Vulvovaginitis is a clinical presentation which can have many causes. It typically presents with one or more of the following; vaginal itch, discharge, dyspareunia, burning, dysuria and swelling.
It is most commonly caused by vaginal thrush, but there are a wide range of other causes, including other infections (e.g. trichomonas, herpes simplex, other STIs), dermatological causes – e.g. psoriasis or eczema, and neurological causes.
Mixed pathology is very common – particularly the combination of vulval dermatitis and thrush.
The treatment typically involves a combination of avoiding irritant causes to the vulvovaginal area, and treating the underlying disorder.
- Associated sensations – burning, sharp pain
- Provoking factors
- Always present at rest
- Symptoms provoked by tampons, clothes, exercise
- Menstrual history
- Are symptoms cyclical?
- Sexual history
- New sexual partners
- Assess STI risk
- VERY importante because some of the treatments are contra-indicated in pregnancy
- Skin conditions
- Any history of psoriasis or dermatitis?
- Recent antibiotics – predispose to thrush
- Might have trialled over-the-counter treatments for thrush
- Examine external genitalia
- Any skin lesions – e.g. herpes simplex, warts or molluscum contagiosum
- Any signs of dermatitis
- Any visible discharge
- Any lichenifiaction?
- This refieres to thickening of the skin
- Speculum examination
- Examine cervix
- Note the qualities of any discharge
- Bimanual examination
- Note pain and tenderness
|Retained foreign body||
||Likely causes include chlamydia or gonorrhoea. Treat as per underlying cause|
Modified from a table in RACGP Check – Women’s Health – Unit 530 – August 2016
- Swab for MC+S
- Test for chlamydia and gonorrhoea – usually PCR from an appropriate swab. Urine PCR can also be performed but is less accurate
- Consider bedside pH testing of any discharge
The management of vulvovaginitis will typically involve with below general measures, in addition to specific treatment for the underlying disorder.
- Loose fitting cotton clothing
- Clean the area once or twice daily without soap (wither water only, or emollient)
- Avoid cycling or horse riding until symptoms settle
- Avoid irritants
- Hygiene wipes
- Sanitary pads or panty liners
- Tight clothes
- Swimming, saunas, spas
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy