There are many different conditions that can affect your vulva, ranging from mild infections to skin conditions and, very rarely, cancer. They can all cause very different symptoms, including itching, bleeding, rashes or a lump. It is very important that if you notice any new symptoms or lumps in your vulval region then you see a doctor promptly. Your doctor will be able to examine you and decide which treatment will be appropriate to you. This will depend on the underlying cause of your symptoms.
Vulvitis is an inflammation of your vulva. It is not a disease or an actual condition. It has many different causes which will be discussed in this article.
What is the vulva?
The outer (external) sex organs of a woman are know as the vulva. The vulva is made up of two pairs of 'lips'. The outer pair, called the labia majora, is covered in pubic hair. The inner pair, called the labia minora, is thinner and more delicate.
There are two openings between these lips. One is the vagina which leads to the womb (uterus). The other is the urethra, which is the short tube that carries urine from the bladder. At the front of the vulva is the small organ called the clitoris.
How common is vulvitis?
Inflammation of the vulva (vulvitis) is very common and can occur in women of all ages.
What causes vulvitis?
Inflammation of the vulva (vulvitis) has many different causes, as listed below. It is sometimes difficult to determine the cause of the vulvitis.
Infections are caused by germs such as bacteria, viruses and fungi. Infections in the vagina are common and these infections can also affect your vulva. The following infections may occur causing vulvitis:
- Thrush: around three quarters of women have thrush at some stage in their lives. Thrush infection can lead to a whitish discharge and often leads to your vulval area becoming red and very itchy. This is usually treated with antifungal creams which are available from your doctor or local pharmacy.
- Genital herpes infection: this is usually a sexually transmitted infection which is passed on by skin-to-skin contact. Many people infected with this germ (virus) never have symptoms but can still pass on the infection to others. If symptoms occur, they can range from a mild soreness to painful blisters on the genitals and surrounding area. Treatment is with antiviral medication.
- Genital warts: these are caused by a virus that can be passed on by close sexual contact. They usually grow on the vulva but can also grow on the skin around your bottom. They are usually either treated with chemicals or with physical treatments such as freezing to destroy them.
- Other infections: these include scabies and pubic lice.
Inflammation of the skin of the vulva can be due to an allergy, similar to an allergy affecting other areas of your skin. This is called an allergic or contact dermatitis. Any skin conditions that affect the skin can also affect the skin of your vulva - for example, psoriasis, lichen sclerosus or lichen planus.
There are many different products that can cause irritation to the vulval area which then leads to vulvitis. Examples of these include:
- Scented toilet paper.
- Perfumed soaps or bubble baths.
- Swimming pool water or hot tub water.
- Horse riding or cycling.
- Synthetic underwear.
Low oestrogen levels
Levels of the female chemical (hormone) called oestrogen are reduced during the menopause. Some women develop vulvitis as a result of their low oestrogen levels. This is usually associated with atrophic vaginitis which causes your vagina to become quite dry and sore.
Vulval cancer is an uncommon cancer and usually affects women aged over 60 years. Vulval cancer can start as a sore or lump in the vulva.
Note: if you have noticed any new changes (however minor) in your vulval area then you should see your doctor.
Vulvodynia is a burning, stinging but often unexplained pain affecting the skin around your vagina or vulva. The skin of your vulva is usually normal but some women have some swelling or inflammation.
What symptoms may occur?
Symptoms vary greatly between women and the symptoms often depend upon what is causing the inflammation of your vulva (vulvitis). The most common symptoms are itching (this can often be worse at night) and soreness.
It is really important to try not to scratch, as this can lead to further irritation and sometimes an infection developing.
What changes may occur to my vulva?
It can be common to develop redness and/or swelling of your vulval area. You may notice thickened or whitish patches around your vulval area. Some women develop clear, fluid-filled blisters.
What is the treatment of vulvitis?
The treatment of inflammation of the vulva (vulvitis) depends on the underlying cause.
It is usually recommended that you do not use soap or fragranced products to wash your vulva. In addition, you should avoid contact of your vulval skin with bubble bath, shampoo, personal deodorants, wet wipes, detergents, textile dyes, fabric conditioners and sanitary wear. These can all worsen the irritation.
You should just wash this area once a day with warm water. Ideally you should wear cotton underwear that is not too tight. Your doctor may recommend an emollient which you can use instead of soap and this can be very soothing for many women. Emollient creams can also be very soothing to use, as they work to moisturise the skin. If the itching is particularly bad then your doctor may recommend you take an antihistamine tablet which will reduce the itching.
If you are using contraception, then it is recommended that your partner should avoid using spermicidally lubricated condoms. Some women find using lubricating gels useful during sex (intercourse).
Steroid creams are often given which are usually used for short periods of time. These work by reducing the inflammation and also the irritation and can be really effective for many women. There are different strengths of steroid cream and usually the weakest strength is given first. However, if this does not work effectively then stronger steroid creams are usually given.
If the underlying cause is an infection then an antifungal or antibiotic treatment may be given.
Sometimes a cream, pessary or vaginal tablet containing the female chemical (hormone) called oestrogen is prescribed if the cause of your vulvitis is low oestrogen levels.
Local anaesthetic creams, some medications and surgery are some treatments for women with burning, stinging but often unexplained pain affecting the skin around the vagina or vulva (vulvodynia).
Further help & information
Dr Louise Newson
Dr Louise Newson
Dr Hayley Willacy