Overview

• Commonly caused by vulvovaginitis → infection, eczema, contact dermatitis.
  • Candidiasis → experienced by up to 75% of women in their lifetime.
  • Atrophic Vaginitis → affects 10-40% of post-menopausal women.
• CONTACT DERMATITIS = MOST COMMON CAUSE.

Making Diagnosis

Clinical Features

• Vulvovaginal Candidiasis → vulvar itching, burning, erythema, thick white curd-like discharge.
  • May be precipitated by recent history of antibiotic use.
• Atrophic Vaginitis → vaginal dryness, soreness, dyspareunia, occasional spotting.
• Vulvar Vestibulitis → dyspareunia, pain, soreness, burning, rawness.
• Contact Dermatitis → pruritus, burning, pain, red.

Investigations

• Investigations (STI)
  • pH → low = candida, raised = BV, TV.
  • Swabs → endocervical swab (gonorrhoea + chlamydia) + high vaginal swab (BV, TV, candida, GBS).
    • Triple Swab → 2x endocervical + 1x high vaginal.

Management Plan

• Vulvovaginal Candidiasis → first line: clotrimazole pessary + 1% clotrimazole cream. Second line/severe → oral fluconazole.
  • Avoid tight fitting clothes, avoid local irritants, do not wash area with soap/shower gels, use simple emollients.
  • Recurrent (≥4) → induction and maintenance fluconazole.
• Atrophic Vaginitis → topical vaginal oestrogen or HRT.

Complications →