Vulval Problems

Authored by Dr Colin Tidy, 18 Oct 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Helen Huins, 18 Oct 2017

There are many different conditions that can affect your vulva, ranging from mild infections to skin conditions and, very rarely, to 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.

Female Genitals

The outer (external) sex organs of a woman are known 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 is called the labia minora, which are 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.

When babies develop during pregnancy, problems may very rarely occur in the development of the sexual organs and the genitalia. Developmental problems may lead to a swollen clitoris or the labia being joined together. These are very rare though.

Obviously the symptoms you experience will depend on the underlying condition. Symptoms may range from pain, itching, and finding a lump to noticing a change in appearance of your vulva.

There are various conditions that can affect your vulva. Some are more common than others; some are more serious than others. If you notice a new lump or swelling on your vulva or have any bleeding from around your vulva then you must see a doctor promptly.

Most conditions that affect your vulva can be diagnosed by examining you. However, it is sometimes necessary for other tests to be undertaken. For example:

  • Internal swabs may be taken. A swab is a small ball of cotton wool on the end of a thin stick. It can be gently rubbed in various places to obtain samples.
  • A biopsy may be carried out. In this procedure, a small sample of tissue is taken from a lump. The sample can then be examined under a microscope in the laboratory.

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:

  • 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 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.
  • Chickenpox can sometimes lead to spots developing on the vulval area. This can sometimes become very itchy and troublesome. Having warm baths and using calamine lotion can often really help.
  • Other infections: these include scabies and pubic lice.

In babies and toddlers wearing nappies, nappy rash can occur and be very irritating and distressing. Most cases are due to a reaction of the skin to urine and poo (faeces). In addition, the germ that causes thrush can grow in the inflamed skin and make nappy rash worse. Nappy rash can lead to the skin of the vulva and the area round the back passage (anus) becoming bright red and very sore. Frequent nappy changing and having times without wearing a nappy can help. So too can using a barrier cream. Some babies need to have a steroid cream or an antifungal cream. Therefore, if the nappy rash does not improve or it worsens, it is very important to see your doctor.

Any skin condition can affect the vulval area too. For example, eczema, psoriasis, lichen planus and lichen sclerosus. Inflammation of the vulva (vulvitis)  can be caused by many different conditions, including infections and skin conditions. Learn more about vulvitis.

Lichen sclerosus is a condition of your vulva which usually causes itching and soreness. It is more often seen in women with immune conditions such as thyroid disorders or diabetes. It is usually treated with a steroid cream to rub in sparingly on the affected area. Read more about lichen sclerosus.

A condition called vulval intraepithelial neoplasia (VIN) can affect the skin of the vulva in different ways. This is not vulval cancer but it is classed as a pre-cancerous condition, as VIN (after several years) may develop into vulval cancer in some women. VIN also usually causes a change in the appearance to the affected part or parts of the vulva. These include areas of redness, or white areas of skin. Sometimes affected areas of the vulva develop raised areas of skin. A persistent itch in the vulva is the most common symptom of VIN. Other symptoms that may develop include soreness, burning or tingling in the vulva. Treatment to clear VIN is usually advised, which is usually by surgery.

Note: VIN is a very uncommon cause of itching of the vulva. Itching of the vulva (pruritus vulvae) is common in women and can be caused by many different conditions. If a woman has VIN, she is likely to have an itchy vulva but an itchy vulva doesn't mean she has VIN. Read more about pruritus vulvae.

There are many different conditions that can cause lumps on your vulva.

Infections

Some infections such as herpes and syphilis can cause lumps. Genital herpes is an infection of your vulva and vagina and surrounding area of skin. Genital herpes is usually passed on by skin-to-skin contact with someone who is already infected with the virus. Treatment is usually with painkillers and antifungal medication which stops the herpes infection from multiplying. Syphilis is a sexually transmitted infection which usually starts with a painless ulcer on your vulva. Although it is an uncommon infection, the number of cases in the UK has increased over recent years.

Bartholin's cyst or abscess

The two Bartholin's glands lie next to the entrance to the vagina. Find out more about Bartholin's cysts and abscesses.

Cancer of the vulva

Cancer of the vulva is a rare cancer that usually affects women aged over 60 years. Most vulval cancers are squamous cell cancers. This means they have developed from the skin cells in the outer layer of the vulva. Rarely, vulval cancers are due to a melanoma which develops from cells in the skin that cause pigmentation. The most common symptoms of vulval cancer are a persistent itch or pain in the vulval area. Some vulval cancers start as a sore or lump in the vulva. Vulval cancer is usually treated by an operation to remove the cancer. Most vulval cancers can be cured. The outlook is good in women who have small cancers that have not spread.

Further reading and references

  • Lawton S; Nappy rash: diagnosis and treatment. J Fam Health Care. 2014 Jul-Aug24(5):36-40.

  • The Management of Vulval Skin Disorders; Royal College of Obstetricians and Gynaecologists (February 2011)

  • Reyes MC, Cooper K; An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis. J Clin Pathol. 2014 Apr67(4):290-4. doi: 10.1136/jclinpath-2013-202117. Epub 2014 Jan 7.

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