Some vaginal itching may require steroid creams or specially medicated lotions. Infections spread during sexual contact. Other symptoms of vulvovaginitis include redness and soreness (74–82%), 3 pruritus (45–58%) 1, 3 and dysuria (19%). You have fever or pain in your pelvis or belly area. The vulva, or external genitalia of the female, includes the mons pubis, labia majora (outer lips), labia minora (inner lips), clitoris, perineum (the tissue between vagina and anus) and the external openings of the urethra and vagina. The cervix is inspected for inflammation (eg, trichomoniasis) and discharge. The most common signs and symptoms are irritation and soreness of the vulva, external vaginal itching, pain while urinating, pain while having sex, and a red and swollen vagina. Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. The most common types are, Trichomonal vaginitis (usually sexually transmitted). Vaginal pH is measured, and samples of secretions are obtained for testing. Women may also experience burning, soreness, irritation, pain during urination, or pain during sex. Use condoms to avoid catching or spreading infections. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Avoid using hygiene sprays, fragrances, or powders in the genital area. Glands in the cervix and the walls of the vagina normally produce clear mucus. Last full review/revision Mar 2020| Content last modified Mar 2020, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Some Causes of Vaginal Pruritus and Discharge, Musculoskeletal and Connective Tissue Disorders, National Institute of Child Health and Human Development (NICHD) Protocol. Vaginal secretions are tested using pH paper with 0.2 intervals from pH 4.0 to 6.0. All patients require the following in-office testing: Testing for gonorrhea and chlamydial infections is typically done unless a noninfectious cause (eg, allergy, foreign body) is obvious. In postmenopausal women, a marked decrease in estrogen causes vaginal thinning (atrophic vaginitis), increasing vulnerability to infection and inflammation. Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. Prepubertal girls should be taught good perineal hygiene (eg, wiping front to back after bowel movements and voiding, washing their hands, avoiding fingering the perineum). Copyright 1997-2021, A.D.A.M., Inc. At any age, conditions that predispose to vaginal or vulvar infection include, Fistulas between the intestine and genital tract (which allow intestinal flora to seed the genital tract), Pelvic radiation or tumors (which break down tissue and thus compromise normal host defenses). In: Ralston SH, Penman ID, Strachan MWJ, Hobson RP, eds. If your vulva feels irritated, however, it is important to seek advice from your doctor as to what might be causing the irritation. The discharge may be: Itching of the skin of the vagina and the surrounding area (vulva) may be present along with vaginal discharge. The colour, smell, and consistency of the discharge can vary, depending on the cause of the problem. Discharge due to cervicitis (eg, due to PID) can resemble that of vaginitis. Some vaginal discharge is normal, particularly when estrogen levels are high. An underlying cause can usually be identified from the history and examination. A water-lubricated speculum is used to check the vaginal walls for erythema, discharge, and fistulas. Pruritus, vulvovaginal erythema, vaginal odor, sometimes dysuria, no discharge, Vaginal discharge, usually with a foul odor and vaginal spotting, Clinical evaluation (may require a topical anesthetic or procedural sedation), Infections (eg, candidal, pinworm, streptococcal, staphylococcal), Pruritus and vaginal discharge with vulvar erythema and swelling, often with dysuria, Worsening of pruritus at night (suggesting pinworm infection), Significant erythema and vulvar edema with discharge (suggesting streptococcal or staphylococcal infection), Microscopic examination of vaginal secretions for yeast and hyphae and culture to confirm, Examination of vulva and anus for pinworms, Vulvovaginal soreness, bloody or malodorous vaginal discharge, Often, vague and nonspecific medical complaints (eg, fatigue, abdominal pain) or behavior changes (eg, temper tantrums), Cultures or PCR for sexually transmitted diseases, Measures to ensure the child’s safety and a report to state authorities if abuse is suspected, Malodorous (fishy), thin, gray vaginal discharge with pruritus and irritation, Clue cells seen during microscopic examination, Vulvar and vaginal irritation, edema, pruritus, Discharge that resembles cottage cheese and adheres to the vaginal wall, Sometimes worsening of symptoms after intercourse and before menses, Sometimes recent antibiotic use or history of diabetes, Yeast or hyphae identified on a wet mount or KOH preparation, Yellow-green, frothy vaginal discharge, often with a fishy odor, Often soreness, erythema, and edema of the vulva and vagina, Sometimes punctate, red “strawberry” spots on the vaginal walls or cervix, Mild cervical motion tenderness often detected during bimanual examination, Motile, pear-shaped flagellated organisms seen during microscopic examination, Rapid diagnostic assay for Trichomonas, if available, Foreign bodies (often a forgotten tampon), Extremely malodorous, often profuse vaginal discharge, often with vaginal erythema, dysuria, and sometimes dyspareunia, Cervical motion and/or adnexal tenderness, Dyspareunia, scant discharge, thin and dry vaginal tissue, Increased number of neutrophils, parabasal cells, and cocci and decreased number of bacilli seen during microscopic examination, Vaginal cancer, cervical cancer, or endometrial cancer, Gradual onset of pain, a watery or bloody vaginal discharge (which precedes bleeding), abnormal vaginal bleeding (eg, postmenopausal bleeding, premenopausal recurrent metrorrhagia), Often no other symptoms until the cancer is advanced, Pelvic ultrasonography or sometimes MRI or CT, Chemical vulvitis due to irritation from urine or feces, Risk factors (eg, incontinence, restriction to bed rest), Vulvovaginal erythema, edema, pruritus (often intense), vaginal discharge, History of recent use of hygiene sprays or perfume, bath water additives, topical treatment for candidal infections, fabric softeners, bleaches, or laundry soaps, Inflammatory (eg, pelvic radiation, oophorectomy, chemotherapy)‡, Purulent vaginal discharge, dyspareunia, dysuria, irritation, Sometimes pruritus, erythema, burning pain, mild bleeding, Diagnosis of exclusion based on history and risk factors, Granulocytes and parabasal cells seen during microscopic examination, Enteric fistulas (complication of delivery, pelvic tumors, pelvic surgery, or inflammatory bowel disease), Malodorous vaginal discharge with passage of feces from vagina, Direct visualization or palpation of the fistula in the lower part of the vagina, Skin disorders (eg, psoriasis, lichen sclerosus, tinea versicolor), Characteristic genital and extragenital skin findings. 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