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Cyclic vulvovaginitis
What is cyclic vulvovaginitis?
Cyclic vulvovaginitis is a recurrent burning and itching sensation that occurs at the same stage of every menstrual cycle. The pain specifically worsens just before or during the menstrual bleeding, or may settle during bleeding.
Cyclic vulvovaginitis occurs in women of all ages that are still menstruating.
Cyclic vulvovaginitis can lead to localised or generalised vulvodynia.
What are the symptoms of cyclic vulvovaginitis?
- Between cyclical flare-ups the patient may have no symptoms
- Intense burning irritation and itching just before or during menstrual bleeding
- Pain can be aggravated by sexual activity and is usually worse the day after intercourse
What causes cyclic vulvovaginitis?
Cyclic vulvovaginitis is sometimes caused by a hypersensitivity to candida antigen in women with recurrent yeast infections. Vaginal smears and cultures should be performed to determine the cause. If a culture taken during a symptomatic phase comes back negative, a swab and a scraping during the asymptomatic phase should be taken and cultured.
The laboratory should report the specific strain of candida and its drug sensitivities so that the most appropriate treatment may be selected.
When candida is not cultured, symptoms may be due to cytolytic vaginosis. This is a newly recognised cause of cyclic vulvovaginal complaints. The diagnosis can be made on on vaginal microscopic examination and by meticulously ruling out other infections.
Management of cyclic vulvovaginitis
The main goal of treatment is to remove the cause.
When candida is responsible, topical and oral antifungal agents are used to treat the flare-ups. The oral agents ketoconazole, itraconazole and fluconazole may also be prescribed to prevent further candidal infection, taken intermittently as recommended by your doctor (there are various regimes).
In contrast, management of cytolytic vaginosis consists of discontinuing all antifungal agents, using pads instead of tampons during menstruation, and taking baking soda sitz baths.
The irritation may settle with hydrocortisone cream; it is not usually helpful or desirable to use more potent topical steroids.
Some patients find the tricyclic antidepressant drug amitriptyline helpful.
Related information
Self-help books
- The V Book: A Doctor's Guide to Complete Vulvovaginal Health
- The Vulvodynia Survival Guide: How to Overcome Painful Vaginal Symptoms & Enjoy an Active Lifestyle
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On DermNet NZ:
- Vulvovaginal candidiasis
- Candida
- Vulvodynia
- Pruritus vulvae
- Genital skin problems
- Bacterial vaginosis