Cyclic Vulvovaginitis

Aka: Cyclic Vulvovaginitis

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II. Epidemiology

  1. Most common cause of Vulvodynia

III. Causes

  1. Eczematous Candidiasis
  2. Candida Hypersensitivity

IV. Symptoms

  1. Cyclic flares with symptom free intervals
    1. Pain worse just before or during Menses
    2. Pain exacerbated after intercourse (day after)
  2. History of frequent Antibiotics
  3. Minimal Vaginal Discharge

V. Labs

  1. Saline Preparation and KOH Preparation (See Vaginitis)
  2. Candida culture and speciation
  3. Consider biopsy after Eliminating Candida

VI. Management

  1. Clotrimazole or Terconazole Cream
    1. Acute
      1. Apply qhs for 10 days then
      2. Apply 1/2 applicator Mon-Wed-Fri for 2-4 months
    2. Maintenance
      1. Apply qhs for 5 days before Menses each Month
  2. Fluconazole 150 mg
    1. Weekly for 2 months then
    2. Bi-Monthly for 2-4 months then
    3. Monthly prior to Symptom flare
  3. Physical Therapy with biofeedback
  4. Low-Oxalate Diet
  5. Oral Calcium Citrate (Citracal) 200 mg bid

VII. References

  1. Black (1995) OBGyn Dermatology, Mosby-Wolfe
  2. Apgar (1996) Am Fam Physician 53(4):1171-80 [PubMed]
  3. Barhan (1997) Postgrad Med 102(3):121-32 [PubMed]
  4. Metts (1999) Am Fam Physician 59(6):1547-56 [PubMed]

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