Vulva is the name for 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.
What is the vulva?
What's normal?
Irritation
Causes of vulva irritation
Diagnosis
Management & treatment
What you can do to look after your vulva
Secretions or discharge
Dryness
Odour
'Good bacteria' versus 'bad bacteria' in the vagina
Probiotics
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.
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.
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:
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.
Vulval irritation can be caused by many things, including:
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.
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:
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.
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:
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 |
|
| Wear cotton underwear |
|
| Avoid talcum powder | Never use talcum powder on your vulva. |
| Swim in salt water |
|
| After swimming change straight away. |
|
| 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 |
|
| Choose period products carefully |
|
| 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. |
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.
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.
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.
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.
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:
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.
