Why Is Irritant Vulvitis Often Misdiagnosed as a Yeast Infection?

Frederick R. Jelovsek MD

Many women equate burning and itching of the vulva with a yeast vaginitis. Often their doctors and nurses do the same thing. Consider for a moment, that many episodes of vulvar irritation may actually be a primary vulvar dermatitis with a secondary yeast colonization. This is quite a different concept, isn't it. It means that on some occasions we need to primarily treat a contact or irritant dermatitis rather than rushing out to get the anti-yeast cream.

If that's the case, what are the irritants? In a recent article, Summers, PR: Vulvovaginal candidiasis: Investigating the dermatologic connection. Obg Management 1998 August Suppl:2- 6, the point was made that many women are sensitive to common constituents of creams used to actually treat vulvovaginitis:

• propylene glycol
• methylparaben
• butylated hydroxyanisol (BHA)
• cetyl alcohol
• sodium lauryl sulfate
• methyl benzethonium chloride
• fragrance

Lubricants, spermicides, scented sanitary products, douches, soaps, and even bubble baths have also be implicated in causing irritant vulvar dermatitis. We have had women on the message board who have been sensitive to lubricants used in condoms. Dr. Summers estimates that almost 50% of the patients seen a special vulvar clinic have a primary irritant dermatitis with or without a secondary yeast vulvovaginitis. This is consistent with one study which did skin patch allergen testing on the vulva and found almost 50% of women allergic to common chemicals in soaps and creams.

Treatment of a contact vulvitis is to protect the skin with petrolatum or solid vegetable oil and to elimininate any further contact with soaps or creams or any other chemicals. Sometimes steroid creams are needed. Be sure to look at the chemical constituents in any products you are using on the vulva or in the vagina.