Managing common vulvar skin conditions

Your clinician will want to know how you care for your vulvar skin, which can help identify possible sources of irritation. Even if you can’t pinpoint a change, that doesn’t mean your standard routine isn’t the culprit. Sometimes vulvar problems are the cumulative effect of long-term practices.

Vulvitis

Vulvitis is inflammation in your vulva, or genitals. Vulvitis is common and can result from an allergic reaction, an infection or an injury. Symptoms include itching, redness and swelling in your vulva. You may also have an abnormal vaginal discharge. Vulvitis is often easily cured once you receive the right treatments.

Overview

What is vulvitis?

Vulvitis is inflammation in your vulva, or your genitals. Your vulva includes the soft folds of skin that surround your vagina, including your labia majora (the outer folds), labia minora (vaginal lips) and your clitoris. Your vulva may become inflamed because of an infection, allergic reaction or injury that irritates your skin.

Your vulva is a particularly moist and warm part of your body, making it especially vulnerable to irritation and infection.

What is the difference between vulvitis and vaginitis?

Both vulvitis and vaginitis describe inflammation that affects your reproductive parts. Vulvitis refers to inflammation affecting your genitals, or vulva — the outer part of your reproductive anatomy. Vaginitis refers to inflammation that affects your vagina inside your body. Inflammation affecting both your vulva and your vagina is called vulvovaginitis.

Your gynecologist may use terms like vulvitis, vaginitis and vulvovaginitis interchangeably.

Who is affected by vulvitis?

Anyone with a vulva can experience vulvitis, but it’s more common in children and people who’ve gone through menopause. People assigned female at birth who haven’t reached puberty have lower estrogen levels than people who menstruate. People who are in post-menopause have less estrogen too. Low estrogen levels can lead to thinner, dryer vulvar tissues. This may increase your risk of injury and inflammation.

Symptoms and Causes

What are the symptoms of vulvitis?

Symptoms of vulvitis may include:

• Itching.
• Burning.
• Vaginal discharge.
• Small cracks on the skin of your vulva.
• Blisters on your vulva that may burst, ooze and form a crust.
• Redness and swelling on your inner labia (lips of your vagina) and elsewhere on your vulva.
• Thick, whitish patches of skin on your vulva that feel scaly.

These symptoms are common enough that they may suggest various disorders or diseases affecting your genitals. Talk to your healthcare provider if you notice these symptoms.

What causes vulvitis?

Infections, allergies, irritants and injuries can all cause inflammation in your vulva. Any of the following can cause vulvitis:

• Dyed or perfumed toilet paper.
• Pads, pantyliners or tampons that are scented or contain harsh ingredients.
• Bubble baths, soaps, vaginal sprays and douches that contain harsh ingredients.
• Wearing a wet bathing suit of sweaty workout clothes for too long.
• Irritation from a chlorinated swimming pool or hot tub water.
• Synthetic underwear that traps moisture and irritates your vulva.
• Laundry detergents and fabric softeners that irritate your skin.
• Injury from activities like cycling or horseback riding.
• Spermicides that trigger an allergic reaction.
• Skin conditions such as eczema or dermatitis.
• Fungal or bacterial infections, including yeast infection, scabies and pubic lice.
• Viral infections, such as genital herpes.
• Vaginal atrophy during menopause.

Is vulvitis contagious?

Vulvitis isn’t contagious, but some of its causes are. For instance, many bacteria that can cause vaginal infections are highly contagious. Vulvitis that results from an allergy or skin irritation isn’t contagious.

Diagnosis and Tests

How is vulvitis diagnosed?

Your healthcare provider will review your medical history and ask about your symptoms and habits related to hygiene. They’ll do a physical exam and a complete pelvic exam. They’ll look for skin changes that may indicate vulvitis, like redness, blisters or lesions. They may also check your vaginal fluid for signs of an infection.

Tests may include:

Many causes of vulvitis produce the same symptoms, so your provider needs to pinpoint what’s causing your inflammation. Once your provider determines whether the cause is an infection, irritation or a skin condition, they can recommend treatments that can help.

Management and Treatment

What is the treatment for vulvitis?

Treatment for vulvitis depends on what’s causing the inflammation. Often, protecting your vulva from potential irritants and practicing proper vulvar care can relieve vulvitis. Your provider may recommend that you:

• Avoid vulvar irritation: Stop using any products (like feminine hygiene products, soap and detergents) that may irritate your vulva. Wear loose-fitting, breathable white cotton undergarments to air out your vulva and vagina.
• Try provider-recommended creams: Your healthcare provider may prescribe an over-the-counter hydrocortisone ointment to reduce the irritation and itching. They may prescribe a topical estrogen cream to ease the itching and other symptoms of vulvitis.
• Take regular sitz baths: A sitz bath is a shallow, warm bath that can help relieve itching and burning caused by vulvitis.

Your provider may order additional tests to rule out rarer, more serious conditions that may be causing vulvitis, like lichen sclerosus or vulvar cancer if these treatments don’t help. More targeted treatments will be needed for these conditions.

What vulvitis treatments should I avoid?

Don’t attempt to self-diagnose vulvitis. Many people purchase over-the-counter anti-itch products to ease their symptoms, but this is a mistake. Using the wrong treatment for what’s causing your vulvitis may worsen your symptoms and make the itching and irritation last longer.

Instead, schedule a visit with your provider to begin the right treatment.

Care at Cleveland Clinic

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Prevention

Can vulvitis be prevented?

The same good habits used to treat vulvitis can prevent it from happening in the first place.

• Use mild, unscented soaps and warm water to clean your genitals, or just use warm water.
• Avoid douching and using fragranced feminine products, like tampons, pads and pantyliners.
• Change into clean, dry clothes soon after swimming or exercising.
• Wear breathable, loose-fitting cotton underwear during the day.

Outlook / Prognosis

What is the prognosis for vulvitis?

The prognosis for vulvitis is excellent. Vulvar inflammation is common, and most people experience relief once they begin treatment.

How long does vulvitis last?

Itching and other symptoms can usually be relieved within a few weeks of your diagnosis, depending on what’s causing your vulvitis.

Living With

How do I take care of myself if I have the symptoms of vulvitis?

Schedule a visit with your provider if you notice signs of vulvitis. Without treatment, vulvar inflammation can progress to an infection. The warmth and moisture of your vulva and vagina make it an especially hospitable environment for bacteria to grow.

Your provider can help prevent a rash from becoming infected. They can prescribe treatments for infections that have already started.

What questions should I ask my doctor?

• What tests are needed to figure out what’s causing my vulvitis?
• Has the inflammation spread to my vagina, or is it only in my vulva?
• What treatments would you recommend?
• How long should it take for my symptoms to disappear?
• How can I care for my vulva and vagina to prevent inflammation and irritation?

Frequently Asked Questions

What does vulvovaginitis look like?

With vulvitis or vulvovaginitis, your genitals may look red or swollen. Your skin may look scaly, white and patchy and you may have blisters. In more severe cases, your skin may be so irritated that it sticks together. Don’t postpone scheduling an appointment with your provider if your vulva looks or feels abnormal.

What is a whiff test?

Your provider may do a whiff test if they suspect that your inflammation is related to a common vaginal infection called bacterial vaginosis. Major symptoms of BV include an off-white or gray discharge and a fishy smell. Your provider may smell (take a “whiff” of) your discharge to see if it’s fishy.

A note from Cleveland Clinic

Don’t be embarrassed if you notice redness, itching, burning or any other signs of inflammation in your genital area. You’re not alone. Vulvitis is a common complaint that people discuss with their gynecologists. Still, it’s important to get treated and diagnosed immediately. Often, proper vulvar care can cure vulvitis. Sometimes, though, you may need treatments like antibiotics or creams to resolve your vulvitis before it gets worse. Either way, your provider can help.

Managing common vulvar skin conditions

Proper diagnosis, treatment vital to get relief from vulvar itching and other irritating conditions

The vulva is subject to a range of skin problems, many of them inadvertently self-inflicted.

You may routinely pamper your face and work hard to keep it moisturized and irritation-free, but what have you done lately for the more sensitive skin of your vulva, the external genital area surrounding your vagina?

Many women have been primed to think no further than “itch equals yeast infection.” But with age and the decline in estrogen after menopause, women become more prone to a variety of conditions that irritate vulvar skin. These conditions aren’t getting the medical attention they need — and women aren’t getting the relief they deserve.

Anatomy of the vulva

The vulva (Latin for womb or covering) consists of several layers that cover and protect the sexual organs and urinary opening. The fleshy outer lips of the vulva — the labia majora — are covered with pubic hair and contain fat that helps cushion the area. Inside the labia majora are the thinner, more pigmented and delicate flaps of skin called the labia minora. The labia minora join at the top to enclose the clitoris. The labia majora, labia minora, and clitoris are made up of erectile tissue, that is, tissue that can become engorged with blood. The area between the labia minora, the vestibule, contains the openings to the urethra and the vagina, as well as the Bartholin’s glands, which are located on either side of the vaginal opening and produce lubricant for the vestibule. The flesh between the vaginal opening and the anus (not part of the vulva but often involved in vulvar skin problems) is the perineum. This is where the incision called an episiotomy is sometimes made during childbirth.

Getting a diagnosis for vulva skin conditions

Getting a diagnosis for vulva skin conditions

Vulvar skin conditions are highly treatable, but the treatment depends on the specific cause. And identifying the underlying diagnosis can be very challenging.

Tell your clinician about any other past or present medical conditions (including bladder and bowel issues) and any skin problems elsewhere on your body. For example, psoriasis anywhere on the body raises the risk of a vulvar condition known as lichen sclerosus. (This condition and others are described, below, in “Vulvar conditions and their treatment.”) Crohn’s disease, a chronic inflammatory intestinal disease, may cause abscesses or draining fistulas in the vulvar area, and vulvar skin problems are often one of its early symptoms. A mouth condition called lichen planus is another cause of vulvovaginal problems. (The term “lichen,” as applied to skin disorders, refers fancifully to skin lesions that resemble lichen on rocks.) Long-term treatment with oral steroids, immune suppressants, or antibiotics can affect vulvar skin and raise the risk infection.

Your clinician will want to know how you care for your vulvar skin, which can help identify possible sources of irritation. Even if you can’t pinpoint a change, that doesn’t mean your standard routine isn’t the culprit. Sometimes vulvar problems are the cumulative effect of long-term practices.

It’s often what you’ve done day after day, year after year, that causes the problem. If you wear abrasive clothing and engage in abrasive activities like bicycling or spinning class and wear tight workout clothes that expose your vulva to sweat or to detergent or soap residue, eventually it might catch up with you.

Report all the symptoms that concern you, including itching, burning, soreness, discharge, bumps, and any rashes the vulva. It will also help if you can provide a history of your symptoms and recall what seems to make them better or worse. Your clinician will examine the vulva, perhaps using a magnifying glass, and insert a speculum to inspect the vagina. She or he may test the pH (acid-base balance) of the vagina and take samples of secretions to examine under the microscope or culture for yeast. Remember, even if you’re seeing an experienced clinician, several visits may be needed to diagnose and improve certain vulvovaginal conditions.

The problem with self-treatment

When vaginal or vulvar itching occurs, women usually assume it’s a yeast infection and treat it with an over-the-counter antifungal cream. Often this does the trick, but not always. Instead, the cause of the symptoms might be dry skin, a sexually transmitted disease or bacterial infection, a less common strain of yeast that required special medication, or irritation by and allergic reactions to common products such as soaps, creams, and lotions.

If yeast isn’t the problem, an antifungal cream isn’t the solution. And if your skin is already irritated, you may exacerbate the problem by introducing preservatives (such as alcohol or propylene glycol) and other ingredients contained in many antifungal remedies. That’s why it’s important to see your gynecologist or dermatologist if a problem persists after you’ve tried a standard antifungal cream.

Another common response of women faced with a vaginal discharge or itch is to wash the vulvar skin vigorously, on the assumption that this will disinfect the area or remove irritants. But aggressive cleansing can add to the irritation. Until the problem is diagnosed, it’s best to follow a gentle skin care routine (see “Gentle vulvar care”). In fact, gentle cleansing applies whether you have a vulvar skin condition or not: Wash the area gently with your fingertips or a soft cloth and pat dry with a soft towel. Don’t use a rough washcloth, and don’t rub.

Vulvar skin conditions and their treatment

Several vulvar skin conditions are familiar from other areas of the body but may be difficult to recognize when they appear on the vulva. These include the following:

Eczema. This inflammatory skin condition disrupts the skin’s surface, causing red patches and thin cracks, weeping, and crust formation. On the vulva, crusts are less likely, but eczema may initiate a cycle of vulvar itching and scratching that leads to lichen simplex chronicus — thickened and intensely itchy skin. If eczema affects an area of the vulva called the vestibule, it may cause stinging and burning. Sometimes eczema appears in early childhood and its cause is unknown. More often, it begins with exposure to an irritant or allergen (see “How irritating”).

Many things can cause an allergic reaction or irritate vulvar skin. Here are some of the leading suspects:

Irritants (on exposure, 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 (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)

Adapted from The V Book, by Elizabeth G. Stewart, M.D., and Paula Spencer (Bantam Books, 2002).

To diagnose vulvar eczema, the clinician will ask about your symptoms; your history of eczema, allergy, and related conditions; your vulvar cleansing habits; and any products the vulva has been exposed to. During the exam, she or he will look for redness, scaling, cracking, and thickening.

All eczema requires gentle skin care. In simple cases, patients use topical corticosteroid ointments twice a day for two to four weeks and then gradually reduce the frequency until the symptoms are gone. Severe cases may require a short course of a potent corticosteroid ointment.

During treatment, you must stop scratching, so your clinician may prescribe an antihistamine (usually taken at night to prevent daytime drowsiness). A cold pack can also help relieve itching.

Psoriasis. This is a common condition in which new skin cells are produced too rapidly, leading to thickened, scaly patches of inflamed and red skin on various parts of the body. On the vulva, skin surfaces are usually too moist for dry scaling, so psoriasis is more likely to appear in the form of pink patches with defined edges. It most commonly affects the labia majora. If the skin cracks open, infection may result.

You may have treated psoriasis outbreaks elsewhere on your body with remedies that may be too harsh to be used on the vulva. Your clinician may prescribe a topical steroid cream or ointment.

Gentle vulvar care

Whether you have a vulvar skin problem or are just prone to irritation, gentle care of the area is a must. Wear loose clothing. Choose cotton underwear (and go without when at home). To cleanse the area, use your fingers instead of a washcloth and an unscented, non-alkaline cleanser such as Cetaphil or Basis (plain water is also fine). Soak for five minutes in lukewarm water to remove any residue of sweat or lotions or other products. Pat dry, and apply any prescribed medication or a soothing and protective substance such as Vaseline or olive oil.

Avoid products with multiple ingredients. Even those that sound designed for vulvar care — like A&D Original Ointment, baby lotion, or Vagisil — contain chemicals that could irritate or cause contact dermatitis. In the bathroom, forgo moistened wipes. If you want moisture, use a spray bottle with plain water, and then pat dry.

Lichen planus. This skin condition, believed to result from an overactive immune system, can affect the vulva, the vagina, the inside of the mouth, and other skin surfaces. In most areas of the body, lichen planus causes itchy purple bumps sometimes streaked with white. On vulvar skin, the most common symptoms are soreness, burning, and rawness. The vulva may appear pale or pink, sometimes with a white lacy pattern. If the vulvar skin breaks down, the eroded areas appear moist and red. Lichen planus often affects the vagina as well, causing a sticky yellow discharge and erosions that can make intercourse painful. Eventually, lichen planus can affect underlying as well as surface tissues and produce scarring that alters the vulva’s shape, sometimes leading to the virtual disappearance of the labia minora.

Lichen planus is diagnosed by its appearance (although it can be difficult to distinguish from atrophy caused by a lack of estrogen or the excessive use of steroids), and the diagnosis is confirmed with a biopsy. The condition may start as a reaction to certain medications, so be sure to tell your clinician about any drugs you take.

The most common initial treatment is high-potency topical steroid medication. Unfortunately, lichen planus is persistent and likely to require long-term maintenance treatment.

Lichen sclerosus. Although it can occur elsewhere on the body, this inflammatory skin disorder usually affects the vulvar or anal area in postmenopausal women. By some estimates, one in 30 older women has lichen sclerosus; it’s especially common in women with psoriasis. Itching is usually the first symptom, and it may become severe enough to disrupt sleep and other activities. During an examination, the clinician may notice white (sometimes crinkly or shiny) patches. Some may contain tears or red areas from bleeding (often the result of scratching) and these areas may be painful and sting. As the disease progresses, there’s a danger that vulvar tissues will scar and shrink.

Lichen sclerosus is diagnosed by its appearance and sometimes by biopsies. No matter how mild the symptoms, it should be treated to prevent progression. The usual treatment is application of a high potency corticosteroid ointment for several weeks, then slowly tapering the dose.

Women also need regular examinations after treatment for lichen sclerosus because the condition can make affected skin more likely to develop skin cancer. Early treatment and prompt attention to new lesions or nonhealing sores in the area will reduce the risk further.

Some women with vulvar skin problems may benefit from estrogen therapy (delivered vaginally via ring, tablet, or cream, or applied directly to the vulva), which can help counter atrophy and inflammation and make the vulvar skin less vulnerable to irritation.

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