The vulva is a term that we may not always use when we talk about our lady parts. But, did you know that this is the proper way to call that entire external area?
With their unique make-up and microscopic residents, it’s important to be familiar with what makes up this sensitive area and how to care for it. More than that, you must also learn how to distinguish when something is wrong. With a host of potential complications waiting to happen when you don’t care for it enough, a simple itch just may lead to a serious problem.
That is why we are shedding some light on this sensitive topic as it is basic for female hygiene. So if you want to level up your care down there, here are some valuable information you need to know about your vulva.
The “normal” vulva
There is no such thing as a normal-looking vulva. These are just as unique as our faces because each one looks a little different.
Most of the time, people mistakenly call it the vagina when they’re referring to the vulva or pudendum. To be exact, the vulva is the visible part of your genitals. It’s a collective term for several anatomical structures. It includes the mons pubis, which is a fatty pad covered by hair, the groin, and the perineum which is the area between the genitals and anus. Another visible part is the labia which includes the hair-bearing outer lips (labia majora), and the hair-free inner lips (labia minora). Enclosed within the inner lips is a tissue called the vestibule. Then you have the clitoris which is the pleasure centre of the vulva.
The vagina is found inside. It’s a stretchy tube that connects your vulva to your cervix or uterus. Unlike in males, the female genitals are mostly hidden. But you can always unravel the mystery and be familiar with these parts of the vulva using a mirror.
Regular checks will also help you better understand your body, the changes that take place during each menstrual cycle, and any problems that may require medical attention. You can check for vaginal sores, abnormal discharge, or other problems, such as genital warts.
Genital itch: Scratching the surface
Genital itching may involve the vagina or the genital area (vulva). It’s an unpleasant sensation that may require scratching for relief. It’s normal to feel some itch once in a while, but if it persists and causes distress, you must have it checked as soon as possible. This could signal a problem that requires medical attention. When the problem is addressed promptly, potential complications can be prevented.
Common Types of Vulval Conditions
Otherwise known as vaginal thrush, Candidiasis is an infection caused by yeast found in the vagina which normally doesn’t cause any problem. Yeast is a type of fungus that belongs to an entire clan, called Candida. Candida Albicans, in particular, causes severe symptoms of thrush which triggers vulvar itching. Meanwhile, 10% of infections are caused by its less virulent cousins, which usually don’t leave any symptoms.
Vaginal thrush often affects women between puberty and menopause due to higher estrogen levels. The cells that line the vagina produce sugar and yeasts feed on them.
Thrush is not a typical sexually transmitted infection—but sexual contact can sometimes lead to yeast infections. It happens when your body chemistry reacts to another person’s natural genital yeast and bacteria which causes the yeast to grow.
Here are some tips to prevent vaginal yeast infections:
- Wear cotton underwear
- Practice good personal hygiene (wipe from front to back to avoid spreading infection between your vagina, urinary tract, and anus)
- Keep yourself dry and clean
- Avoid tight-fitting jeans
- Avoid perfumed deodorant sprays or vaginal douches
- Consume probiotics to balance the good bacteria in your body (e.g. natural yogurt with live cultures)
- Change pads and tampons regularly
Contact Dermatitis of the Vulva
Vulvar dermatitis is a common noninfectious cause of vulvar itch that is often underdiagnosed. This happens when the soft folds of the skin around the opening of the vagina become red, itchy, and painful. It can be caused by either heat or wetness, or it can also be due to products called contact irritants (e.g. body soaps, laundry detergents, sweat, sanitary pads, feminine products). It’s also important to know that it can worsen with repeated exposure.
Your skin’s reaction to the offending may be immediate, marked by itching, blisters, and weeping, or it may gradually appear with some redness, burning and swelling. Vulvar contact dermatitis may occur alone or it can complicate other vulvar skin conditions like yeast infections, psoriasis, lichen sclerosus, or eczema.
Here are important reminders to avoid contact dermatitis of the vulva or prevent it from recurring:
- Instead of soap which strips the skin’s protective cover, use gentle, unscented cleaning products on the genital area.
- Thoroughly dry your genitals after bathing.
- Do not wear pads daily.
- Avoid the use of douches and other fragranced feminine products.
- Wearing breathable, loose-fitting cotton undergarments.
- Change your underwear when they are damp.
- Do not sleep in underwear at night.
Vulvar Lichen Sclerosus
This is a chronic skin disorder that affects the genital skin. It often starts around the age of menopause, but it can also affect children. It appears as ivory white plaques or patches that may appear crinkly, but it is smooth and shiny on the surface.
Lichen Sclerosus (LS) is often associated with autoimmune diseases (when your immune system mistakenly attacks your own body) such as thyroid disorders or vitiligo. It may itch terribly, but it is not contagious and neither is it an infection. You cannot pass it on to a sexual partner, but it has genetic, hormonal, irritant, traumatic and infectious components.
If you have LS, you need to observe the affected area because it is more likely to develop skin cancer. Observe any new lumps or non-healing sores and report this to your doctor. This is why being familiar with the appearance of your vulvar area helps. While cancer risk may occur in about 3-4% of patients, early treatment can help reduce the risk.
There is no way to prevent lichen sclerosus, but there’s something you can do to relieve symptoms with lifestyle changes.
You can reduce friction and irritation with the following suggestions:
- Avoid scratching the area.
- Wear cotton underwear instead of synthetic underwear
- Do not use scented soaps, detergents, or bubble baths
- Pat the vulva dry after washing, and don’t rub.
- Don’t use soap to wash your genital area.
- Avoid horseback riding and long bike rides.
- Do not wear a pantyhose.
- Do not use feminine sprays or douches.
- Change out of wet swimsuits and clothing right away.
Vulvar Lichen Planus
Lichen planus is a multisystem disease, but genital involvement is often missed or misdiagnosed.
Anybody can get it, but it’s common in middle-aged individuals and it is marked by a rash that contains small purplish bumps. Since it can last a long time, it can even be erosive resulting in painful ulcers usually affecting the labia minora and the entrance to the vagina. These areas are also marked by severe itching. In some cases, long-term erosive lichen planus can increase the chance of some types of cancer developing.
The exact cause is unknown, but it may be caused by an allergy or autoimmune disease. Meanwhile, some medications may cause a rash that looks like lichen planus, but it resolves upon withdrawal. Fortunately, this condition isn’t infectious and it doesn’t usually run in families. You can’t pass it on to other people, including sexual partners.
As a long-lasting skin condition, it can pose an increased risk of developing local types of skin cancers. You should keep an eye out for raised, bleeding, or non-healing areas.
Skin cells normally renew and they move up the surface layers in vulva 30 days. But, in psoriasis, this renewal process goes on overdrive, only taking about a week. Since the body can’t get rid of them all, the skin sheds off in large scales or plaques, but vulvar psoriasis has unique symptoms.
The cause of psoriasis is unclear. However, it is known that it can run in families but there is not always a family history. It is not related to allergies, diet, or hormonal changes. It is also not contagious and neither is it contagious or a sexually transmitted infection. But stress can make the problem worse or trigger flare-ups.
Here’s a list of everyday things that can aggravate symptoms:
- Tight clothes
- Personal hygiene products that are scented
- Soaps or body wash that have harsh ingredients
- Rough toilet paper
- Sanitary products
- Anything that rubs against your skin or causes friction, including sexual activity
Vulvar cancer is the abnormal growth of malignant or cancerous cells in the vula. This type of cancer is relatively rare, representing about 4% of cancers affecting the female genital organs, usually among postmenopausal women.
Vulvar cancers come in different types and it is named after the type of tissue where the cancer started. Squamous cell carcinoma is the most common among vulvar cancers, accounting for 90% of cases. Since the squamous cells make up the outer layer of the skin. These types of vulvar cancer occur mostly on the labia majora, but it can be found anywhere on the vulva. Other rarely occurring forms of vulvar cancer include Melanomas, Adenocarcinomas, Paget’s disease, Sarcomas, Verrucous carcinoma and Basal cell carcinoma.
How can Vulval Conditions be treated?
If there is one reminder about vulval conditions, women should remember not to self-treat.
When vaginal or vulvar itching strikes, women often assume that a yeast infection is behind it. But when they grab the next over-the-counter antifungal cream, some may realise that it’s not doing the trick.
The reason why some DIY treatments fail is because you are not targeting the real cause. What you might think is a yeast infection could simply be dry skin, an allergic reaction, or it could already be a sexually transmitted infection. This is why you need medical care to ensure that you can treat the problem based on what’s causing it.
What is important is that you seek help from your healthcare provider to find a suitable treatment and strict monitoring. Interventions can range from oral antibiotics, steroids, or ointments. On top of that, you need to ensure that you carefully follow the course of treatment that your doctor prescribes.
Another problem with simply relying on self-treatment is that women tend to vigorously wash the vulvar area assuming that it can disinfect and remove irritants. It seems right if the problem is persistent itching. However, this will result in the opposite because aggressive cleansing can add to the irritation.
Until a vulvar problem is diagnosed, it is wise to follow a gentle vulvar care routine. This applies even if you’re not dealing with a skin condition or not.
You can check some of the important tips below.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.