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Inflammation of the vagina and vulva most often caused by a bacterial, fungal, or parasitic infection.


Vulvovaginitis, vulvitis, and vaginitis are general terms that refer to the inflammation of the vagina and/or vulva (the external genital organs of a woman). These conditions can be caused by bacterial, fungal, or parasitic infections. Also, vulvovaginitis can be caused by low estrogen levels (called "atrophic vaginitis") or any type of allergic or irritation response from things such as spermicidal products, condoms, soaps, and bubble bath.
In general, vulvovaginitis causes vaginal discharge, irritation, and itching. One of the most common reasons why women visit their doctor is because of a change in vaginal discharge. It is completely normal for a woman to have a vaginal discharge, the amount and consistency of which varies during the course of the menstrual cycle. Each of the three most common types of vulvovaginitis will be described separately.

Bacterial vaginosis

Bacterial vaginosis is the most common cause of vaginitis during the childbearing years. Forty percent to 50% of vaginitis cases are caused by bacterial vaginosis. The occurrence of bacterial vaginosis is difficult to determine but studies have proposed that 10%-41% of women have had it at least once. The occurrence of bacterial vaginosis in the United States is highest among African-American women and women who have had multiple sexual partners and lowest among Asian women and women with no history of sexual contact with men. Bacterial vaginosis is not considered a sexually transmitted disease although it can be acquired by sexual intercourse.
Bacterial vaginosis is not caused by a particular organism but is a change in the balance of normal vaginal bacteria. Ninety percent of the bacteria found in a healthy vagina belong to the Lactobacillus family. For unknown reasons, there is a shift in the bacterial population that results in overgrowth of other bacteria. Patients suffering from bacterial vaginosis have very high numbers of such bacteria as Gardnerella vaginalis, Mycoplasmahominis, Bacteroides species, and Mobiluncus species. These bacteria can be found at numbers 100 to 1000 times greater than found in the healthy vagina. In contrast, Lactobacillus bacteria are in very low numbers or completely absent from the vagina of women with bacterial vaginosis.

Candida vulvovaginitis

Candida vulvovaginitis also has been called "vulvovaginal candidiasis," "candidal vaginitis," "monilial infection," or "vaginal yeast infection." Twenty to 25% of the vaginitis cases are Candida vulvovaginitis. It has been estimated that about 75% of all women get a vaginal yeast infection at least once. In 80-90% of the cases, Candida vulvovaginitis is caused by an overgrowth of the yeast Candida albicans. The remaining cases are caused by other species of Candida. It is not known what causes the yeast overgrowth. However, antibiotics can inadvertently kill normal bacteria in the vagina and cause an overgrowth of Candida.
Candida vulvovaginitis is not considered a sexually transmitted disease because Candida species are commonly found in the healthy vagina. It is a rare disease in girls before puberty and celibate women. Vaginal yeast infections tend to occur more frequently in women who are pregnant, diabetic and not controlling their disease, taking birth control pills, or taking antibiotics. The stress of military deployment has also been found to be a factor in triggering vaginal yeast infections. Some women have four or more attacks per year, a condition called "recurrent vaginal candidiasis."


Trichomoniasis, which is sometimes called "trich," accounts for 15-20% of the cases of vaginitis. It is estimated that two million to three million American women get trichomoniasis each year, and as many as 120 million women worldwide. Unlike the previous two causes of vulvovaginitis, trichomoniasis is a sexually transmitted disease. This means that the disease is passed from person to person only by sexual contact. Trichomoniasis occurs in both men and women and is caused by infection with the single-celled parasite Trichomonas vaginalis. Infection with Trichomonas vaginalis is frequently associated with other sexually transmitted diseases and assists the spread of the AIDS virus.

Causes and symptoms

Vulvovaginitis is most often caused by a bacterial, fungal, or parasitic infection as described above. Other microorganisms may cause vulvovaginitis, or it may be caused by allergic reaction, irritation, injury, low estrogen levels, and certain diseases. Risk factors for bacterial vaginosis include using an intrauterine device (IUD), non-white race, prior pregnancy, first sexual activity at an early age, having multiple sexual partners, and having a history of sexually transmitted diseases. Persons at an increased risk for Candida vulvovaginitis include those who have had previous candida infections, frequent sexual intercourse, use birth control pills, have AIDS, are pregnant, are taking antibiotics or corticosteroids, are diabetic, use douches, use perfumed feminine hygiene sprays, wear tight clothing, or use vaginal sponges or an IUD.
The typical symptoms of vulvovaginitis are: vaginal discharge, itching, and irritation. Women may have few or no symptoms, while others may have pronounced symptoms. The main symptom of bacterial vaginosis is a fishy-smelling, thin, milky-white or gray vaginal discharge but itching and burning may also be present. The fishy smell is stronger after sexual intercourse. The symptoms of candida vulvovaginitis are itching, soreness, painful sexual intercourse, and a thick, curdy, white (like cottage cheese) vaginal discharge. Trichomoniasis symptoms are: painful urination, painful sexual intercourse, and a yellow-green to gray, foul smelling, sometimes frothy, vaginal discharge.


Vulvovaginitis can be diagnosed and treated by a nurse practitioner or physician. Most insurance companies cover the costs of diagnosis and treatment. To diagnose vulvovaginitis, the doctor will examine the vagina (using a speculum to keep the vagina open) and take a sample of the vaginal discharge for tests and microscopic analysis. Laboratory culture results should be available in two to three days but the microscopic examination of the vaginal discharge may be immediately performed in the doctor's office. Diagnosis may be difficult because there are many different causes of vulvovaginitis. Women who think that they have vulvovaginitis should always visit their doctor to get an accurate diagnosis. Many women assume that they have a yeast infection and take over-the-counter medicines without first consulting their doctors.
There are four signs that indicate that a woman has bacterial vaginosis. These signs (known as Amsel's criteria) are: a thin, milky white discharge that clings to the walls of the vagina, presence of a fishy odor, a vaginal pH greater than 4.5, and the presence of clue cells in the vagina. Clue cells are vaginal cells that are covered with small bacteria. A diagnosis of candida vulvovaginitis is made after finding a normal vaginal pH (4 to 4.5) and the presence of many yeast cells in the sample of vaginal discharge or growth of yeast on laboratory media. In the spring of 2004, the U.S. Food and Drug Administration (FDA) cleared a new quick test to diagnose trichnomonas infection. The test provides results in 10 minutes. The company that manufactures the test also has a rapid result test to bacterial vaginosis. A trichomoniasis diagnosis is made when the parasites are found in the vaginal discharge either by microscopic examination or in laboratory cultures.
Trichomoniasis tends to be underdiagnosed in men because of the relative mildness of symptoms in men and insufficiently sensitive diagnostic tests. The recent introduction of DNA amplification, however, indicates that the incidence of trichomoniasis in men is much higher than was previously thought.


Both bacterial vaginosis and trichomoniasis require prescription medication for treatment. Candida vulvovaginitis may be treated with either prescription or over-the-counter medicines. It is not advisable to take over-the-counter vaginal yeast infection medicines if one does not have a yeast infection. An Institute of Epidemiological Research survey of 390 gynecologists found that 44% of the women who were diagnosed with bacterial vaginosis had first treated themselves with over-the-counter yeast infection medications.
Bacterial vaginosis should be treated daily for one week with the antibiotics metronidazole (Flagyl, Protostat) or clindamycin (Cleocin) either as pills taken orally or in a gel or cream form put into the vagina. Trichomoniasis is treated with either a large, single dose of metronidazole or with a smaller dose taken twice daily for one week. Male sexual partners of women with trichomoniasis also must be treated.
Candida vulvovaginitis is most often treated by the application of medicated gels, creams, or suppositories applied directly to the vagina. The antifungal drugs used to treat candida vulvovaginitis include oral fluconazole (Diflucan), butoconazole (Femstat), clotrimazole (Gyne-lotrimin, Mycelex), miconazole (Monistat), and ticonazole (Vagistat). Most require only one or a few days of therapy to be effective. Women who have recurrent Candida infections may receive treatment for several weeks and then some form of a long-term preventative treatment.

Alternative treatment

One of the primary focuses of alternative treatment for vaginal conditions including vulvovaginitis is rebalancing the normal vaginal flora. To assist with this rebalancing, Lactobacillus acidophilus and L. bifidus are recommended, either taken internally or introduced directly into the vagina. Garlic (Allium sativum), both taken internally and inserted into the vagina (a peeled whole clove wrapped in gauze), may be helpful due to its antibacterial and antifungal actions. A variety of other herbs can be used as douches or in suppository form to help treat acute flare-ups of vaginal symptoms. For example a douche made by steeping 1-2 tsp. of calendula (Calendula officinalis) in boiling water (let the water cool before using) may help reduce inflammation. A boric acid douche can help to acidify the vaginal pH so that unwanted bacteria cannot survive and multiply. For atrophic vaginitis, especially in menopausal women, topical application of progesterone cream can help with symptoms caused by thinning of the tissue lining the vagina.
Dietary modification and nutritional supplementation may also be helpful in the treatment of vulvovaginitis. Antioxidant vitamins, including A, C, and E, as well as B complex vitamins, and vitamin D, are recommended. Foods to avoid include cheese, alcohol, chocolate, soy sauce, sugar, vinegar, fruits, and any fermented foods. Wearing cotton underwear and loose fitting clothes and avoiding panty hose can help keep the vagina cool and dry, thus helping to prevent some forms of vulvovaginitis. Cases of chronic vulvovaginitis should be addressed on systemic level by an alternative practitioner.

Key terms

Parasite — An animal or plant that can only survive by living inside or upon another animal or plant.
Vulva — The external genital organs of a woman, including the outer and inner lips, clitoris, and opening of the vagina.


Vulvovaginitis is a disease with minor symptoms and most women respond well to medications. It is believed that certain vaginal infections, if left untreated, can lead to more serious conditions such as pelvic inflammatory disease, endometritis, postsurgical infections, and spread of the AIDS virus.


Vaginal infections may be prevented by following these suggestions:
  • Over-the-counter yeast infection treatments should not be taken unless the woman had been diagnosed with candidiasis before and recognizes the symptoms.
  • Douching should be avoided because it may disturb the balance of organisms in the vagina and may spread them higher into the reproductive system.
  • Thoroughly dry oneself after bathing and remove a wet bathing suit promptly.
  • Avoid wearing tight clothing and wear cotton underwear.
  • Clean diaphragms, cervical caps, and spermicide applicators after use. Use condoms to avoid sexually transmitted disease.
  • After a bowel movement, wipe from front to back to avoid spreading intestinal bacteria to the vagina.



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Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311.
National Vaginitis Association. 117 South Cook St., Suite 315, Barrington, IL 60010. (800) 909-8745.


Centers for Disease Control and Prevention (CDC). "Fact Sheet: Trichomonas Infection."
Women's Health STD Information Center. JAMA.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


inflammation of the vulva and vagina.
Candida vulvovaginitis (candidal vulvovaginitis) vulvovaginal candidiasis.
senile vulvovaginitis atrophic vaginitis in which there is intense itching around the vagina, almost complete lack of vaginal secretions, and tissue atrophy.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


Inflammation of both vulva and vagina.
Farlex Partner Medical Dictionary © Farlex 2012


Inflammation of the vulva and vagina.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Inflamed vulvae Gynecology Inflammation of vulva/vagina, most common in prepubertal ♀ Etiology Bubble baths, soaps, perfumes, tight or non-absorbent clothing, poor hygiene, STDs, allergens,
bacteria–N gonorrheae, Gardnerella vaginalis, fecal or skin contaminants–eg, staphylococci, streptococci, yeasts–eg, Candida albicans, viruses, parasites–eg, pinworms
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


Inflammation of both vulva and vagina.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012


Inflammation of the VULVA and the VAGINA. The condition is commonest in childhood as a result of poor hygiene, a foreign body in the vagina or sexual assault. There is soreness on urination, redness and sometimes a slight discharge. Daily washing is often all that is necessary.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
As for the correspondence between clinical and laboratory diagnosis, it was noted that bacterial vaginosis was the predominant clinical diagnosis in contrast to the finding of intermediate biota in the laboratory as the most frequent, so observation alone of symptoms does not allow to an accurate diagnosis in most cases, as well as noted Rathod et al., in a study of vulvovaginitis conducted in India, hence the importance of applying the relevant tests for a correct diagnosis [16].
Se resalta que en el caso de los bovinos, 5 de las 11 patologias afectaron a hembras vacias y gestantes (vulvovaginitis, mastitis, metritis, anestro, distocia, retencion de placenta y repeticion de celo); y 4 a hembras prenadas (aborto, cria debil, prematura y natimorto), mientras que en las bufalas 2 de las 5 patologias afectaron animales vacios (repeticion de celos y anestro) y 3 animales durante parto (aborto, cria debil y natimorto) (Figura 2).
Adverse reactions occurring in at least 5% of users were vulvovaginitis (20%), abdominal/pelvic pain (19%), acne/seborrhea (15%), ovarian cyst (13%), headache (12%), dysmenorrhea (9%), breast pain/discomfort (9%), increased bleeding (8%), and nausea (6%).
Contributed by specialists from Europe, Israel, the US, and South America, chapters cover gynecological examination of the child and adolescent, normal female puberty, endocrine evaluation of reproductive function, diagnostic methods, disorders of sex development, vulvovaginitis and other common vulvar disorders, precocious and delayed puberty, ovarian cysts, sexual abuse, menstrual disorders, dysmenorrhea, hyperandrogenism, ovarian masses, breast diseases, cervical cancer prevention, chronic pelvic pain, congenital developmental defects of Mullerian derivates, eating disorders, contraception, teen pregnancy, sex education, high-risk sexual behaviors, and culturally sensitive care.
Jones (2009) reported a case where a patient with chronic vulvovaginitis used tea tree and lavender oil for vulval and peri-anal irritation and had an allergic reaction.
CHICAGO - Even though the numbers remain small, fluconazole-resistant Candida albicans vulvovaginitis appears to be emerging as a thorny clinical problem, one expert suggests.
These changes may lead pregnant women to a picture of vulvovaginitis. The vulvovaginitis is bacterial polymicrobial infection that causes vaginal discharge without clinical signs of inflammation.
Vulvovaginitis: correlation with predisposing factors, clinical manifestations and microbiological studies].
Sacco reports that doctors began to uncover what they described as an epidemic of gonorrhea vulvovaginitis in prepubertal girls.