Vulva skin is prone to many conditions, says Dr Melanie Wynn-Jones. Here’s what you need to know but may have been too embarrassed to ask.
The vulva (our external female genitalia) consists of the skin-covered external labia (lips) and the internal labia, clitoris and urethra (urine pipe), and vaginal entrances, covered by delicate membranes.
Vulva skin disorders can be embarrassing and unpleasant, but are often easily solved. However, if simple measures don’t work quickly, or you have a vaginal discharge, consult your GP or practice nurse.
Vulva skin lumps
The labial skin contains lubricating sebaceous glands that may block, producing a skin-coloured/yellowish swelling (cyst). Like hair follicles, this may become infected. The lump will be red, hot and sore, and you’ll need antibiotics and/or a minor operation to drain any pus.
Recurrent boils are sometimes a sign of diabetes or a sweat gland disorder, hidradenitis suppurativa, which can cause scarring. Bartholin’s glands, at the vaginal entrance, may also get blocked and swell (Bartholin’s cyst) or become infected (abscess). You may need an operation (under a general anaesthetic).
Cancer of the vulva is very rare, but show any persistent lump or ulcer/sore to your GP if you’ve had it for more than two weeks.
Itching and soreness
Thrush (candida and other yeasts) often lives harmlessly on our skin, but may flare up, producing intense itching, redness, soreness during lovemaking or urination, and/or a white cottage-cheese discharge. You can treat this with anti-fungal creams such as clotrimazole, or tablets, such as fluconazole (from your pharmacy), but you may need tests for diabetes and other infections if these don’t work.
Psoriasis, eczema and allergic dermatitis can cause redness, scaling, itching and cracking,and you may have patches elsewhere. Your GP can diagnose these, and prescribe steroid
or other creams.
Falling hormone levels after the menopause can produce irritation, soreness, urinary discomfort and dryness, particularly during lovemaking. Membranes may look pale and dry. You can buy various lubricants from your pharmacy (often near the contraceptive counter), but if these don’t help, your GP may suggest an occasional oestrogen top-up cream, pessaries or hormone replacement therapy if you have other troublesome menopausal symptoms.
Lichen sclerosus and atrophicus makes vulva skin itchy and fragile, with crinkly white thickened patches, cracking and scarring. It’s sometimes linked to immune-system disorders. Emollients (moisturisers) and steroid creams help, but you’ll need a sample taken (biopsy) to rule out pre-cancerous changes, and regular checks, as these can occasionally develop.
Vulvodynia (pain with no obvious signs) may be a form of neuralgia (pelvic nerve irritation) and improve with small doses of antidepressants/anticonvulsants that block nerve signals.
Sexually transmitted infections
These are becoming more common in women of all ages. Genital herpes causes painful blistering, can make you feel as though you have the flu and can recur. It is treated with anti-viral tablets. Genital warts may spread to the anus and be soft, frond-like, large and/or multiple.
They’re caused by HPV (human papilloma virus) and can be treated with prescription creams or paints, or removed using local anaesthetic and a laser or hot/cold cautery.
It’s best to visit your local sexual health clinic for a full range of tests (visit nhs.uk for locations), as you may have picked up other infections too, for example chlamydia doesn’t always cause urinary symptoms or a discharge.
Make sure you always have smear tests when they’re due (some HPV strains are linked to cervical cancer).
4 ways to keep your vulva skin comfortable
1. Wash regularly but not with strong or highly scented soaps, washes or wipes, which can cause inflammation or allergy.
2. Avoid tight clothes, synthetic fibres and being overweight, as these increase sweating and friction.
3. Use condoms to protect against infections. Those containing spermicides may cause allergies.
4. Get handy with a mirror – check regularly and report any unusual changes.