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Vulval & vaginal irritation

Vulva is the name for to the external parts of the female genitals (private parts). The vulva is often mistakenly called the vagina, but the vagina is the internal, or inside part of your genitals.

All women have vaginal discharge or secretions which help to keep the vulva and vagina moist and remove bacteria and dead cells.

If your vulva feels irritated, it is important to seek advice from your doctor as to what might be causing the irritation. There are many treatments available for vulva and vaginal irritation.

Topics on this page

What is the vulva?

Vulva is the general name given to the external parts of the female genitals.

The parts of the vulva include:

Mons pubis. The pad of fatty tissue covered with pubic hair.
Labia majora.
The outer lips, which are covered with pubic hair.
Labia minora.
The inner lips, which are hairless.
Clitoris and its hood or covering.
Positioned at the front of the genital area.
Vestibule.
Immediately surrounds the vaginal opening and the urinary opening.
Urinary opening (urethral meatus).
Above the vaginal opening.
Vaginal opening (introitus).
Below the urinary opening.
Perineum.
The area of skin between the vagina and the anus.

Vulva diagram1 RGB

What's normal?

Each woman’s vulva is unique in size, colour and appearance. No two look the same! It is also normal if there are noticeable differences between the left and right side of the vulva, especially the labia minora. Vulvas also vary in size, shape and length. All these differences and variations are normal. However, images seen online are often heavily edited to make the vulva look symmetrical and childlike.

Because it is difficult for women to see their own vulva, many women do not know what their vulva looks like. They are also unsure whether their vulva looks ‘normal’. If you do not know what your vulva looks like, use a mirror so you can look and become familiar with what is normal for you. This will make it easier to detect any changes in appearance, such as changes in colour, bumps, thickening or thinning of the skin, or dry, cracked skin. The Labia Library is a great online resource, with numerous realistic pictures of labia.

Downloadable resources
Underwear

Irritation

The skin of the vulva is extremely delicate, making it vulnerable to a wide range of conditions.

Any itching, burning or discomfort of the vulva is often described as vulval irritation, which is relatively common in women of all ages. A small part of the vulva, or sometimes the entire vulva, can be affected.

Signs and symptoms to watch for include:

  • burning and/or itching
  • the feeling of crawling under the skin
  • redness and/or swelling
  • associated vaginal discomfort and/or discharge
  • skin cracking or splitting (fissuring)
  • whitening of skin (leukoplakia)
  • painful sex (dyspareunia)

Most cases of vulval irritation are not serious and will improve with treatment. However, there are a few rare conditions that can become serious if left untreated. Finding out what is causing your vulval irritation and having it treated quickly by a doctor or nurse is important. If it is ignored, the irritation can become a source of increased discomfort and worry.

Causes of vulva irritation

Vulval irritation can be caused by many things, including:

  • an imbalance in the bacteria and microorganisms that naturally live inside the vagina (known as the vaginal microbiome)
  • sweating and/or discharge from the vagina
  • fungal, bacterial or viral infections such as:
    • candidiasis/’thrush’ – a fungal/yeast infection of the vulva and vagina. Symptoms include itching, redness, swelling and a cottage cheese-like vaginal discharge
    • trichomoniasis/‘trich’ – a sexually transmissible infection (STI). Common symptoms are itchiness and a smelly, green frothy discharge. Sex may be painful
    • bacterial vaginosis – bacterial infection of the vagina that occurs when its normal balance of bacteria changes. Main symptoms are a thin, grey or white discharge and a strong fishy odour especially after sex
    • genital herpes – a virus spread by skin-to-skin contact during vaginal, oral or anal sex. The first time it appears is usually the worst and symptoms may include painful ulcers, blisters, a rash, flu-like symptoms, vaginal discharge and trouble passing urine. When it reappears, it is often less severe, but usually in the same area. Affected areas may include the vulva, inner thighs, buttocks and the skin around the anus. Symptoms can be managed, but genital herpes does not always cause symptoms and therefore may go unnoticed and unknowingly spread
  • allergies/adverse reactions to products, such as:
    • perfumed products such as ‘feminine hygiene’ sprays
    • sanitary pads and tampons
    • tight and/or synthetic clothing, tights or stockings, G-strings
    • chlorine or wet, sandy swimwear that is left on
    • perspiration and other bodily fluids
    • soaps, bath and hair products
    • laundry detergent
    • hair removal and bleaching products
    • condoms, spermicides and lubricants (you can buy non-latex condoms and lubricants made from other ingredients to avoid allergies)
    • nail polish and/or fake nails, hand creams
    • scented or coloured toilet paper or wipes
    • douches (using a vaginal wash or douche is never advised as it disrupts the normal vaginal microbiome)
  • some medications and local anaesthetic
  • piercings – these may cause infections or localised reactions
  • ingrown hairs – common after hair removal. If you are prone to ingrown hairs, a gentle loofah to the area may help
  • bartholin glands cyst – these glands are located on either side of the lower part of the vaginal opening, towards the perineum, and produce lubricating fluid during sex. A gland may become blocked, causing a cyst or abscess to develop, leading to discomfort or pain
  • varicose veins – can develop in the vulva, particularly during pregnancy. They usually improve after childbirth, but they can be treated if they persist
  • hormonal changes – like the vagina, the vulva can become thinner, drier or more uncomfortable due to hormonal changes in a woman’s body, such as after having a baby, while breastfeeding or after menopause
  • skin conditions such as:
    • dermatitis/eczema – this common skin condition can occur anywhere on the body, including the vulva. Scratching to relieve itching may cause further skin damage. These may be a response to the products listed above
    • lichen sclerosus – an inflammatory autoimmune skin condition that can cause itching. Skin may become thin, white, wrinkled and cracked. It is often misdiagnosed as thrush. If untreated, lichen sclerosus can lead to scarring with changes to both the vulva and the vaginal entrance and, in a small number of cases, cancer of the vulva
    • psoriasis – an inflammatory autoimmune skin condition that can affect vulval skin, causing reddened patches. Scratching may lead to further damage of the skin
    • lichen planus – an autoimmune skin condition that can affect the vulva, vagina and other body parts, including the mouth. Symptoms include pain, burning, itching, rawness, redness and changes to vaginal discharge. White, lacy or fern-like streaks can be seen on the vulva and there may be areas where the skin wears away leaving holes (erosions) and blisters (ulcerations). If untreated, the skin can scar and change the shape or appearance of the vagina and vulva. In rare cases, cancer can occur
  • Vulval cancer is uncommon, less than 1% of all new female cancers diagnosed. Sometimes vulval cancer may be linked to the presence of a persistent itch, roughened skin, a non-healing sore, or a lump. It is important to be aware of your vulva and what is normal for you. If you feel something has changed see your medical practitioner. If a cancer is diagnosed you will be referred to a special gynaecologist or gynae-oncologist.

Diagnosis

Sometimes vulval irritation involves a cycle of itching, scratching, skin tearing or splitting and then a secondary infection. Many women are embarrassed to discuss their problem and symptoms can occur for many years before they seek help.

Rather than try to treat the problem yourself, because you feel embarrassed, it is important to see your doctor so you can get an accurate diagnosis and receive effective treatment.

Your doctor will take your medical history, ask you questions about your symptoms and should check your vulva. If the doctor does not check your vulva, ask for an examination. You might also need a urine test, vulval or vaginal swab, blood test or a vulval biopsy.

Management & treatment

The treatment of vulval irritation will depend on the cause and your doctor will help you decide which is the right treatment.

Treatment options may include:

  • local treatments (external/outside): medicated creams (corticosteroid, antibiotic, antifungal, antiseptic, anaesthetic), barrier creams, gels
  • local treatment (internal/inside): vaginal cream, gels, tablets and pessaries (antibiotic, antifungal, acidic, hormonal)
  • oral treatments
  • combination of both (local & oral)

If you follow your doctor’s recommended treatments and your symptoms do not improve, see your doctor again. They may refer you to a gynaecologist, a dermatologist or a women’s health specialist. Some larger hospitals have specialist vulval clinics or refer to the Jean Hailes Vulval Clinic.

What you can do to look after your vulva

The treatment of vulval irritation will depend on the cause and your doctor will help you decide which is the right treatment.

In this video Dr Elizabeth Farrell gives some tips for treatment. You can also refer to the table below to learn what you can do to look after your vulva, and how to reduce irritation.

Recommendation What to do
Cortisone creams/ointments

Follow the instructions which may include washing prior to applying the cream/ointment.

Pat dry then apply any cream/ointment prescribed by your doctor.

See your doctor if your symptoms do not improve.

Ways to reduce irritation

Bathing in bicarbonate of soda or salt

Bath your vulva once or twice a day for 5-10 minutes in a basin or bath:

  • To a tub or basin of water, add:
    • 2 tablespoons of bicarbonate of soda or a ¼ teaspoon of salt per litre
  • To a bath, add:
    • 1 cup of bicarbonate of soda or a handful of salt

Spray bottle

Another option is to put a teaspoon of salt into a 600ml spray bottle of water. Spray this mix on your vulva while sitting on the toilet. You can do this while urinating (peeing) to reduce stinging.

Use cold compresses

These may help ease itching and pain. Don’t apply ice or anything frozen directly to your skin. Cover ice with material such as a hand towel.

Only use water or non-soap substitutes to wash your vulva
  • Don't use perfumed soaps and bath products.
  • Don’t use douches or vaginal washes as these disrupt the normal vaginal microbiome.
Wear cotton underwear
  • Avoid nylon underwear.
  • Wash cotton underwear in pure/unscented soap.
Avoid talcum powder

Never use talcum powder on your vulva.

Swim in salt water
  • Avoid swimming in chlorinated water if you can.
  • If swimming irritates your vulva, use a barrier ointment (you can buy this at the chemist or supermarket).
After swimming change straight away.
  • Change out of bathers and shower to remove any chlorine or salt from your vulva.
  • Avoid wet clothing next to your vulva.
After gym, change straight away

Lycra and sweat can irritate your vulva.

Wear loose fitting pants

Avoid tight fitting jeans, pants, G-strings, and if you have to wear pantyhose try those with a cotton gusset.

Lean forward when passing urine
  • This helps to avoid burning.
  • Always wipe or pat from front to back after urination or bowel movements, using unscented toilet.
Choose period products carefully
  • Use 100% cotton sanitary pads and tampons.
  • Menstrual blood may irritate your vulva, so consider using tampons or a menstrual cup instead of pads.
  • Change frequently.
Use natural lubricants

Use silicone or water-based lubricants with intercourse. Good quality natural oils such as olive or almond oil may be suitable too, but don’t use oils with condoms as oils will make them break down.

Secretions or discharge

All women have vaginal discharge or secretions which help keep the vagina and vulva moist and remove bacteria and dead cells. Normal secretions vary throughout the menstrual cycle, from thin and slippery during ovulation to thick and white just before your period. It is common for discharge to be discoloured red or brown a day or two before or after as the period starts and finishes.

After menopause the vaginal skin thins and discharge may alter.

Some vulval and vaginal secretions change in colour and consistency with an infection.

Dryness

Sometimes women find their vulva and vagina feels dry and lubrication is poor, mostly due to the hormonal changes at menopause that make the vagina dry and thin. This can make sex painful and inserting a tampon painful as well.

Try using a natural lubricant like olive or almond oil.

Odour

It is normal for your vulva to smell different at different times in your menstrual cycle.

There are many fluids and secretions associated with the vulva, including urine, sweat, menstrual blood, skin oils and vaginal and gland secretions all of which can affect the smell.

If the odour is unpleasant, yeasty or fishy smelling this may be a sign of an infection. Other causes of odour may be a sexually transmissible infection (STI), a tampon left in the vaginal canal too long or the presence of urine or faeces.

If you are worried about the odour of your vulva and vagina, and/or have symptoms such as itching, burning, irritation, soreness, painful sex or painful urination, see your doctor.

After menopause, odour may change as the bacteria in the vagina also changes. The odour will be different compared to when you were still having periods.

'Good bacteria' versus 'bad bacteria' in the vagina

There are many different types of micro-organisms (tiny living organisms that are invisible to the naked eye) that are found in the vagina. They include bacteria and fungi, however, the main types can be generally called 'good bacteria' and 'bad bacteria'. Healthy vaginas are rich in good bacteria. These friendly micro-organisms, called lactobacilli, keep the environment acidic and help protect the vagina from infections and keep the populations of bad bacteria in check.

An imbalance or overgrowth of ‘bad’ bacteria and other unfriendly micro-organisms in the vagina can cause symptoms such as vaginal discharge, redness and itchiness. They can also make you more prone to the common conditions of fungal infections such as vaginal candidiasis (‘thrush’) or bacterial infections such as bacterial vaginosis (BV). However, it is important to note that not all vulval irritation is due to an imbalance of vaginal bacteria.

Current research suggests that your vaginal bacteria may be connected to the bacteria in your digestive system. So, what you eat and digest may affect the health and populations of bacteria in both your gut and your vagina. However, more research is needed before we can make specific recommendations about particular foods to improve vaginal bacteria.

Live cultured yoghurt and other fermented foods, such as kimchi, sauerkraut and kefir, contain good bacteria as an ingredient. Eating these foods regularly can help to maintain healthy populations of good bacteria in your digestive system. This may also influence the vaginal bacteria but once again, more research is needed in this area.

It is important to note that the number of friendly bacteria found in these foods varies and in many cases is unpredictable.

High sugar foods, soft drinks, too much alcohol and too many refined carbohydrates in your diet (such as white breads, biscuits and white pasta) may help the bad bacteria to grow and flourish in place of the good.

Holding yogurt breakfast muesli

Probiotics

The World Health Organisation defines probiotics as “live microorganisms that, when administered in adequate amounts confer a health benefit on the host”.[1]

For a food to be considered ‘probiotic’ it must contain one billion microorganisms per daily serve (and one million per gram/ml),[2] so look for a product that specifies the dose of good bacteria it contains. We know that a whole food diet rich in fruits, vegetables and fibres is associated with a healthier and diverse gut microbiota.[3]

Probiotics can be taken orally as a capsule, or as a powder, and contain good bacteria in much higher quantities than what you would get from fermented foods alone.

There is some evidence that probiotic supplements can be useful in treating and preventing vaginal infections, especially bacterial vaginosis (BV), but further research is needed to support this.[4]

A large review of research looking at the management of vaginal candidiasis or thrush, showed that using probiotics together with the normal anti-fungal treatment may increase the rate of cure and may also prevent the infection recurring after a month.[4] Research also suggests that some strains of Lactobacillus (a good bacteria) are more effective for treatment of these conditions.[6] More high-quality research in this area is needed to confirm these findings.

There are many kinds of probiotic supplements available. All the research mentioned used probiotics that contained lactobacillus strains, but there were specific strains of bacteria that were more effective in treating infections such as BV.[6] These strains include:

  • Lactobacillus rhamnosus Lcr 35
  • Lactobacillus rhamnosus GR-1
  • Lactobacillus reuteri RC-14 (previously known as Lactobacillus fermentum RC-14)
  • Lactobacillus plantarum P17630 specifically for the prevention of vaginal candidiasis[6]

Note: the numbers and letters at the end of each probiotic name are very important as they identify the exact strain of probiotic. Research suggests that a dose of 10 billion CFU/day (colony forming units) of both Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 for at least two months is most beneficial for BV, with some women requiring longer treatment of up to six months.[7]

As always, inform your health practitioner of any medicines, including probiotics that you are taking.

If you are experiencing vulval or vaginal irritation and your symptoms are not getting better, make an appointment with your doctor or qualified health professional. The sooner you see a doctor, the sooner your symptoms will improve.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2021.

References

  • 1
    Hill, C., Guarner, F., Reid, G. et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 11, 506–514 (2014). https://doi.org/10.1038/nrgastro.2014.66
  • 2
    Kechagia, M., Basoulis, D., Konstantopoulou, S., Dimitriadi, D., Gyftopoulou, K., Skarmoutsou, N., & Fakiri, E. M. (2013). Health benefits of probiotics: a review. ISRN nutrition, 2013, 481651. doi:10.5402/2013/481651
  • 3
    Jandhyala, S. M., Talukdar, R., Subramanyam, C., Vuyyuru, H., Sasikala, M., & Nageshwar Reddy, D. (2015). Role of the normal gut microbiota. World journal of gastroenterology, 21(29), 8787–8803. doi:10.3748/wjg.v21.i29.8787
  • 4
    van de Wijgert JHHM, Verwijs MC 2019. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG Jul 12. doi: 10.1111/1471-0528.15870.
  • 5
    Xie, H. Y., Feng, D., Wei, D. M., Mei, L., Chen, H., Wang, X., & Fang, F. (2017). Probiotics for vulvovaginal candidiasis in non-pregnant women. The Cochrane database of systematic reviews, 11(11), CD010496. doi:10.1002/14651858.CD010496.pub2
  • 6
    De Seta, Parazzini F, De Leo R, Banco R et al 2014. Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study. Eur J Obstet Gynecol Reprod Biol Nov;1 82:136-9. doi: 10.1016/j.ejogrb.2014.09.018
  • 7
    Ziyadi, Somayeh & Homayouni, Aziz & Mohammad-Alizadeh, Sakineh & Bastani, Parvin. (2016). Probiotics and Usage in Bacterial Vaginosis. 10.1016/B978-0-12-802189-7.00049-6.
Last updated: 06 August 2021 | Last reviewed: 09 April 2021

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