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The health issues we don’t like to discuss

Medical & health articles 12 Oct 2021
Online at home

When something goes wrong (or doesn’t seem quite right) with our vulval or vaginal health, women often turn to information online rather than raising the issue with their doctor. That’s why we recently updated and expanded the Jean Hailes vulval and vaginal health webpages to include more health conditions, the latest treatments, and trusted advice. Below, we share the highlights from the updated information, along with a gentle reminder that when it comes to your vulval and vaginal health, self-diagnosis is no substitute for an examination and discussion with your doctor.

We are reminded to undergo breast, cervical and STI (sexually transmissible infection) screenings. We are encouraged to drink less alcohol, exercise more, eat a balanced diet, watch our heart health, and take care of our bones.

But there is one area of the body that is often forgotten or not mentioned at the doctor’s office – the vulva: home to the clitoris, the urethral opening (where your urine or wee comes out), the vaginal opening as well as the inner and outer lips (the labia).

It seems that when it comes to these ‘wonders down-under’, many of us are too embarrassed to talk about them, especially with our doctors. And yet the Jean Hailes vulval and vaginal health webpages are some of the most highly-viewed webpages on our website – with over 700,000 pageviews in the past year alone. This figure suggests we are seeking information about these important parts of the body, but prefer to do so anonymously or from behind a screen.

Online at home2

Why are we embarrassed?

“I think there is still a reluctance that all things genitalia are ‘women’s business’, not to be broadcast, and somehow to be ‘put up with’ because you don’t talk about them,” explains gynaecologist and Jean Hailes Medical Director Dr Elizabeth Farrell.

The notion that the vulva and vagina belong to the private parts of a woman’s body somehow fuels a notion that women should just learn to live with problems or pain in this area. But, as Dr Farrell warns, ignoring these issues can pose a serious risk to health and overall wellbeing.

Dr Farrell recommends for women to see their doctors and insist on an examination if they have pain, irritation, itching, bleeding, fissures (skin splitting) or lumps in the genital area.

We need to break down the myth that it’s shameful to seek help for these symptoms."

Dr Elizabeth Farrell, Jean Hailes gynaecologist and Medical Director

“A lack of diagnosis and ongoing discomfort can greatly impact the quality of life for women. If it’s constant, it can make them fearful to a point where they don’t even want to go out,” says Dr Farrell.

Out of the shadows and into the limelight

The newly updated Jean Hailes vulval and vaginal health webpages cover the common conditions and troublesome symptoms of these important body parts. Many of these conditions can be successfully treated by your doctor, but getting the right diagnosis, via an examination and appointment with your doctor, is key. Read about them below with links to discover more.

Bacterial vaginosis (BV)

The warning sign that you may have this infection – caused by a change in the healthy balance of vaginal bacteria – is a watery, vaginal discharge with an unpleasant smell. “When you get that fishy smell, you immediately think BV,” says Dr Farrell.

A woman will typically be treated with a course of antibiotics and advised to avoid sexual contact until she has finished taking the medication and the symptoms have gone. The reason for this is that BV can reoccur with sexual contact.

woman in underwear pudendal nerve

Learn more about BV

Go to webpage

Vulval irritation

Vulval irritation – including itching, burning or discomfort – can affect women of all ages.

“Sometimes it can involve a cycle of itching, scratching, skin tearing or splitting and then a secondary infection. Many women endure symptoms for years because they are too embarrassed to raise them with their doctors,” says Dr Farrell.

“The most important thing to remember is that it’s okay to talk to your doctor about these symptoms,” says Dr Farrell. “But there is no point in even going unless the doctor examines you. You need to find a doctor who is interested in women’s health.

“If they’ve looked at [your vulva] and are not sure [what the diagnosis is], they can always refer you on – and that is why our vulval clinic is invaluable.”

Read more about vulval irritation including what’s normal when it comes to vaginal discharge and odour.

Underwear

Learn more about vulval irritation

Go to webpage

An itch is not always thrush

According to Dr Farrell, thrush tends to be more common in women of reproductive age. But it’s important that women, especially those postmenopause, avoid self-diagnosis and simply assume that an itch automatically means they have thrush.

There are many conditions that cause itch, for example, a skin condition, lichen sclerosus (see more below), or dermatitis/eczema.

“If a woman is not on any hormones and she’s fit and well, and not taking antibiotics, then thrush should not be common,” she explains. It is advisable to see your doctor.

“The doctor will be able to look at any roughness or lumps, any bleeding or skin splitting – which we call fissures – discharge or ulcerations, and provide appropriate treatment,” she says.

Lichen sclerosus (LS)

Lichen sclerosus is an inflammatory autoimmune skin condition that can cause itching, which as mentioned, is often mistaken by women as thrush. Dr Farrell says that while LS is more likely to occur in postmenopausal women, it can also affect younger women and even children.

In LS, patches of skin around the genital area can appear white, thickened and crinkly. It usually affects the vulva but can also extend to the groin and around the anus.

If left untreated, lichen sclerosus can lead to scarring with physical and structural changes, including narrowing to both the vulva and the vaginal entrance. In a very small number of cases, it can also lead to cancer of the vulva, so it’s important to see your doctor for the correct diagnosis and on-going management.

Illustration pink flowers vagina

Learn about lichen sclerosus

Go to webpage

Vulval pain

Many women experience vulval pain during their lifetime. Sometimes the pain may only be a minor discomfort but other times it can be chronic and impact many areas of life. There are many causes of vulval pain including infections, inflammatory skin conditions, tissue damage related to surgery or childbirth and other conditions such as vulvodynia.

Female gp advice vulvodynia

Learn more about vulval pain

Go to webpage

Park the embarrassment

Dr Farrell says it’s time to park the embarrassment and front up to your doctor if you are concerned about your vulval or vaginal health. If you’re not comfortable seeing your regular doctor, or not satisfied with the care you’re receiving, you might want to try a women’s health clinic or a doctor who specialises in women’s health.“The most important thing for all women to know is that it’s okay to discuss vulval and vaginal symptoms with your doctor,” says Dr Farrell.

And be sure ask your doctor to examine your vulva if they haven’t already. “Vulval conditions can be tricky to diagnose based only on what you report,” says Dr Farrell. “Your GP and/or specialist should actually look at what’s going on, in order to make the correct diagnosis and give you the correct treatment and advice.”

For more information on these very important parts of the body, and to view our updated webpages, go to: jeanhailes.org.au/health-a-z/vulva-vagina-ovaries-uterus