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Vulvitis and Bartholinitis

December 25, 2010

Vulvitis

Vulvitis is inflammation of the vulva. When both the vulva and vagina are inflamed, the disorder is called vulvovaginitis. Vulvitis may result from allergic reactions to substances that come in contact with the vulva (such as soaps, bubble bath, fabrics, and perfumes), from skin disorders (such as dermatitis), or from infections, including yeast infections and sexually transmitted diseases (such as herpes). The vulva may be infested by pubic lice—a disorder called pediculosis pubis.

In children, infections of the vagina may also affect the vulva. These infections may be due to bacteria from the anus or other bacteria.

Urine or stool, if it remains in contact with the vulva, can irritate it and cause ongoing (chronic) vulvitis. Women who have incontinence or are confined to bed may have this problem.

Vulvitis causes itching, soreness, and redness. Rarely, the folds of skin around the vaginal and urethral openings (labia) become stuck together. Chronic vulvitis may result in sore, scaly, thickened, or whitish patches on the vulva. If chronic vulvitis does not respond to treatment, doctors usually do a biopsy to look for the cause, including skin disorders of the vulva (vulvar dystrophies, such as lichen sclerosus or squamous cell hyperplasia) or cancer.

Bartholinitis

Bartholinitis—infection of one or both glands or their ducts—may develop when bacteria from the vagina enter the glands. Rarely, bartholinitis is due to a sexually transmitted disease. Pus can accumulate in the gland, causing a painful, swollen abscess.

If the ducts to the gland become blocked, the gland may swell without causing pain—a disorder called Bartholin’s cyst. A cyst may become infected.

Doctors can diagnose Bartholin’s cyst and bartholinitis during a physical examination. In women 40 and older, a cyst is usually biopsied.

Cysts that cause no symptoms do not require treatment. Infections are treated with an antibiotic, which usually clears the infection in a few days if there is no abscess. However, the infection may recur. Analgesics may be taken to relieve pain.

Abscesses are usually drained.

Symptoms

Typically, vaginal infections produce a vaginal discharge. This discharge differs from a normal one because it is accompanied by itching, redness, and sometimes burning or soreness in the genital area. A discharge may have a fishy odor. The appearance and amount of the discharge tend to vary depending on the cause. However, different disorders sometimes cause similar discharges.

Itching may interfere with sleep. Some infections can make sexual intercourse painful and make urination painful and more frequent. Rarely, the folds of skin around the vaginal and urethral openings become stuck together. However, sometimes symptoms are mild or do not occur.

Diagnosis

Girls or women who have a vaginal discharge with itching or who have other vaginal symptoms should see a doctor. To determine the cause, the doctor asks questions about the discharge (if present), about possible causes of the symptoms, and about hygiene. Questions may include the following:

  • Have lotions or creams (including home remedies) been used to try to relieve the symptoms?
  • When did the discharge begin?
  • Was the discharge accompanied by itching, burning, pain, or a sore in the genital area?
  • When do symptoms occur in relation to the menstrual period?
  • Does the discharge come and go, or is it always present?
  • Has an abnormal discharge occurred before, and if so, how did it respond to treatment?
  • What kind of birth control has been and is being used?
  • Is pain felt during sexual intercourse?
  • Has the woman had previous vaginal infections?
  • Does the sex partner have symptoms?

The doctor also asks about the possibility of sexually transmitted diseases. This information helps the doctor determine whether other people require treatment.

A pelvic examination is done. While examining the vagina, the doctor takes a sample of the discharge (if present) with a cotton-tipped swab. The sample is examined under a microscope. With this information, the doctor can usually determine whether the cause is bacterial vaginosis, trichomonas vaginitis, or a yeast infection. Usually, the doctor also uses a swab to take a sample of fluid from the cervix. The sample is tested for sexually transmitted diseases.


To determine whether there are other infections in the pelvis, the doctor checks the uterus and ovaries by inserting the index and middle fingers of one gloved hand into the vagina and pressing on the outside of the lower abdomen with the other hand. If this maneuver causes substantial pain or if a fever is present, other infections may be present.

Prevention

Keeping the genital area clean and dry can help prevent infections. Washing every day with a mild, nonscented soap (such as glycerin soap) and rinsing and drying thoroughly are recommended. Wiping front to back after urinating or defecating prevents bacteria from the anus from being moved to the vagina. Young girls should be taught good hygiene.

Wearing loose, absorbent clothing, such as cotton or cotton-lined underpants, allows air to circulate and helps keep the genital area dry. Douching frequently and using medicated douches are discouraged. Douching can remove normal, protective bacteria from the vagina and reduce the acidity of the vagina, making infections, including pelvic inflammatory disease, more likely. Practicing sex safe and limiting the number of sex partners are important preventive measures.

Treatment

Measures used for prevention, such as keeping the genital area clean and dry, also help treat infections. Strong or scented soaps and unnecessary topical products (such as feminine hygiene sprays) should be avoided. Occasionally placing ice packs on the genital area, applying cool compresses, or sitting in a cool sitz bath (with or without baking soda or Epsom salts) may reduce soreness and itching. A sitz bath is taken in the sitting position with the water covering only the genital and rectal area. Flushing the genital area with lukewarm water squeezed from a water bottle may also provide relief.

If these measures do not relieve symptoms, drugs may be needed. For itching, a corticosteroid cream (such as hydrocortisone) can sometimes be applied to the vulva but not in the vagina. Antihistamines taken by mouth help relieve itching. They also cause drowsiness and may be useful if symptoms interfere with sleep.

Specific treatment depends on the cause.

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