Last updated: September 11, 2023

Summarytoggle arrow icon

Vulvovaginitis refers to a large variety of conditions that result in inflammation of the vulva and vagina. The causes may be infectious (e.g., bacterial vaginosis in most cases) or noninfectious. Physiologically, the normal vaginal flora (mainly lactobacilli) keeps the pH levels of the vaginal fluids low, thus preventing the overgrowth of pathogenic and opportunistic organisms. Disruption of that flora (e.g., due to sexual intercourse) predisposes to infection and inflammation. Diagnosis of infectious vulvovaginitis is based on histology examination of vaginal discharge. Treatment consists of administration of antibiotics or antifungals (depending on the pathogen).

For information on vulvovaginal atrophy caused by declining estrogen levels, see “Menopause.”

Infectious vulvovaginitistoggle arrow icon

Etiology [1]

Differential diagnoses of infectious causes of vaginal discharge [1]

Features Bacterial vaginosis Trichomoniasis Vaginal yeast infection Gonorrhea Chlamydia infections
  • Gray/milky
  • Fishy odor
  • Frothy, yellow-green
  • Foul-smelling
  • White, crumbly, and thick (cottage cheese-like)
  • Odorless
  • May be malodorous
Vaginal inflammation
  • Typically absent
  • Present
  • Present
  • Absent
  • Typically absent
  • Often present
  • Absent
  • Present
Vaginal pH
  • > 4.5
  • 4–4.5
  • Variable
Microscopy findings

Partner therapy is recommended in most cases of STDs, particularly chlamydia, trichomoniasis, and gonorrhea. Bacterial vaginosis and vaginal yeast infection do not require treatment of the partner(s).

Bacterial vaginosistoggle arrow icon

ABCDEFG: Amsel criteria, Bacterial vaginosis, Clue cells, Discharge (gray or milky), Electrons (pH of vaginal secretions is alkaline), Fishy odor of discharge, and Gestation (increased risk for miscarriage) are the most important features of bacterial vaginosis.

Vaginal yeast infection (vulvovaginal candidiasis)toggle arrow icon

Oral fluconazole is not recommended for use in pregnant patients because of a possible association with spontaneous abortions and fetal malformations. [1]

Trichomoniasistoggle arrow icon

“After sex, Burn the Foul, Green Tree:” burning sensation and foul-smelling, yellow-green discharge are the features of trichomoniasis.

Noninfectious vulvovaginitistoggle arrow icon

Differential diagnoses of noninfectious vulvovaginitis
Features Genitourinary syndrome of menopause Aerobic vaginitis Allergic vulvovaginitis Mechanical vulvovaginitis
  • Noninfectious microbiome disturbance (lower concentrations of Lactobacillus species in the vaginal flora)
  • Secondary bacterial overgrowth with gram-negative (e.g., Escherichia coli) and gram-positive (e.g., Streptococcus agalactiae) bacteria
  • Vaginal immune reaction
Clinical features
  • Decreasing labial fat pad
  • Vaginal soreness, dryness
  • Dyspareunia
  • Urinary symptoms
  • Receding pubic hair
  • Typically prepubescent girls
  • Signs of inflammation
  • Pruritus
  • Burning sensation
  • Dermatological and/or rheumatological workup
  • Avoid irritants
  • Moisturizers and cooling
  • Cortisone creams
  • Cause-specific
  • Moisturizers and cooling

Aerobic vaginitistoggle arrow icon

Allergic vulvovaginitistoggle arrow icon

  • Epidemiology: may affect all age groups, but are especially common in prepubescent girls
  • Etiology: allergies to laundry or cleaning detergents, textile fibers, sanitary napkins, etc.
  • Clinical features: pruritus, redness, swelling, burning sensation
  • Diagnostics: Special allergy diagnostics (e.g., prick/puncture, intradermal test) may be indicated if symptoms persist despite treatment.
  • Treatment
    • Avoid irritants
    • Soothing lotions, ice packs, and sitz baths (e.g., containing chamomile)
    • Cortisone creams if needed

Mechanical vulvovaginitistoggle arrow icon

Special patient groupstoggle arrow icon

Vulvovaginitis in pediatric patients

Infectious vulvovaginitis in pregnant patients

Referencestoggle arrow icon

  1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70 (4): p.1-187.doi: 10.15585/mmwr.rr7004a1 . | Open in Read by QxMD
  2. American College of Obstetricians and Gynecologists. Vaginitis in Nonpregnant Patients. Obstetrics & Gynecology. 2020; 135 (1): p.e1-e17.doi: 10.1097/aog.0000000000003604 . | Open in Read by QxMD
  3. Koumans EH, Sternberg M, Bruce C, et al. The Prevalence of Bacterial Vaginosis in the United States, 2001???2004; Associations With Symptoms, Sexual Behaviors, and Reproductive Health. Sex Transm Dis. 2007; 34 (11): p.864-869.doi: 10.1097/olq.0b013e318074e565 . | Open in Read by QxMD
  4. Amsel R, Totten PA, Spiegel CA, Chen KCS, Eschenbach D, Holmes KK. Nonspecific vaginitis. Am J Med. 1983; 74 (1): p.14-22.doi: 10.1016/0002-9343(83)91112-9 . | Open in Read by QxMD
  5. Silverberg B, Moyers A, Hinkle T, Kessler R, Russell NG. 2021 CDC Update: Treatment and Complications of Sexually Transmitted Infections (STIs). Venereology. 2022; 1 (1): p.23-46.doi: 10.3390/venereology1010004 . | Open in Read by QxMD
  6. Brotman RM. Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective. J Clin Invest. 2011; 121 (12): p.4610-4617.doi: 10.1172/jci57172 . | Open in Read by QxMD
  7. Krieger H, Kimmig P. [Survival ability of Trichomonas vaginalis in mineral baths].. Gesundheitswesen. 1995; 57 (12): p.812-9.
  8. Miller JM, Binnicker MJ, Campbell S, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018; 67 (6): p.e1-e94.doi: 10.1093/cid/ciy381 . | Open in Read by QxMD
  9. Vulvovaginal Candidiasis. Updated: June 4, 2015. Accessed: April 9, 2017.
  10. Chinawa J, Obu H, Uwaezuoke S. Foreign Body in Vagina: An Uncommon Cause of Vaginitis in Children. Annals of Medical and Health Sciences Research. 2013; 3 (1): p.102.doi: 10.4103/2141-9248.109463 . | Open in Read by QxMD
  11. Nyirjesy P, Peyton C, Weitz MV, Mathew L, Culhane JF. Causes of chronic vaginitis: analysis of a prospective database of affected women.. Obstet Gynecol. 2006; 108 (5): p.1185-91.doi: 10.1097/01.AOG.0000239103.67452.1a . | Open in Read by QxMD
  12. Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis.. BJOG. 2002; 109 (1): p.34-43.doi: 10.1111/j.1471-0528.2002.00432.x . | Open in Read by QxMD
  13. Donders G, Bellen G, Rezeberga D. Aerobic vaginitis in pregnancy. BJOG. 2011; 118 (10): p.1163-1170.doi: 10.1111/j.1471-0528.2011.03020.x . | Open in Read by QxMD
  14. Donders GG, Ruban K, Bellen G. Selecting anti-microbial treatment of aerobic vaginitis. Curr Infect Dis Rep. 2015; 17 (5): p.477.doi: 10.1007/s11908-015-0477-6 . | Open in Read by QxMD
  15. Heczko PB, Tomusiak A, Adamski P, et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health ;15:115.. 2015; 15: p.115.doi: 10.1186/s12905-015-0246-6 . | Open in Read by QxMD

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