The treatments for bacterial vaginosis recommended in Canada in the PHAC’s guidelines on STI are presented in Table below. [ijogr.com]
It is a good idea to check with a doctor before starting boric acid treatment. Takeaway Treatment for vulvovaginitis depends on the cause, and some cases may go away without treatment. [medicalnewstoday.com]
Treatment consists of administration of antibiotics or antifungals (depending on the pathogen). [amboss.com]
Determining the cause is key to successful treatment. [consultqd.clevelandclinic.org]
Treatment Treatment will typically involve the use of antifungal medication, which will usually take the form of an oral tablet and/or topical skin cream. Following treatment, most cases of thrush will resolve in a few days. [ada.com]
Prognosis
Prognosis Most cases of pruritus resolve once the correct diagnosis is made and appropriate treatment instituted. The prognosis will depend on the underlying condition causing the vulvitis. [patient.info]
Expectations (prognosis) Proper treatment of an infection is usually very effective. [indiatoday.in]
Outlook (Prognosis) Proper treatment of an infection is effective in most cases. [ufhealth.org]
Outlook (Prognosis) Proper treatment of an infection is most often very effective. Prevention Keep your genital area clean and dry when you have vaginitis. Avoid soap. Just rinse with water to clean yourself. [account.allinahealth.org]
Etiology
This article reviews the etiology, pathogenesis, clinical features, diagnosis, and management of NAC vulvovaginitis. [mdpi.com]
May try topical antibiotics or low potency steroids If there is any suspicion of abuse, cultures should be obtained with the proper culture media to try to delineate a specific etiology. References Kokotos, Faye, and Henry M. Adam. Vulvovaginitis. [pedclerk.bsd.uchicago.edu]
While many theories have been proposed, the etiology of this condition remains unknown. [emedicine.medscape.com]
System(s) affected: reproductive, skin/exocrine Synonym(s): vaginitis; vulvitis Epidemiology Incidence Unknown Prevalence Most common gynecologic problem in prepubertal girls Etiology and Pathophysiology In the prepubertal child, the levels of estrogen [unboundmedicine.com]
Table 2: Etiology of prepubertal vulvovaginitis percentage of microorganism isolates Click here to view Unfortunately, we do not have studies in Saudi Arabia about prepubertal vulvovaginitis and its etiological factors. [jnsmonline.org]
Epidemiology
Differential diagnoses of infectious vulvovaginitis Bacterial vulvovaginitis Bacterial vaginosis Epidemiology : most common vaginal infection in women (40–45% of all cases) Pathogen : Gardnerella vaginalis (a gram-variable rod) (Gram-variable) Pathogenesis [amboss.com]
The epidemiology and presentation of vulvovaginitis differ in prepubescent and adolescent girls. [pedsinreview.aappublications.org]
System(s) affected: reproductive, skin/exocrine Synonym(s): vaginitis; vulvitis Epidemiology Incidence Unknown Prevalence Most common gynecologic problem in prepubertal girls Etiology and Pathophysiology In the prepubertal child, the levels of estrogen [unboundmedicine.com]
Epidemiologic determinants of vaginal pH. Am J Obstet Gynecol. 1999;180(5):1060-6. [ Links ] 36. Nai GA, Mello ALP, Ferreira AD, Barbosa RL. [scielo.br]
Epidemiology Exact figures are not available because the term covers so many different conditions and many women self-treat and do not consult a health professional. Females of all ages are affected, from prepubertal girls to the elderly. [patient.info]
Pathophysiology
System(s) affected: reproductive, skin/exocrine Synonym(s): vaginitis; vulvitis Epidemiology Incidence Unknown Prevalence Most common gynecologic problem in prepubertal girls Etiology and Pathophysiology In the prepubertal child, the levels of estrogen [unboundmedicine.com]
Etiology and Pathophysiology Listen Most vulvovaginal Candidiasis is caused by Candida albicans (Figure 77-3).1,7 Candida glabrata now causes a significant percentage of all Candida vulvovaginal infections. [obgynkey.com]
[…] by an alkaline vaginal discharge may lead to chronic irritation and inflammation Other - Some authors have associated vulvar vestibulitis with a history of sexual abuse, elective abortions, severe marital conflicts, depression, and anxiety Neurologic pathophysiology [emedicine.medscape.com]
Pathophysiology Prepubertal girls are susceptible to vulvovaginitis due to behavioral, anatomic, and physiologic predisposing factors. [jnsmonline.org]
Prevention
Prevention There are a number of practices and habits that are thought to help prevent vaginal thrush. It should be noted, however, that these practices are not medically proven to be effective and may only be useful in some cases. [ada.com]
Good hygiene is the best way to prevent non-infectious vulvovaginitis. Wearing comfortable clothing that absorbs moisture can also reduce infection. Using a condom can prevent most sexually transmitted forms of vulvovaginitis. [medicalnewstoday.com]
Removing underwear at bedtime may also help prevent vulvovaginitis. Proper cleansing is important and may help prevent irritation. This is especially true if the infection is bacterial. [healthline.com]
Prevention Use of a condom during sexual intercourse can prevent most sexually transmitted vaginal infections. [indiatoday.in]
Possible causes of pediatric vulvovaginitis include: Bacteria Irritation due to harsh soaps or chemicals Poor hygiene Tight clothing Yeast Viruses Allergic reaction Treatment and prevention of vaginitis or vulvovaginitis Once the cause of vulvovaginitis [nortonchildrens.com]