Each woman’s vulva is unique in size and appearance including differences between the right and left labia. There is also variation in the size, shape and length. These differences and variations are normal.
What is normal?
Because it is difficult for women to see their own vulva, many women do not know what their vulva looks like and/or what is normal for them. If you don’t know what your vulva looks like, it is a good idea to use a mirror so you can look and become familiar with what is normal for you. It is then easier to detect any changes in appearance, such as changes in colour, bumps, thickening or thinning of the skin or dry, cracked skin.
The skin of the vulva is extremely delicate, making it vulnerable to a wide range of conditions.
Vulval irritation and vulvitis (inflammation) are common terms used to describe the irritation.
Sometimes part of the vulva, or sometimes the entire vulva, has some of the following:
- skin cracking or splitting (fissuring)
- whitening of skin (leukoplakia)
- associated vaginal inflammation or discharge
Causes of vulva irritation
Vulval irritation can be caused by any of the following:
- vaginal secretions
- skin conditions such as:
- lichen sclerosus (skin is often pale or whitish)
- fungal, bacterial or viral infections such as:
- candidiasis (thrush)
- genital herpes
- some medications, preservatives and local anaesthetics
- tight clothing, pantyhose, G-strings
- allergies to substances such as:
- soaps, bath and hair products
- synthetic underwear
- feminine hygiene products
- laundry detergents
- scented or coloured toilet paper
- lubricants used for intercourse
- douches (vaginal irrigation – this is never advised)
Sometimes there is a cycle of itch, scratch, skin tearing or splitting and then a secondary infection. Many women are embarrassed to discuss their problem and symptoms can occur for many years before seeking help.
Rather than try to treat the problem yourself, it is important to see your doctor.
Investigations such as blood tests, urine tests, vulval or vaginal swab tests or a vulval biopsy may be necessary.
Management & treatment
The treatment of vulval irritation will depend on the cause and your doctor will help you decide which is the right treatment.
In this video Dr Elizabeth Farrell gives some tips for treatment or refer to the table below:
|Treatment||What to do|
|Cortisone creams/ointments||Follow the instructions which may include washing prior to applying the cream/ointment|
|Bathing in bicarbonate of soda||
|Only use water or non-soap substitutes to wash your vulva||Don’t use perfumed soaps and bath products.|
|Wear cotton underwear||
|Avoid talcum powder||Never use talcum powder on your vulva.|
|Swim in salt water||Avoid swimming in chlorinated water if you can.|
|After swimming change straight away||
|Wear loose fitting pants||Avoid tight fitting jeans, pants, G-strings, and if you have to wear pantyhose try those with a cotton gusset.|
|Lean forward when passing urine||This helps to avoid burning and always wipe or pat from front to back.|
|Choose period products carefully||
|Use natural lubricants||Use natural oils such as olive or almond oil instead of commercial lubricants|
Secretions or discharge
All women have vaginal discharge or secretions which help to keep the vagina and vulva moist and remove bacteria and dead cells. Normal secretions vary throughout the menstrual cycle, from thin and slippery during ovulation to thick and white just before your period. It’s common for discharge to be discoloured red or brown a day or two before or after your period.
Some vulval and vaginal secretions change in colour and consistency with an infection.
Sometimes women find their vulva and vagina feels dry and lubrication is poor. The hormonal changes at menopause can make the vagina dry and thin. This can make sex painful and it can make insertion of a tampon painful as well.
Try using a natural lubricant like olive or almond oil.
It is normal for your vulva to have a smell that may vary at different times in your menstrual cycle.
There are a number of different fluids and secretions associated with the vulva, including urine, sweat, menstrual blood, skin oils and vaginal and gland secretions all of which can affect the smell.
If the odour is unpleasant, yeasty or fishy smelling this may be a sign of an infection. Other causes of odour may be a sexually transmissible infection (STI), a tampon left in the vaginal canal too long or the presence of urine or faeces.
If you are worried about the odour of your vulva and vagina, and/or have other symptoms such as itching, burning, irritation, soreness, painful sex or painful urination, you should see your doctor.
After menopause, odour may change as the normal bacteria also changes. The odour will be different compared to when still having periods.
‘Good bacteria’ versus ‘bad bacteria’ in the vagina
There are many different types of micro-organisms (tiny living organisms that are invisible to the naked eye) that are found in the vagina. They include bacteria and fungi, however the main types can be generally called ‘good bacteria’ and ‘bad bacteria’. Healthy vaginas are rich in good bacteria and these friendly micro-organisms help to protect the vagina from infections and keep the populations of bad bacteria in check.
An imbalance or overgrowth of bad bacteria and other unfriendly micro-organisms in the vagina can cause symptoms such as vaginal discharge, redness and itch. They can make you more prone to the common conditions of fungal infections such as vaginal candidiasis (thrush) or bacterial infections such as bacterial vaginosis (BV). It’s important to note that not all vulval irritation is due to an imbalance of vaginal bacteria.
Your vaginal bacteria is closely connected to the bacteria in your digestive system, and what you eat and digest can affect the health and populations of bacteria in both your gut and your vagina.
Live cultured yoghurt and other fermented foods, such as kimchi, sauerkraut and kefir, contain good bacteria as an ingredient. Eating these foods regularly can help to maintain healthy populations of good bacteria, introducing the right types to your digestive system and your vagina.
High sugar foods, soft drinks, too much alcohol and too many refined carbohydrates in your diet (such as white breads, biscuits and white pasta) can help the bad bacteria to grow and flourish in place of the good.
Some women who have thrush, bacterial vaginosis or vulval irritation may benefit from taking a probiotic supplement. Probiotics can be taken orally as a capsule and contain good bacteria in much higher quantities than what you would get from fermented foods alone. There are many different kinds of probiotic supplements available and research has found that only specific strains of bacteria are effective in treating infections such as BV.
These strains include:
- Lactobacillus rhamnosus Lcr 35
- Lactobacillus rhamnosus GR-1
- Lactobacillus reuteri RC-14 (also known as Lactobacillus fermentum RC-14)
Note: the numbers and letters at the end of each probiotic name are very important and identifies the exact strain of probiotic. Research suggests that a dose of 10 billion CFU/day (colony forming units) of both Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 for at least 2 months is most beneficial for BV, with some women requiring longer treatment of up to 6 months. As always, inform your health practitioner of any medicines you are taking.
Other natural therapies
Other commonly used natural therapies for vulval and vaginal irritation including special diets, vinegar treatments, tea tree oil and garlic. There are no high quality clinical research trials on these treatments so it is difficult to say whether these treatments are effective, safe or otherwise. However, it is important to remember that if you are experiencing vulval or vaginal irritation and it isn’t getting better, make an appointment with your doctor or qualified health professional.
What is the vulva?
Vulva is the general name given to the external parts of the female genitals.
The parts of the vulva include:
|Mons pubis||The pad of fatty tissue covered with pubic hair.|
|Labia majora||The outer lips, which are covered with pubic hair.|
|Labia minora||The inner lips, which are hairless.|
|Clitoris and its hood or covering||Positioned at the front of the genital area.|
|Vestibule||Immediately surrounds the vaginal opening and the urinary opening.|
|Urinary opening||Above the vaginal opening.|
|Vaginal opening||Below the urinary opening.|
|Perineum||The area of skin between the vagina and the anus.|