The vulva is the external part of the female genital area, and includes the mons pubis (the mound of fatty tissue over the pubic bone), the outer and inner labia, the clitoris, the urethral (urinary) and vaginal openings, and the perineum (the skin between the vagina and the anus). Many women experience discomfort or pain in this area at some time in their lives, which can cause considerable distress and interfere with sexual functioning and self-image.
Common vulval symptoms
Common symptoms that women with vulval problems suffer from include itching, burning, pain and soreness of the vulva, and painful intercourse (dyspareunia). Depending on the cause, symptoms may be constant or come and go (sometimes in relation to the menstrual cycle).
Common vulval problems
Because the skin and tissues of the vulva are very delicate, the area is susceptible to irritation and inflammation. Some common vulval problems include:
Dermatitis, psoriasis and lichen sclerosus can all affect the skin of the vulva. They typically cause itching, and sometimes a burning sensation. Dermatitis is the most common cause of ongoing (chronic) vulval symptoms, and may be associated with allergies or contact with irritants. These include soap, vaginal sprays and douches, and feminine hygiene products. The vulva can also be irritated by rubbing against tight clothing or underwear.
Avoiding irritants can help you manage vulval dermatitis. Corticosteroid creams are usually effective treatment for these skin problems, and a cold compress can be used to reduce itching and scratching.
Thrush (an infection usually caused by the yeast Candida albicans) is one of the most common causes of vulval problems. Symptoms include itching, occasional burning and a thick, white or watery vaginal discharge. Thrush may be recurrent (repeated infections), and symptoms are often worse just before you have a period.
Other infections, including sexually transmitted infections (e.g. trichomoniasis) and bacterial vaginosis, can also cause vulval itching and irritation as well as vaginal discharge. Genital herpes and genital warts can cause lesions on the vulva, resulting in pain or discomfort.
Antifungal creams, pessaries or oral tablets can be used to treat thrush infections, and antibiotics and antiviral medications are available to treat other vulval infections.
Vulval pain syndromes
The so-called vulval pain syndromes include vulvar vestibulitis (which typically affects younger women, and is characterised by pain following pressure in the genital area, e.g. when trying to insert a tampon) and generalised vulvodynia (chronic pain, burning or discomfort in the vulval area). The exact cause of these conditions is not known, but they are more common than previously thought and can cause significant distress. Treatment may consist of a combination of medicines, local anaesthetics and biofeedback training.
Reduced oestrogen levels following menopause can cause vaginal and vulval dryness, itching and occasional burning. Oestrogen cream or a vaginal lubricant can effectively treat this condition.
Precancerous and cancerous conditions
Although they are not common, more serious diseases such as vulval cancer and precancerous lesions can cause itching, burning, discomfort and bleeding. It’s important to see your doctor for an accurate diagnosis if you are experiencing any of these symptoms.
How are these conditions diagnosed?
Your doctor will need to ask about the specific symptoms that are troubling you in order to determine possible causes of your condition. Then your doctor will examine the area to assess any signs of skin irritation and inflammation, tenderness, and other problems such as blisters, sores or lumps.
Your doctor may take swab samples from the vulva and vagina to test for infection. Sometimes, if there is an abnormal looking area of skin, a biopsy may need to be done. This involves taking a small sample of tissue after the area has been treated with local anaesthetic.
What else can be done to treat vulval problems?
Good vulval skin care should be part of the treatment for all vulval conditions. By taking these simple steps, you can help treat the symptoms and prevent further problems developing.
- Wear cotton underwear that is not too tight.
- Avoid wearing trousers that are too tight, and also try to avoid g-strings, panty-hose, and underpants made from synthetic materials.
- Make sure you change out of exercise gear and wet swimming costumes as soon as possible after exercising.
- Use soft, unperfumed toilet paper.
- Avoid anything that tends to irritate the area, such as soap, bubble bath, bath oils, deodorants and douches. Use a soap substitute when cleaning your genital area.
- Moisturise dry skin with creams such as Sorbolene (cetomacrogol) or Aqueous cream.
- Use barrier creams such as petroleum jelly if you are incontinent or have a vaginal discharge.
- Protect your vulval skin before sexual intercourse with a lubricant. Vegetable oil or petroleum jelly may be less irritating than water-based lubricants but should not be used with condoms.
- Apply a cold compress to the genital area to reduce itching and pain.
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4. Welsh BM, Berzins KN, Cook KA, Fairley CK. Management of common vulval conditions. Med J Aust 2003;178: 391-5. http://www.mja.com.au/public/issues/178_08_210403/wel10498_fm.html (accessed Mar 2011).