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Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons
Vaginal and genital skin conditions affect the delicate skin around the vagina. Vaginal skin issues are very common, and the vast majority are easily treatable with medication, topical medicines or lifestyle changes.
Symptoms vary, but these may include itching, swelling, white patches, warts, blisters and vaginal discharge. Sometimes vaginal skin issues can cause pain, particularly when having sex or going to the toilet.
There are a number of things that can potentially cause vaginal skin issues, including infections, irritants such as perfumed soaps and bubble baths, allergies, sexually transmitted infections and falling oestrogen levels. Sometimes it is not clear exactly why vaginal skin issues develop.
Vaginal and genital skin issues can be misdiagnosed, and as a result, treatment can prove ineffective. Therefore it is important that you see an expert in vaginal skin issues who is able to correctly identify your condition and treat it swiftly, leaving you free of pain and irritation. Our expert vaginal dermatology team here at the Cadogan Clinic will be able to diagnose and treat any vaginal skin issues promptly and effectively.
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There are a number of common vaginal dermatology issues. These include:
Eczema in the soft folds of skin around the vagina is known as vulvar dermatitis. Symptoms include burning or itching, weeping from the irritated skin, redness and swelling on the vulva and a ‘raw’ feeling from the vulva irritation. If you have vulvar dermatitis you may find it painful to have sex, use a tampon or accommodate a speculum, for example for cervical screening or other gyanecological examinations. These symptoms may appear suddenly or slowly worsen over a period of time.
Vulvar dermatitis can occur in response to irritants, including; perfumed soaps or bubble baths, perfumes, talcum powder, nylon underwear, sanitary pads or panty liners, lubricants or spermicides. Some women may even experience symptoms caused by their own urine, sweat or vaginal discharges.
Vulvar dermatitis can also be triggered by common allergens, such as latex (in condoms), chlorhexidine (present in popular lubricant K-Y Jelly), tea tree oil, fragrances, propylene glycol (a preservative), imidazole antifungal, benzocaine and neomycin. However sometimes the symptoms may not appear until several days after you have used them.
Sometimes it is not clear exactly what causes vulvar dermatitis.
Vulvitis is a condition that causes the delicate vulva to become irritated or inflamed. Symptoms include itching, soreness, swelling and redness. A woman with vulvitis may find sexual activity painful and find there is increased sensitivity when wiping with toilet paper.
Vulvitis can be caused by anything that irritates the vulva, including infections and allergies. These can often produce additional symptoms, such as warts, blisters, thickened or white patches, scaly skin and vaginal discharge.
The most common causes of vulvitis are; vaginal infections (including herpes, thrush and vaginitis), irritants (such as perfumed soaps and synthetic materials), vaginal douches, poor hygiene habits (for example not changing a sanitary pad or underwear often enough or not wiping properly after going to the toilet) and certain medications (including antibiotics and anti-anxiety medicine).
Women who are perimenopausal or have gone through menopause are more susceptible to developing vulvitis. This is because a fall in oestrogen levels associated with menopause and perimenopause cause the vulva to become thinner, less lubricated and much more delicate and prone to irritation.
Young girls who have yet to go through puberty are also susceptible to vulvitis as their bodies do not yet produce adult levels of oestrogen.
Genital herpes is a sexually trasmitted infection (STI) spread through unprotected vaginal, oral or anal sex. It can also be spread by sharing sex toys that have not been washed or covered with a new condom each time they're used.
The condition presents as a series of small blisters which burst to leave red, open sores around the vagina. An infected person may also find these blisters around their anus, bottom or thighs and, in men, on the penis. If you have herpes, you are likely to experience a tingling, burning or itching feeling around your genitals and pain during urination. Women with herpes may also experience unusual vaginal discharge.
It may take months or even years for blisters to appear after infection. Unfortunately there is no cure for herpes but the symptoms can be treated. The symptoms may go on their own, but another outbreak may occur in the future.
Genital warts is a common sexually transmitted infection which is caused by the human papillomavirus (HPV).
A person who has genital warts may notice small lumps or growths with a rough texture which were not there before around the vagina, penis or anus, but in some cases warts may also appear on the cervix. As a result, these are harder to spot.
Although the appearance of a wart may cause no physical discomfort, some people can find them itchy and painful. The good news is that genital warts are easily treated.
Lichen sclerosus is a skin condition which causes white patches to develop on the genitals and other parts of the body. It can affect adults and children but it is much more common in women aged over 50.
The condition is characterised by itchy, white patches, which may be smooth or crinkled. These are easily damaged and often hurt or bleed if scratched, rubbed or irritated. The patches can appear anywhere on the body but in women they are more often found on the vulva or anus.
There is no cure for lichen sclerosus, but treatment can help to relieve symptoms.
Although the condition can be managed, skin affected by lichen sclerosus may become scarred and tight over a period of time. This may cause the vulva to shrink, affecting the clitoris and labia minora. This can cause discomfort during sex and when going to the toilet. If this is severe, then an operation may be needed, such as surgery to widen the vagina.
Lichen sclerosus increases the risk of getting vulval or anal cancer. Although the overall risk remains low, it is advisable to check yourself for symptoms regularly if you have been diagnosed with lichen sclerosus.
It is not known exactly what causes lichen sclerosus, but it is not caused by poor hygiene and it is not contagious, so it cannot be passed on through sexual intercourse.
Thrush is a common yeast infection. It is harmless, but it can cause great discomfort and in some cases it can keep coming back. Symptoms of vaginal thrush include odourless white vaginal discharge and irritation and itching around the vagina. Women with thrush may find they experience stinging or soreness when urinating or while having sex.
Thrush is not an STI, but it can be triggered by sexual intercourse. Other things that may trigger thrush include antibiotics, damaged or irritated skin, pregnancy, HRT, poorly controlled diabetes or a weakened immune system (including people going through chemotherapy).
The doctor will carry out an external examination of the area around the vagina, looking for typical signs of vaginal skin issues such as redness, dryness and swelling. You may opt to have a chaperone with you during this part of the diagnostic process if you wish.
If the doctor suspects any type of infection or thrush, then they will carry out tests, such as a blood test, urine test or swab test. A skin biopsy may be taken, which will see a small portion of the skin removed and examined more closely under a microscope.
The doctor will also ask you some questions about your symptoms, your medical history, the medication that you take and your sexual habits. They ask these questions so they can give you a correct diagnosis and work out the best treatment for you. You should answer these questions openly and honestly. We appreciate that this may be difficult for you, but rest assured that our doctors are highly qualified professionals and will treat you with the dignity and respect you deserve.
Treatment options depend on the diagnosis, but may include:
Emollients: Most suited to mild cases of vulvar dermatitis, emollients are moisturising treatments, in the form of ointment, cream or lotion, which are applied directly to the affected area of skin on a daily basis to reduce water loss and cover the skin with a protective film. Some emollients are also anti-inflammatories. There are a number of different emollients and some are more greasy than others. Sometimes you may be advised to use a mix of emollients.
Topical corticosteroids: Topical corticosteroids may be prescribed if the affected skin is sore and inflamed. These vary in strength, depending on the severity of the inflammation, and are applied directly to the skin. Although topical corticosteroids are highly effective as a dermatitis treatment, long-term use or using large quantities may cause side effects. These include skin thinning, increased hair growth, acne and changes in skin. Topical corticosteroids can also be prescribed to treat the symptoms of lichen sclerosus.
Antihistamines: Antihistamines are typically used to treat hay fever and other allergies, where the body mistakes harmless substances like pollen as a threat and releases histamine to fight them off, resulting in typical allergy symptoms. Antihistamines block the effects of histamine, providing relief from the symptoms. This helps to break the vicious ‘itch scratch’ cycle associated with eczema.
Corticosteroid tablets: These tablets may be prescribed for a short course of five to seven days to help control particularly severe dermatitis symptom flare-ups. This is not suitable as a long course of treatment as corticosteroid tablets carry a risk of potentially serious side effects.
Antivirals: There is no cure for herpes, but outbreaks can be treated with antiviral medicine to stop the symptoms getting worse.
Antifungal medication: Thrush is treated with antifungal medicine. The doctor may prescribe this in tablet, pessary or cream form. Thrush should clear up within seven to 14 days of starting treatment.
Vaginal oestrogen therapy: If low oestrogen levels are causing vulvitis, then this treatment involves delivering oestrogen directly into the vagina. This can be done via the application of a cream, vaginal suppository or a vaginal oestrogen ring. The flexible ring is placed in the vagina and releases a consistent dose of oestrogen. However a doctor will need to swap it out for a new ring every three months.
Systemic hormone therapy: Hormone replacement therapy (HRT) can help with falling oestrogen levels in menopausal women. HRT is given in pill form and taken orally. This contains a higher dosage of oestrogen which is taken to other parts of the body, not just the vagina.
Cryotherapy: Genital warts can be treated with cryotherapy, where a carefully measured dose of liquid nitrogen is applied to the affected area, killing the skin cells and causing the warts to scab over and fall off.
We have invited a selection of the country's very best consultants to join us at the Cadogan Clinic so that you can be sure that whatever the nature of your treatment, you will be seeing one of the top practitioners in the country.
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