It’s never too late to learn about – and start talking about – this important part of our bodies.
A vulva is not a vagina. Yet many women often mistakenly call their vulva their vagina, or think ‘vulva’ is just a less common name for the same body part.
And after more than 35 years in medical practice, Dr Tanja Bohl is still surprised by the number of women who refer to their vaginas and vulvas as ‘down there’.
Sometimes it’s a reason for despair. So many women find the word ‘vulva’ confronting. It’s as if it’s a dirty word and you cannot talk about it without a snigger. We can discuss penises or impotence or the little blue pills at dinner parties, but we cannot discuss women’s issues in the same way. It might be because we cannot see our vulvas, so they’ve become part of women’s secret business.Dr Tanja Bohl, head of the Jean Hailes Vulva Clinic
Whatever the reasons, Dr Bohl has spent much of her career lifting the vulva from ‘down there’ and onto the national discussion table. Her efforts and those of other doctors in the field are helping to normalise this critically important area of women’s health.
Clinical Professor Thierry Vancaillie, joint founder of the Women’s Health and Research Unit of Australia, describes vulval health as “one of the last frontiers of gynaecology”.
He estimates that more than 10% of women will experience pain or discomfort in the vulval region at some time in their lives. Yet he is often astonished when many will wait years before seeking specialist medical help.
Part of the blame lies in the fact that it’s considered to be “a bit of a taboo subject”, he says, and that many women, particularly older women, are embarrassed, so suffer in silence.
I would always encourage women to seek help sooner rather than later. If they ignore issues for too long, they can develop secondary issues.Clinical Professor Thierry Vancaillie
The vagina tends to have fewer problems than the vulva. It cares for itself, as it is self cleaning. If it has a problem, it will let you know via a discharge or changes to secretions.
On the other hand, the vulva tends to be more complex and its problems can potentially affect a woman’s quality of life. However, the good news is that most problems can be successfully managed by health professionals.
Many women often mistake the vulva for the vagina, or think the names are interchangeable – but they are very different.
The vagina is the internal tube that connects the uterus (womb) to the outside of the body, while the vulva describes the outside parts of a woman’s genitals.
The vulva includes the inner and outer lips (labia), the clitoris, the urethral (urinary) opening and the vaginal entrance. See diagram below.
Some conditions that affect the vulva include:
Better known as thrush, candida is common. Most women will experience it at least once in their lives. It causes inflammation and swelling of the vulva, an itch, and often a cottage cheese-like discharge. Most women recognise it by its burning sensation as they pass urine. It is treated with an over-the-counter medication.
Dr Bohl sees a significant number of women with chronic thrush (it is chronic when it occurs up to four times a year). It can be caused by ongoing use of antibiotics, or could be linked to a woman’s immune system.
Treatment is complex. “We look very carefully for factors such as diabetes or anaemia that can affect a woman’s wellbeing,” Dr Bohl explains. “We encourage women to eat a healthy, non- processed diet as that can boost the immune system. They may also require oral and/or topical medication for months rather than days.”
It is important for women to know that not all itch is thrush. They need to see a doctor for an examination and accurate diagnosis.
There is a group of conditions that can affect the skin of the vulva. Known generally as the lichens, the most common is lichen sclerosus.
Lichen sclerosus is a condition that is more common in postmenopausal women, but can occur in younger women. It can begin with an itch and can become painful, as it can cause the skin to become thin, white, wrinkled and cracked.
Vulva specialist Dr Ross Pagano says lichen sclerosus can affect one in 80 women. If not diagnosed, it can cause enormous damage such as scarring.
“One of the problems we have is that you can buy things over the counter to stop the itch,” says Dr Pagano. “But then it comes back in a month, or two, or three, and each time it causes damage.”
If an itch returns repeatedly, it is unlikely to be thrush. “When someone looks closely at the vulva, they can see it has an enormous amount of scarring,” says Dr Pagano. “In young women, it is a big tragedy. It can be very difficult to have intercourse.”
Lichen planus is an inflammatory condition that is often painful and sometimes itchy. It is also quite rare. Dr Pagano has received several referrals from dentists because it is often seen in the mouth and gums.
Lichen simplex is a form of eczema and is also rare. Women can experience vulval irritation due to stress brought on by big events such as exams or a wedding.
Lesions on the vulva are often seen with lichen sclerosis, or as a result of human papillomavirus (HPV) infection. If untreated, they can develop into cancer.
“If you have an itch in one particular area of the vulva, you have to exclude cancer and pre-cancer,” says Dr Pagano. “Itch and irritation should never be ignored.”
The feeling of vulval burning, soreness or pain when there is no obvious cause is known as vulvodynia. There may be symptoms all the time, or just when your vulva is touched, and can be felt in one area or across the entire vulva. It can be debilitating for women, making sexual intercourse or inserting a tampon difficult.
Dr Pagano says vulvodynia might affect around 2-3% of women, but worryingly, only about 1% would seek help from a vulva specialist.
Because its cause is unknown, vulvodynia can be difficult to diagnose. It is generally treated by a multidisciplinary team.
If you are experiencing vulval irritation or pain, don’t try to diagnose it yourself. See your doctor. When you do see your doctor, make sure they examine your vulva. It’s an important part of getting the right diagnosis and treatment.
This article was originally published in the Jean Hailes Magazine 2020.