Vulvitis, or inflammation of the vulva, may be caused by one of several medical conditions, medicated creams, or external irritants. It can also be caused by an injury; oral sex; a bacterial, viral, or fungal infection; sitting in a hot tub; allergies to common commercial products such as body soaps, powders, and deodorants; or irritation from sanitary napkins, synthetic underwear, or panty hose.
Vulvitis often accompanies vaginal infections. Stress, inadequate diet, and poor hygiene can increase the likelihood of vaginal infections. Women with diabetes may develop vulvitis because the sugar content of their cells is higher, increasing susceptibility to infection. Postmenopausal women often develop vulvitis because as hormone levels drop, the vulvar tissues become thinner, drier, and less elastic and therefore more prone to irritation and infection.
Symptoms of vulvitis include itching, redness, swelling, burning, and pain. Sometimes fluid-filled blisters form that break open, ooze, and crust over (these could also be herpes). Scratching can cause further irritation, pus formation, and scaling, as well as secondary infection. Sometimes, as a result of scratching, the skin whitens and thickens.
Women with this problem tend to overclean the vulva, contributing to further irritation. Wash once a day with warm water only.
Medical Treatments for Vulvitis
The first step in treating vulvitis medically is to get a diagnosis. Depending on the cause, your healthcare provider may prescribe antifungal creams or antibacterial treatment. Cortisone cream or other soothing lotions can relieve severe itching. (Low-dose cortisone creams are good for a short time; fluorinated ones can cause thinning and atrophy of the skin if used for a long time, though these may be required for some conditions.) Postmenopausal women may be given a form of local estrogen. If you have a vaginal infection or herpes, treating these problems will usually clear up the vulvitis as well.
If the vulvitis persists or worsens, you may need a vulvar biopsy to rule out the possibility of cancer or chronic vulvar conditions such as lichen sclerosus, a skin disease that can produce itching, bruising, pain, and scarring. This biopsy can be done in the practitioner’s office with local anesthetic.
Discontinue using any substances that might be a cause of vulvitis. All commercial preparations may be irritating, including antifungal agents and lubricants containing propylene glycol.
Keep your vulva clean, cool, and dry—and remember to wipe from front to back. Hot boric acid compresses and hot sitz baths with comfrey tea are soothing. Use unscented white toilet paper (as perfumes and dyes may be aggravating) and soft cotton or linen towels, and wear cotton underwear to prevent chafing. Aveeno colloidal oatmeal bath and cold compresses made of plain, unsweetened, live-culture yogurt or cottage cheese also help relieve itching and soothe irritation. Calamine lotion can be used to address itching. Use a sterile, nonirritating lubricant such as K‑Y jelly or Astroglide during intercourse and other genital sex.