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Vulvitis is inflammation of the outer female genitalia (vulva). The vulva . It includes the "lips" or folds of skin (labia), clitoris, and the openings to the urethra and vagina.

Vulvitis can be caused by a number of conditions, including:

• Allergies, particularly to soaps, colored toilet paper, vaginal sprays, laundry detergents, bubble baths, or fragrances
• Long-term dermatitis, seborrhea or eczema
• Infections such as fungal and bacterial infections, pediculosis, or scabies

Vulvitis can affect women of all ages. The condition may be due to low estrogen levels in young girls and women who have reached menopause.

The following symptoms affect the skin in the vulva area:

• Burning or itching
• Possible small cracks in the skin
• Possible vaginal discharge
• Redness and swelling
• Thickening of the skin

A pelvic examination often reveals redness and thickening and may reveal cracks or skin lesions on the vulva.

If there is any vaginal discharge, a wet prep test may show that an infection (such as vulvovaginitis or vaginitis)is the cause.

Stopping using any products that may cause irritation. Apply an over-the-counter cortisone ointment two or three times a day on the affected area for up to 1 week. If these methods do not relieve symptoms, see your health care provider.

Vaginal infections will be treated as appropriate. Cortisone ointment may be used to decrease vulvar itching.

If treatment does not work, biopsy of the skin of the vulva may be done to rule out vulvar dystrophy or vulvar dysplasia, a precancerous condition. A biopsy may also be necessary if any skin lesions are present.

Itching may be hard to control, but after the cause is identified and treated, it should go away in several weeks.

Itching of the vulva may be a sign of genital warts (HPV - human papilloma virus), vulvar dystrophy, or precancerous or cancerous conditions of the vulva.

Sexually transmitted diseases (STDs), which can cause vulvitis, may lead to other problems such as infertily. STDs should be treated appropriately.

Call for an appointment with your health care provider if symptoms occur and do not respond to self care measures, or if vaginal discharge accompanies the symptoms. Also call if you see sores on the vulva.

Daily cleansing with mild soap, adequate rinsing, and thorough drying of the genital area can be helpful.

Avoid using feminine hygiene sprays, fragrances, or powders in the genital area.

Avoid wearing extremely tight-fitting pants or shorts, which may cause irritation by constantly rubbing against the skin and reducing air flow.

Wear cotton underwear or cotton-crotch pantyhose. Avoid underwear made of silk or nylon, because these materials are not very absorbant and restrict air flow. This can increase sweating in the genital area, which can cause irritation and may provide a more welcoming environment for infectious organisms.

Do not wear sweaty exercise clothing for prolonged periods.

Infections that may spread by intimate or sexual contact may be prevented or reduced by avoiding sexual activities or using safer sexual behaviors.

Katz VL. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 18.

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.

Updated by: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.