Vulval Skin Conditions

Common skin conditions that occur on the rest of the body can also occur on the vulva.

Vulval Dermatitis

Dermatitis is the most common cause of chronic vulval symptoms. In some cases, vulval dermatitis can be caused by a genetic predisposition to allergies and hypersensitivity. These women will have conditions like asthma, hay fever or dermatitis in other areas of the body. Vulval dermatitis can also be caused by contact with an irritant or allergen such as:

laundry detergents, toilet paper, deodorants, dusting powders/talc
lubricants and spermicides
sanitary pads and panty liners
bath products, soap and shower gels
depilatory products
underwear (lace, G-strings)
latex in condoms or a diaphragm
over-the-counter medication (thrush treatments)

The main initial symptom of dermatitis is itching. Scratching the area can result in broken skin, burning or stinging, and pain during sex. Treatment for dermatitis usually involves the use of a topical corticosteroid cream. Cool compresses and antihistamines may be used to bring relief from symptoms. If the dermatitis is thought to be due to an allergy or irritant, it is important that attempts are made to identify and avoid the substance. It can take some time for symptoms to resolve as the skin of the vulva generally takes longer to heal than in other areas of the body. If a woman’s symptoms persist she should return to her doctor as women with vulval dermatitis may develop secondary infections such as thrush. Some general tips for vulval care are:

Switch to hypoallergenic versions of products like toilet paper and laundry detergent as these products have no or limited perfume and colourings known to cause irritation.
Avoid soap or use a soap substitute.
Take showers instead of baths and do not use douches or talc.
Wear cotton underwear and avoid tight-fitting trousers, pantyhose and G-strings.
When showering avoid getting shampoo or conditioner residue on the vulval area. Alternatively, wash hair in the basin.
Use tampons rather than sanitary pads where possible—they are less irritating to the vulva. If pads are preferred, consider using washable cloth sanitary pads. Avoid the use of panty-liners between periods. Avoid repeated use of over the counter anti-fungal preparations for thrush. If symptoms of thrush continue after an initial treatment women should consult their doctor as these preparations are a common cause of irritation.

Vulval Itching (Pruritus Vulvae) & Vulval Soreness

A wide number of conditions are included under the umbrella of this term, as follows. Most of these present as vulvitis, vulval itching and or vulval soreness.

Infection

Candida, trichomoniasis, bacterial vaginosis.
Pubic lice, threadworm, scabies.
Herpes simplex, urinary tract infection (UTI), vulval vestibulitis.
Group A beta-haemolytic streptococcal (GAS) infection has been reported in prepubertal girls and, on rare occasions, in adult women.

Dermatological conditions

Contact or seborrhoeic dermatitis.
Psoriasis, lichen simplex/planus/sclerosus.
Squamous cell hyperplasia.

Neoplasia

Squamous cell carcinoma (90% of cases have vulvitis).

Atrophic

Atrophic vulvo-vaginitis.
Breast-feeding can result in lowered oestrogen levels and consequent vulval symptoms.

Miscellaneous

Poor hygiene.
Pregnancy.
Generalised pruritus.
Psychological problems.
Idiopathic – uncommon, and only diagnosed when all other causes have been excluded.
Vulvitis circumscripta plasmacellularis (Zoon’s vulvitis). This is a distinct entity, presenting as shiny, atrophic, erythematous plaque of the vulva.

Miscellaneous Vulval Pain syndromes

Vulvar vestibulitis syndrome – thought to be due to nonspecific inflammation of the minor vestibular glands.
Vulvodynia – causes chronic vulval and pelvic pain, of unknown aetiology.

Conditions causing the vulva to become excessively moist, such as vaginal discharge and urinary incontinence, lower the defences against commensal organisms and make the area vulnerable to infection and inflammation – vulvitis.