For vulva owners, many are steered to believe that any “itch” must be a yeast infection, or some form of hormonal imbalance. The truth is, there are numerous reasons why one’s vulva may have this issue. When we think of “skin care,” we often immediately think of our faces. We moisturize, apply special creams and preventatives, and generally pamper our facial tissues. But do we treat the genitalia tissues with anything at all?
What is the Vulva?
The vulva is made up of several layers that cover and protect the urinary opening and sexual organs. The meaty, fleshy outer “lips” of the vulva are called the labia majora. These are covered with pubic hair and contain fat to help cushion the area. Inside of the labia majora are the thinner, more pigmented, delicate flaps of skin called the labia minora. These join towards the “top” to surround the clitoris. These parts- the labia majora & minor, as well as the clitoris, are made up of erectile tissue, which is tissue that becomes engorged with blood. The urethra is located between the labia majora and vestibule, where the Bartholin’s glands also reside. These glands are responsible for providing natural lubrication and moisture to the vagina. The perineum is the patch of flesh between the vaginal opening and anus, and often where an “episiotomy” occurs during childbirth.
There are many issues that can cause itching around and in the vagina. Some are caused by age, decline in estrogen levels after menopause or surgical menopause, and others can be caused by medications and life’s stressors. The condition of vulvar itching and discomfort is not addressed as openly as it should be, which is why so many are unaware of how to treat the itch.
Vulvar Conditions & Treatment Options
While some skin conditions that affect skin on the arms, legs and torso may be easily visible and identifiable, vulvar skin conditions are the opposite. In an area that is hard to clearly see, skin coloring makes seeing a visible rash difficult. Here are some of the common skin conditions that affect the vulva:
Eczema. This is an inflammatory skin condition that disrupts the skin’s surface, causing red patches and thin cracks, weeping skin, and sometimes crust formation. On the vulva tissues, crust is less likely to form, but eczema can begin a cycle of itching and scratching that can lead to lichen simplex chronicus. LSC is the thickening of the skin with intense, relentless itching. If eczema affects an area of the vulva called the vestibule, it may cause a stinging and burning sensation, along with the itching. This condition is most often connected with the exposure to an irritant or allergen, like laundry detergent, medication, or friction irritation.
All eczema requires gentle skin care and, in most cases, can be treated with a topical corticosteroid cream a few times a day, for a duration chosen by your doctor. With severe cases, long term steroid creams may be needed. The key during treatment is to stop scratching so all the tissues have a chance to heal. Cold packs can be used to ease itching, along with antihistamines.
Psoriasis. This common condition occurs when new skin cells are produced too rapidly on the body, leading to thickened, scaly patches of inflamed, red skin that can cover the body. On the vulva, skin surfaces are usually too moist for the dry crusts to form, so the psoriasis shows with pink patches with clearly defined edges. This condition most commonly affects the labia majora. If the labia skin cracks, this can result in an unwanted infection.
With vulvar psoriasis, it is also common to have psoriasis outbreaks elsewhere on the body. Remedies designed for treatment on body skin may be too harsh for vulvar treatment. Your doctor may give you a special topical steroid cream or ointment that will be safe for your vaginal tissues.
Lichen Planus. This skin conditions results from an overactive immune system, which affects the vulva, vagina, inside of the mouth, and other skin surfaces. In most areas on the body, this condition creates itchy purple bumps that are sometimes also streaked with white. On the skin of the vulva, the most common symptoms are soreness, burning, and rawness. The vulva may appear pale or pink, with a white lacey pattern. If the vulvar skin breaks down, from the itching or the condition, the eroded areas appear moist and red. Lichen planus usually affects the vagina, causing a sticky yellow discharge and erosions that can make intercourse painful. If this condition goes untreated in the vulva and vagina areas, it can cause the excessive build of scar tissue that can alter the shape and size of the labia minora.
Lichen planus is diagnosed by its appearance and can also mimic the looks of vaginal atrophy- which is why a biopsy is often done to confirm. This condition can start due to a reaction to medications being taken, so always let your doctor know what you are taking. The most common treatment for this condition is a high-strengthen topical steroid medication. This condition is very persistent and often requires months of treatment.
Lichen Sclerosus. This inflammatory condition can appear anywhere on the body, but this specific condition is known to affect the vulva and anal area in post-menopausal women. The statistics show that nearly one in ever thirty older women are affected by lichen sclerosus, and more prevalent in those women who also have psoriasis. Itching is typically the first symptom and becomes quite severe, disrupting sleep and daily activities. You may notice white patches that can look crinkly or shiny, and some of these patches may have small tears or red areas from bleeding. These areas are usually very sore and may sting. As this disease progresses, the vulvar tissue will scar and shrink.
Lichen sclerosus is diagnosed by its appearance and using a biopsy. No matter how mild the symptoms may appear, this should be treated as soon as possible to avoid permanent, future damage. The usual treatment is a high potency corticosteroid ointment, for a duration selected by your doctor. Women also need regular examinations after treatment, because this condition is also linked to the development of skin cancer of the vulva and vagina. Early treatment and prompt attention to any new sore or lesion will reduce further risk. Some women with this condition may benefit from estrogen therapy, which can help counter atrophy and inflammation, making the vulva less susceptible to irritation.
Another way to combat vaginal atrophy holistically is to begin dilator therapy using dilators at home. If you are seeking more information on this therapy, please reach out to our Reclaiming Intimacy specialists.
Vulvar Irritants & Allergens
Many things can cause an allergic reaction or irritate vulvar skin. Here are some of the most common irritants and allergens.
Irritants– on exposure or contact, can cause immediate stinging or burning:
- Soap, bubble baths and salts, detergent, shampoo, conditioner
- Adult or baby wipes
- Panty liners and their adhesives
- Nylon underwear, chemically treated clothing
- Vaginal secretions, sweat, and urine
- Douches, yogurt
- Spermicides, lubricants
- Perfume, talcum powder, deodorants
- Alcohol and astringents
Allergens– these symptoms may not appear until several days after exposure:
- Benzocaine
- Neomycin
- Chlorhexidine (in K-Y Jelly)
- Imidazole antifungal
- Propylene glycol (a preservative used in many products)
- Fragrances
- Tea tree oil
- Latex (in condoms and diaphragms)
If you have used a new or different item in your routine, try to note what it was, when you used it, and when your symptoms began. This may help to determine the cause. There are many other irritants and allergens not listed here that can cause significant discomfort and issue.
Be Gentle with the Vulva
Whether you have a sensitive vulva or are prone to irritation, gentle care of this fragile area and tissues is a must. Wearing loose clothing, cotton underwear, and cleansing the area with fingers instead of a washcloth, along with an unscented, non-alkaline cleanser such as Cetaphil, or simply plain water is the best way to go. Soak the vulva in lukewarm water for five minutes, and pat dry.
Avoid using any unnatural products, or those full of extras or hormones- even if they say they are designed for your personal vaginal care. Many of these over-the-shelf “vaginal and vulvar” products cause many of the cases of contact dermatitis reported. If you must, find a daily moisturizer that is naturally made with organic ingredients designed to work with your natural pH, which can help your tissues to heal.
Getting the Right Diagnosis for Vulvar Skin Conditions
Vulvar skin conditions are highly treatable once the specific cause for the issue is determined. In some cases, identifying the underlying cause is much more difficult and time consuming than the actual treatment will be.
If you have other medical conditions, be sure to be open and honest about them with your doctors. Any inflammatory disease, like Crohn’s or Ulcerative Colitis, may cause abscesses or fistulas in the vulvar area, and these skin conditions can be one of the first signs of these inflammatory diseases progressing. Your doctor will also want to know how you care for your vulvar tissues and skin, which can pinpoint irritants or allergens.
For many people, it is often our daily routines that cause these problems. Wearing tight, abrasive clothing (like tight jeans, tight leggings, etc.) can trigger these issues. Bicycling or spinning classes, where tight clothes and sweat build up are present, have also been linked to being the culprit.
By reporting all symptoms that are affecting you- burning, discharge, soreness, bumps, and any rashes to the vulva- it will help your doctor determine where your issues could be stemming from. They will examine your vulva and vagina, possibly test the pH and take samples of the secretions produced to check under the microscope or culture for yeast.
Why Self Treatment is not Always Best
When the itching begins, most women immediately route to a yeast infection and begin treating themselves with over-the-counter medications. While this can help, it can also mask other issues that may be causing the infection. The cause of the symptoms could range from dry skin to a sexually transmitted disease or bacterial infection, to a less common strain of a yeast infection that will require special medications- or could even be caused by allergic reactions to common products and goods.
If yeast is not the sole issue, over-the-counter creams will not be a solution. If your skin is already irritated, using these products can exacerbate the problem and make it worse. This is why it is important to see a gynecologist or dermatologist if your attempt at handling it fails.
Another common action of those facing the vaginal itch is to overly wash the area, in attempts to wash away the itch and/or bacteria. It is best to follow a gentle skin care plan, as mentioned above. In fact, it is always best to use the gentle method of cleansing when handling your vulva and vagina at all times- not just when the itch or infection are present.
It is important to understand that allowing vulvar and vaginal issues to go untreated can cause more extensive and permanent damage for your sensitive, fragile tissues. Seek treatment from your doctor when you notice things are off, and do not wait to begin your treatment.
Citations:
Dermatology.com (image used for education purposes only)
American Cancer Society
Gynecology of America