What is the vulva?
The vulva is the external part of the female genitals. It protects a woman’s sexual organs, urinary opening, vestibule, and vagina and is the center of much of a woman’s sexual response. The outer and inner ‘lips’ of the vulva are called the labia majora and labia minora. The vestibule surrounds the opening of the vagina, or introitus, and the opening of the urethra, or urethral meatus. The perineum is the area extending from beneath the vulva to the anus.
Vulva & vaginal irritation
All women have a characteristic vaginal discharge which helps to remove bacteria and dead cells and to keep the vulva and vagina moist. If the vulva is irritated, is important to seek advice from the doctor as to what might be producing the irritation.
What is normal?
Each woman’s vulva is unique in size and appearance including differences between the right and left labia and between major and minor labia. There is also variation in the size, shape, and length.
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 signs and symptoms: redness, swelling, burning, itching, skin fissuring, whitening of skin (leukoplakia), associated vaginal inflammation or discharge
What causes vaginal itching, burning, and irritation?
There are several common causes of vaginal itching, burning, and irritation, including:
- Bacterial vaginosis. Symptoms of bacterial vaginosis are inflammation, burning, discharge, and a fishy-smelling odor.
- Sexually transmitted disease. Chlamydia, genital herpes, genital warts, trichomoniasis, gonorrhea, and other organisms can cause vaginal/vulvar itching and irritation and other symptoms.
- Yeast infection. Yeast infections occur when the candida albicans, grow excessively in the vagina and vulva. Pregnancy, intercourse, antibiotics, and a weakened immune system can all make women more likely to get a yeast infection. A yeast infection will produce a thick and white discharge.
- Menopause. The drop-in estrogen production that occurs at the end of a woman’s reproductive years can cause the vaginal walls to thin and dry out.
- Chemical Irritants. Several chemical substances, including creams, douches, condoms, contraceptive foams, laundry detergents, soaps, scented toilet paper, and fabric softeners can irritate the vagina and vulva.
- Lichen sclerosis. This is a rare condition that causes thin white patches to form on the skin, especially around the vulva. Postmenopausal women are most likely to develop this condition.
Management & treatment
Vaginal irritation will often get better without any pharmacological treatment. Sometimes there is a cycle of itch, scratch, skin tearing or splitting and then a secondary infection. Investigations such as blood tests, urine tests, vulvar or vaginal swab tests or a vulvar biopsy may be necessary.
How vaginal discomfort is treated depends on what condition is causing the problem:
– Vaginosis and Sexually Transmitted Disease are treated with antibiotics/antiparasitics.
– Yeast infections are treated with local antifungal medication, inserted into the vagina in the form of creams, ointments, or suppositories. Some woman will need oral medication.
– Menopause-related itching may be treated with estrogen cream, tablets, or a vaginal ring insert.
There are a few tips for preventing and treating vaginal irritation at home:
- Avoid scented pads or toilet paper, creams, bubble bath, feminine sprays, and douches.
- Use water and a plain, unscented soap to regularly clean your external genital area.
- Always wipe from front to back after having a bowel movement.
- Wear cotton panties, and change your underwear every day.
- Do not douche.
- Use condoms during sexual intercourse to help prevent sexually transmitted diseases.
- If you are experiencing vaginal dryness, use a vaginal moisturizer. Apply a water-based lubricant before having sex.
- Avoid sexual intercourse until your symptoms improve.
- Don’t scratch.
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. Some vulvar and vaginal secretions change in colour and consistency with an infection.
In the case of discharge, it is necessary to consider:
– Infections not associated with sex: Group B streptococcal vaginitis, bacterial vaginosis, Candida albicans
– Non-infectious causes: hormonal contraception, physiological, cervical ectropion, and cervical polyps, malignancy, foreign body, dermatitis, fistulae, allergic reaction, erosive lichen planus, desquamative inflammatory vaginitis, atrophic vaginitis in lactating and postmenopausal women
– Sexually Transmitted Disease: Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoea, Trichomonas vaginalis, herpes simplex virus.
Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone oestrogen helps maintain that fluid and keeps the lining of the vagina healthy, thick, and elastic. A drop in estrogen levels reduces the amount of moisture available. It can happen at any age from several different causes.
Vaginal dryness is a common symptom of menopause. Vaginal atrophy and vaginal dryness can cause pain and discomfort during sex and increase the chance of vaginal infections. Decreased estrogen levels also thin the lining of the urinary tract, which can result in more frequent urination and urinary tract infections. These symptoms can certainly affect how a woman enjoys sex and how she feels about herself.
It is normal for the vulva to have a smell that may vary at different times in the 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. Vaginal odor may vary throughout the menstrual cycle and may be especially noticeable right after having sex.
Common causes of abnormal vaginal odor include:
- Vaginitis (bacterial vaginosis)
- Poor hygiene
- Foreign body
Less commonly, the abnormal vaginal odor may result from:
- Rectovaginal fistula
- Cervical cancer
- Vaginal cancer
‘Good bacteria’ versus ‘bad bacteria’ in the vagina
The vaginal flora is the bacteria that live inside the vagina. The normal vaginal flora is dominated by various Lactobacillus species. Lactobacilli help to keep the vagina healthy by producing lactic acid, hydrogen peroxide, and other substances that inhibit the growth of yeast and other unwanted organisms. When the Lactobacillus population is disrupted, the bad bacteria take over.
There are many different types of micro-organisms that are normally located 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.
The vaginal bacteria is closely connected to the bacteria in the digestive system, and what the woman eat and digest can affect the health and populations of bacteria in both the digestive system and the vagina.
Live cultured yoghurt and other fermented foods 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. In contrast, high sugar foods, soft drinks, too much alcohol and too many refined carbohydrates in the diet can help the bad bacteria to develop 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 kinds of probiotic supplements available such as Lactobacillus rhamnosus Lcr 35, Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14.
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. 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.
You can make an appointment with Dr Kenny on 07 3188 5000.
This article is written to be informative and does not substitute seeking a professional consultation from a medical professional.