Can vulvovaginitis cause urinary urgency?

Vulvovaginitis and Urinary Urgency

Yes, vulvovaginitis can cause urinary urgency as inflammation in the vulvovaginal area can irritate the nearby urethral opening, leading to urinary symptoms including urgency. 1

Relationship Between Vulvovaginitis and Urinary Symptoms

Vulvovaginitis, characterized by inflammation of the vulva and vagina, commonly presents with:

• Pruritus (itching)
• Vaginal discharge
• Vulvar burning
• Vaginal soreness
• Dyspareunia (painful intercourse)
• External dysuria (pain with urination)

The inflammation associated with vulvovaginitis, particularly when it affects the vulvar area, can irritate the urethral opening and trigger urinary symptoms including urgency. This occurs because:

1. The vulva and urethral opening are in close anatomical proximity
2. Inflammation can spread to adjacent tissues
3. Chemical irritants from discharge can affect the urethral area

Common Causes of Vulvovaginitis

Vulvovaginal Candidiasis (VVC)

• Most commonly caused by Candida albicans
• Presents with pruritus, erythema, and white discharge
• Treatment options include:
  • Topical azoles (clotrimazole, miconazole, terconazole)
  • Oral fluconazole 150mg as a single dose 1

Bacterial Vaginosis (BV)

• Associated with malodorous discharge
• Can cause vulvar irritation and urinary symptoms
• Treated with metronidazole or clindamycin 2

Trichomoniasis

• Presents with diffuse, malodorous, yellow-green discharge
• May cause vulvar irritation
• Treated with oral metronidazole 2

Management Algorithm for Vulvovaginitis with Urinary Urgency

1. Confirm diagnosis:

   • Evaluate discharge characteristics
   • Perform wet mount/KOH preparation
   • Check vaginal pH (<4.5 suggests candidiasis)
   • Consider urine culture to rule out UTI

2. For Candida vulvovaginitis:

   • Use topical azoles (clotrimazole 1% cream for 7-14 days) or
   • Oral fluconazole 150mg single dose 1

3. For bacterial vaginosis:

   • Oral metronidazole or clindamycin 2

4. For trichomoniasis:

   • Oral metronidazole 2

5. Address urinary symptoms:

   • Maintain adequate hydration
   • Avoid potential irritants (soaps, douches)
   • Consider sitz baths for symptom relief

Important Clinical Considerations

• Urinary symptoms may persist even after appropriate treatment of vulvovaginitis until inflammation fully resolves
• Unnecessary or inappropriate use of over-the-counter preparations is common and can delay proper treatment 2
• Patients should return for follow-up only if symptoms persist or recur within 2 months 2, 1
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1

Pitfalls to Avoid

1. Misdiagnosis: Urinary urgency may be mistakenly attributed to urinary tract infection rather than vulvovaginitis
2. Incomplete treatment: Inadequate treatment duration may lead to recurrence of symptoms
3. Overlooking non-infectious causes: Not all vulvovaginitis is infectious; consider dermatologic conditions affecting the vulva
4. Treating asymptomatic colonization: 10-20% of women normally harbor Candida without symptoms and do not require treatment 1

For recurrent vulvovaginitis (≥4 episodes in 12 months) causing persistent urinary symptoms, consider a longer initial treatment course followed by maintenance therapy with fluconazole 150mg weekly for 6 months 1.