Diabetic vulvitis is inflammation of the vulva caused most often by overgrowth of the yeast Candida albicans in the setting of diabetes mellitus. Diabetes predisposes to vulvitis both through general immune dysfunction and the elevation of blood and urinary glucose, which allows for overgrowth of some commensals, including yeast.

Vaginal Candida colonization rates are reported to range from 12%-67.5%, with diabetic women experiencing higher prevalence. Elevated blood sugar levels impair neutrophil function against Candida and increase urinary glucose, creating a nutrient-rich environment that promotes Candida overgrowth.

Recurrent candidal infection is defined as more than 3 symptomatic episodes within a 12-month period. Diabetic individuals, in particular, are predisposed to recurrent disease. Recurrent vulvovaginal candidiasis can also occur secondary to sodium-glucose cotransporter receptor-2 (SGLT2) inhibitor-induced glucosuria. This typically presents with extensive vulvar involvement in postmenopausal women. Recurrent disease may be caused by Candida species less susceptible to first-line antifungal agents, such as Candida tropicalis and Candida glabrata.

Diabetic vulvitis is characterized by severe pruritus, vaginal soreness, and odor. Dyspareunia and dysuria may be reported as well. Vulvitis secondary to SGLT2 inhibitors is characterized by severe, persistent vulvar pruritus and erythema.

Related topics: diabetes mellitus type 1, diabetes mellitus type 2, vulvovaginal candidiasis