What it is
Vulvovaginitis means the vulva, the vagina or both are inflamed. It describes what is happening. It does not name a cause.
The common causes look alike from the outside. Yeast, bacterial vaginosis and trichomonas all itch and all discharge. Treating the wrong one wastes weeks.
Not every case is an infection. Low estrogen after menopause, soap, a forgotten tampon and skin conditions such as lichen sclerosus produce the same complaints.
What you might notice
- Itching that gets worse at night
- Burning when you urinate or during sex
- Discharge that changed color, thickness or smell
- A fishy odor, stronger after sex
- Redness, swelling or splitting of the skin at the opening
- Dryness and rawness rather than discharge
- An over-the-counter yeast treatment that did nothing
- White patches, or skin that looks thin and pale
How Dr. Mueller finds the cause
- 1
Symptom history
Dr. Mueller asks what changed: soaps, antibiotics, partners, menopause.
- 2
Vulvar and vaginal exam
She looks at both directly.
- 3
pH and microscope
A swab is checked for pH and looked at under the microscope.
- 4
Targeted testing
When the picture is unclear, a vaginal panel or culture is sent out.
- 5
Treat the cause
Treatment follows the finding rather than the guess.
- 6
Recheck if it returns
Symptoms that come back get re-examined, not re-treated blind.
Questions people ask
- Is it yeast or bacterial vaginosis?
- They itch much the same way. pH and the microscope separate them in minutes, which is why guessing so often fails.
- Can I try an over-the-counter yeast treatment first?
- Once. If it does not work, stop repeating it and come in for the swab.
- Does my partner need treatment?
- Not for yeast or bacterial vaginosis. Trichomonas is treated in both partners.
- Why does it keep coming back?
- Recurrence usually means the original cause was never confirmed, or it was never an infection at all.
- Do you do routine STI screening?
- No. Dr. Mueller tests when you have symptoms and the result would change your treatment.
- Could this be a skin condition instead?
- Yes. Lichen sclerosus and vulvar eczema itch for years. Sorting them out takes a look and sometimes a biopsy.