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The vulva & vagina - fact sheet

Do you know the difference between your vulva and vagina? Many women don’t. In fact, some women mistakenly call their vulva their vagina. This fact sheet explains the difference and discusses some conditions that can affect the vulva and vagina.

Vulva diagram1 RGB

What are the vulva and vagina?

The vagina is the internal tube that connects the uterus (womb) to the outside of the body.

The vulva is the name given to the outside parts of a woman’s genitals. It includes the inner and outer lips (the labia), the clitoris, the urethral opening (where your urine/wee comes out), and the vaginal opening.

It might help you to use a mirror to look at your vulva. When you know what it looks like, you can monitor any changes in the skin, such as colour or texture, which might indicate a medical issue.

Vulval irritation

The skin of the vulva is very delicate, so vulval irritation is very common. Symptoms can include redness, swelling, itching, discomfort and/or burning pain. Sometimes there is a vaginal discharge or inflammation.

The irritation can be caused by a range of factors such as sweating, wearing tight clothes, eczema or dermatitis, personal hygiene issues, product allergies, as well as infections and skin conditions such as lichen sclerosus (see reverse page).

While vulval irritation can usually be managed by making simple changes and by practising good vulval care – eg, only washing with warm water, wearing breathable fabrics – it is important to see your GP so you can be checked, diagnosed and treated.

Infection

Infections that cause pain and produce a feeling of heat can affect the vulva and/or vagina.

Candida, or ‘thrush’ as it is often called, causes inflammation and swelling of the vulva, itchiness, and often a white cottage cheese-like discharge. However, it is important to see your GP for an accurate diagnosis rather than try to manage it on your own or with over-the-counter medications.

Bacterial vaginosis is another common infection that causes a watery, white or green/grey vaginal discharge, a strong fishy odour, and sometimes vulval or vaginal pain.

STIs that cause pain

Sexually transmissible infections (STIs) such as gonorrhoea, chlamydia, trichomoniasis and herpes can lead to vulval and/or vaginal pain.

However, some STIs, such as chlamydia, can show no symptoms. If left untreated, the infection can develop into a condition called pelvic inflammatory disease. This can cause vaginal and low pelvic pain, leading to permanent damage of the reproductive system and infertility.

It is important to have regular sexual health checks, especially if you have a change of partner, as many STIs are easily treated with medication.

Vaginismus

This occurs when the pelvic floor muscles tighten too much and narrow the lower vagina. It is linked to painful sex and sometimes an inability to have sexual penetration.

Some women can also experience pain with using tampons or menstrual cups, or they may not be able to use them at all.

Vaginismus often needs a team of specialists to be involved in treatment, such as a GP, a pelvic floor physiotherapist and a psychologist.

Vulval/vaginal dryness

While this can occur at any stage of life, it is very common after menopause when there is a drop in levels of the hormone oestrogen. Vaginal and vulval tissues can become thinner, drier, and more susceptible to damage and irritation.

Good-quality personal lubricants can help avoid uncomfortable dryness. They can be bought at supermarkets and chemists. However, if pain persists, see your doctor.

Vulvodynia

This is a chronic pain condition that can last for months or years. The pain, often described as a burning pain or discomfort in the vulva, can be located in one area, or across the entire vulva.

The pain cannot be linked to a specific cause and may or may not be triggered by touch. ‘Provoked vulvodynia’ means the pain happens with touch, such as inserting a tampon or attempting sex.

‘Unprovoked vulvodynia’ means the pain is there all the time.

Vulvodynia shows no visual symptoms. A team of specialists is usually involved in treatment.

Lichen sclerosis

This condition typically affects the skin around the vulva and anus. It can occur at any age, but most commonly affects postmenopausal women.

Its exact cause is unknown, but researchers think it is likely an autoimmune disease (where the immune system mistakenly attacks the body).

Patches of skin in affected areas tend to look white, thickened and crinkly, and feel itchy and painful. Lichen sclerosis can cause permanent changes to the vulva, such as the shrinking and disappearance of the inner lips, known as adhesion.

Women with the condition have a small increased risk of vulvar cancer, so must be monitored for life.

Vaginal tears and episiotomy

Vaginal tears are common during childbirth. Some may need stitches, while smaller tears tend to heal on their own. A surgical cut to enlarge the vaginal entrance, called an episiotomy, is a common procedure. It is needed if the baby is in distress and needs to be delivered quickly, or if forceps or a vacuum extraction is required.

Pain relief such as paracetamol is often given to a woman recovering from stiches or an episiotomy. However, any increase in pain, swelling around the area and an odour may indicate an infection, so a GP must be seen as soon as possible.

Persistent pelvic pain

Women who suffer persistent pelvic pain may also develop vulval/vaginal pain because of overactive pelvic floor muscles or vulvodynia, or because of both these conditions.

What can you do?

Do not suffer in silence

Pain is like a messenger telling you that something might be wrong. Listen and work out what your body is trying to tell you.

See your doctor

Vulval or vaginal pain can be complex. It is important to see your GP to have your condition correctly diagnosed and treated.