Inflammation of the Vulva and Vagina

Inflammation of the vulva and vagina is a condition that can lead to many annoying symptoms and problems. Lack of adequate estrogen is the most common cause in older women; vulvar and vaginal inflammation that results from lack of estrogen is called atrophic vaginitis. Lack of estrogen often causes the lining of the urethra to become thin and fragile (atrophic urethritis). These changes in the urethra can lead to increased frequency and urgency of urination and in many cases an uncontrollable loss of urine (urinary incontinence), which can irritate the vulva and worsen existing inflammation.

Use of perfumes and scented laundry detergents, fabric softeners, and soaps can also cause inflammation. Other causes include allergic reactions (allergic vaginitis); changes in the concentration of normal bacteria (bacterial vaginosis) and yeast (Candida) in the vagina; and trichomonal or other infections. Candidal (yeast) infections are especially common in older women with diabetes.

Symptoms and Diagnosis

Inflammation, especially if it results from lack of estrogen, causes vaginal and vulvar dryness, itching, burning, and pain. A watery vaginal discharge is sometimes present. A thicker discharge is much more common when infection is present. All of these changes may lead to discomfort or pain during sexual intercourse.

A doctor performs a physical examination to diagnose inflammation. During the examination, the doctor takes a sample of the vaginal discharge to identify bacteria or other organisms.

Treatment

Treatment depends on the cause. Inflammation due to low estrogen levels is treated with estrogen cream. Estrogen cream can be applied directly to the vulva or inserted into the vagina with a plastic applicator. Alternatively, tablets or plastic rings containing time-released estrogen can be inserted into the vagina. Tablets are inserted 2 to 3 nights per week. Rings need to be replaced only once every 3 months. Low-dose estrogen inserted into the vagina is not significantly absorbed into the bloodstream, so women concerned about the possible adverse effects of estrogen have little to worry about.

Inflammation caused by irritants or allergies subsides with avoidance of perfumes and scented soaps and with the use of loose-fitting cotton underwear and clothes. Bacterial infections are treated with antibiotics, and candidal infection is treated with antifungal cream or pills. Corticosteroid creams may provide temporary relief for some women but may initially worsen the burning sensation.

Many older women benefit from using moisturizers, especially just before sexual intercourse. It is best to avoid any that contain perfumes or other unnecessary chemicals that might cause irritation.