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Vulval Conditions

The vulva is the external part of the genital area and includes the labia, clitoris and vaginal opening. Vulval symptoms such as itching, pain, burning or skin changes are very common and can affect comfort, sex and quality of life. Most causes are treatable once correctly diagnosed.

Vulval Hygiene and Everyday Care

The vulval skin is delicate. In most cases, simple care works best.

Washing

  • Wash once daily using water only or a mild soap-free cleanser if needed
  • Use your hands, not cloths or sponges
  • Avoid perfumed soaps, bubble baths, antiseptics and “feminine hygiene” products
  • Do not wash inside the vagina – it cleans itself
  • Pat dry gently; avoid rubbing

Clothing and moisture

  • Wear loose, breathable underwear (cotton or bamboo)
  • Avoid tight synthetic clothing and G-strings if irritation is an issue
  • Change out of wet or sweaty clothes promptly
  • Sleeping without underwear can help reduce moisture

Periods, toileting and sex

  • Wipe front to back
  • Avoid daily panty liners
  • Change pads and tampons regularly
  • Use water-based lubricants during sex if dry or uncomfortable
  • Avoid vaginal sex if the vulva is sore or inflamed

Hair removal

  • Shaving, waxing and laser can trigger irritation and abscesses
  • Use a fresh razor and shave in the direction of hair growth
  • Trimming rather than full removal is often kinder to the skin

Common Vulval and Vaginal Conditions

Bacterial Vaginosis (BV)

BV causes a greyish discharge with a fishy smell. It occurs when vaginal bacteria are out of balance. It is not an STI, but is more common with new partners, condom-free sex, female partners, or vaginal douching.

Treatment: Antibiotics (oral or vaginal). Partners do not need treatment, but it does reduce recurrence.

Thrush (Candida)

Thrush causes itching, soreness and thick white discharge. It is very common and not due to poor hygiene.

Triggers include: antibiotics, diabetes, immune suppression.
Treatment: Antifungal creams, pessaries or tablets.
Important: Persistent or recurrent symptoms should be reviewed, as many vulval conditions mimic thrush.

Vulval and Bartholin’s Abscesses

Abscesses are painful, swollen collections of pus that can occur on the labia or in the Bartholin’s glands.

Causes: ingrown hairs, skin infection, shaving or waxing.
Treatment: warm salt baths, antibiotics, or drainage. Recurrent cases may need surgery.

Lichen Sclerosus

Lichen sclerosus is a chronic inflammatory vulval skin condition causing itch, pain and white or fragile skin. Scarring can occur, and long-term follow-up is essential due to a small cancer risk.

Treatment: Regular strong topical steroid ointment. This is safe and prevents progression when used correctly.
Not contagious and not sexually transmitted.

Vulvodynia

Vulvodynia is chronic vulval pain or burning without visible skin changes. Pain may be provoked (e.g. sex, tampons) or spontaneous.

Management: vulval care, medications, pelvic floor physiotherapy and multidisciplinary support. Many people improve over time.

Menopause and Vulval Health

Around menopause, falling oestrogen levels can cause the vulval and vaginal skin to become thinner, drier and more sensitive (genitourinary syndrome of menopause).

Common symptoms include:

  • dryness or burning
  • recurrent infections
  • pain with sex
  • tearing or irritation

Treatment options include:

  • vaginal oestrogen (cream, pessary or ring)
  • lubricants and moisturisers
  • ongoing gentle vulval care

These treatments are safe for most women and can significantly improve quality of life.

Postnatal Vulval Care

After childbirth, the vulva and perineum may be sore, swollen or healing from tears or stitches.

Helpful measures include:

  • gentle washing with water only
  • keeping the area dry and well ventilated
  • cold packs in the early days
  • barrier creams if the skin is irritated
  • avoiding fragranced pads or products

Persistent pain, non-healing wounds, or new lumps should be reviewed.

When to See a Doctor

Seek medical advice if you have:

  • persistent vulval itching or pain
  • skin colour or texture changes
  • ulcers, lumps or sores that do not heal
  • recurrent infections or symptoms that don’t respond to treatment

Accurate diagnosis is essential for effective treatment.

Dr Sam Holford

You Are Not Alone

Vulval symptoms are common and treatable. Compassionate, expert care can make a real difference to comfort and quality of life.

Book an appointment

FAQs

What is the difference between the vulva and the vagina?
The vulva is the external genital area, including the labia and clitoris. The vagina is the internal canal that leads to the cervix. Knowing which area is affected helps guide diagnosis and treatment.
Is it normal to feel embarrassed about vulval symptoms?
Yes. Many people feel embarrassed, but vulval symptoms are extremely common. These are issues I see and treat every day, and open discussion helps ensure the right care.
Do vulval symptoms always mean thrush?
No. While thrush is common, many other conditions cause itching or pain, including skin conditions such as lichen sclerosus, eczema, or vulvodynia. Repeated thrush treatment without improvement should be reviewed.
When is a vulval biopsy needed?
A biopsy may be recommended if the diagnosis is unclear, symptoms persist, or there are concerning skin changes. It is a small procedure done with local anaesthetic.

Resources

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.