Vulval Conditions

The vulva is the skin surrounding the entrance to the vagina. There are a number of conditions that can cause pain in the vulva, including:

  • Vulvodynia – a persistent, unexplained pain in the vulva
  • Thrush – a vaginal infection that can be persistent
  • Irritant contact dermatitis – sensitivity to chemicals found in certain products such as soap, bubble bath and feminine wipes.
  • Dryness caused by a drop in Oestrogen levels. This is particularly common during the menopause.
  • A skin condition called lichen schlerosus that can cause intense irritation or soreness of the vulva
  • Sjogren’s syndrome – a rare immune disorder that causes vaginal dryness
  • Behcet’s disease – a condition of the blood vessels that causes genital ulcers
  • Vulval cancer – a rare type of cancer that mostly affects women over the age of 65. Only 1200 cases are diagnosed in the UK each year.

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Symptoms

The symptoms of Vulvodynia are persistent, unexplained pain in the vulva. The condition can affect women who are, otherwise, healthy. The vulva looks normal, however, there is ongoing pain, which may be accompanied by other problems such as painful periods, irritable bowel syndrome or vaginismus (where the muscles around the vagina tighten involuntarily).

The pain of Vulvodynia can very from woman to woman. It might be experienced as:

  • a burning, stinging sensation
  • pain when touched
  • pain in a specific part of the vulva, such as the opening of the vagina
  • persistent background pain that gets worse when you sit down
  • pain that extends to the buttocks and/or thighs

It can be a long-term problem that can cause anxiety and depression. It can be difficult to talk about and can impact relationships and reduce sex drive. There are things that can be done to help manage the symptoms.

Causes

The causes of Vulvodynia are not precisely known, but it is likely to be nerve related. Possible triggers might include severe vaginal thrush, trapped nerves or damage during childbirth or surgery.

Diagnosis

If you have persistent pain in this area, you need to talk to your GP or a gynaecologist. They will discuss the symptoms with you and carry out a gentle examination of your vulva. They may take a swab (a small sample of cells using something like a cotton bud) to check for infection.

Treatment

There are a number of self-help measures that you can take to reduce the impact of vulval pain. These include:

  • Avoiding harsh chemicals in this sensitive area, including soap, bubble bath and feminine wipes.
  • Wearing cotton underwear.
  • Activities to reduce stress as Vulvodynia can be a stressful condition to live with.
  • Applying cool packs to the affected area.

Your GP may also suggest other types of treatment including:

  • Anaesthetic gel that you can apply to your vulva during the day if the pain is constant or before sex if the pain is worse when touched. This can be bought over the counter but it is a good idea to talk to your GP before using it.
  • Vaginal lubricants and aqueous cream to soothe the area if it is dry.
    Local anaesthetic or steroid medication injected into a nearby nerve to provide temporary relief.
  • A TENS machine to reduce pain.
  • Antidepressants called amitriptyline and nortriptyline, which can help to ease the pain. Also anti-epilepsy medications gabapentin and pregabalin have the same effect.
  • Physiotherapy, which can teach you pelvic floor exercises to relax the muscles around the vagina.
  • Vulvodynia can be a distressing condition. Your GP may refer you for Cognitive Behavioural Therapy to help you manage your feelings about the condition. You may also be offered psychosexual counselling to help with any problems that occur between you and your partner in relation to intimacy.
  • Surgery to remove part of the vulva. This is offered rarely as the pain can recur.

FAQs

Vulval cancer is a rare type of cancer that mostly affects women over the age of 65. There are only 1200 cases in the UK each year. Symptoms can include:

  • persistent vulval itch, pain or soreness
  • a lump or wart-like growth on the vulva
  • patches or red skin or sores
  • bleeding from the vulva or blood-stained vaginal discharge
  • a burning pain when you wee
  • a mole on the vulva that has changed shape or colour

These symptoms do not necessarily mean you have cancer but it is important to visit your doctor to be on the safe side. If you do have cancer, the earlier it is detected the better your chances of successful treatment.

The skin of the vulva and surrounding area is very sensitive and easily irritated by chemicals that are found in soap, bubble bath and scented wipes. It is a good idea to avoid using chemically-based products if you can. Washing the vulva with water is perfectly adequate or try using an emulsifying ointment such as Dermol 500. If the skin is sore you can use a bland moisturiser but nothing perfumed. Use soft, white, non-recycled toilet paper and cotton pads or tampons.

Yes, anything that contains harsh chemicals can irritate this delicate skin, or worsen existing problems. Avoid detergents that contain dyes, perfumes or enzymes (referred to as biological washing powder). Choose dermatologically-approved detergents or those recommended for babies. Avoid fabric conditioners. Ensure your underwear is rinsed thoroughly so no traces of detergent remain.