VULVAR CONCERNS

The vulva refers to the external female genitalia. Common symptoms of vulvar conditions include itching, burning, stinging and general irritation. Vulvar conditions can include skin conditions, infections, chronic pain, and occasionally cancerous or pre-cancerous conditions. Vulvar issues can be associated with sexual dysfunction and/or pain and bladder dysfunction and/or pain. The skin of this area can be quite sensitive and can be easily traumatized by friction of clothing and activities.  Moisture in the area can also play a role in irritation.

VULAR HYGIENE

The skin can be very sensitive to exposure to many products such as soap, perfumes, feminine hygiene products, bubble bath, shampoo in the bath water and laundry products etc..  Avoiding such irritants can be very beneficial. It is preferable to wash the vulva with plain water or with mild soap without perfumes.  Unscented soaps, or soaps for sensitive skin such as Dove, are the best to use in this area.  Avoid harsh soaps and deodorant soaps.  Special soap products such as Aveeno can be found at some pharmacies and health food stores. Frequent washing can increase irritation.  Allowing shampoo to fall into bathwater can also irritate the vulvar skin. Hand held showers can be useful. Peribottles/squirt bottles containing plain, lukewarm water can be helpful.  After rinsing, pat the skin gently dry or use a handheld hair dryer on a cool setting to dry the skin. An irritated anal area can be cleansed separately with a moist, clean washcloth and the the cloth laundered.  Avoid perfumed wipes. Commercially available feminine hygiene products including wipes and sprays should generally be avoided.  Lubricants for intercourse should be plain without scents, flavouring or heating or cooling components. Undyed cotton undergarments are preferable and the under garments should be washed with mild soaps only. Fabric softeners and dryer sheets should be avoided.  Synthetic materials, pantyhose, tights and tight-fitting clothing should be avoided as they can increase symptoms of discomfort by holding in heat and moisture and by causing mechanical irritation. Some patients find the use of cool gel packs on the vulva to be helpful. 

VULAR PAIN

Vulvar pain can be primary (has no underlying identifiable cause) or secondary (has an underlying cause).  Vulvar pain can be associated with anal problems such as anal fissures, primary or recurrent bladder infections, interstitial cystitis (inflammation of the bladder) and painful intercourse.

VULVAR RASHES AND SKIN CONDITIONS

The most common type of rash involving the vulva is  caused by yeast.  Yeast is ubiquitous and has reservoirs in the body including the vagina and the GI tract or gut.  Yeast infections can also present as discharge and itchiness related to an overgrowth of yeast in the vagina.  A vaginal yeast infection can also cause vulvar irritation and itching.  If the skin of the vulva is involved it can be very red, irritated and itchy.  Yeast on the vulvar skin can be treated with an over the counter dermatological yeast treatment such as Canestan or Monistat. If the symptoms are primarily vaginal, the vaginal insert treatments for yeast can be used.  Some people with chronic or recurrent yeast problems find that probiotics, or yogurt with lactobacillus can be helpful .  Some patients find boric acid caplets inserted vaginally can be helpful for chronic yeast problems.

Any skin conditions such as eczema or psoriasis can affect the vulva as well as other skin areas.  Inflammatory conditions can affect the vulva.  These include lichen sclerosus which presents with symptoms of burning and itching.  It results in changes in the appearance of the vulvar skin and it’s normal anatomy.  A biopsy by a doctor may be required to confirm the diagnosis and get treatment started.

Menopausal changes can result in dryness and irritation of the vulvar skin and vagina.  Unscented moisturizers such as glaxol base or Cetaphil can be used on the vulvar skin to manage dryness.  Estrogen based products can be helpful for vaginal and urogenital health in menopause.  There are also some commercially available non estrogen vaginal moisturizers such as Replens.