‘Vulva’ is the general name given to the external parts
of the female genitals. It includes: the mons pubis
(the pad of fatty tissue covered with pubic hair); the
clitoris; labia majora (the outer lips); labia minora (the
smaller, inner lips); the vestibule (area immediately
surrounding the vaginal opening); the urinary
opening; vaginal opening; and the perineum (area of
skin between the anus and vagina).
The skin of the vulva is extremely delicate, making it
susceptible to a wide range of conditions. Women can
experience difficulty in obtaining a correct diagnosis
and may be told their symptoms are psychosomatic.
While vulval conditions are not “all in the mind”,
their sometimes chronic nature can lead to mental
and emotional health issues. By providing a brief
overview of some of the more common conditions,
this factsheet aims to assist women in obtaining an
appropriate diagnosis and treatment.
Conditions of the vulva are loosely grouped into:
dermatological; sexually transmitted infections and
thrush; vulvodynia (vulval pain); and pre-cancerous
and cancerous conditions.
There are a number of different dermatological
conditions associated with the vulva.
Dermatitis is the most common cause of chronic
vulval symptoms. In some cases, vulval dermatitis can
be caused by a genetic predisposition to allergies and
hypersensitivity. These women will have conditions
like asthma, hay fever or dermatitis in other areas
of the body. Vulval dermatitis can also be caused
by contact with an irritant or allergen. Irritants or
allergens can include laundry detergents, toilet
paper, deodorants, dusting powders, lubricants and
spermicides, sanitary pads and panty liners, bath
products, soap and shower gels, depilatory products,
underwear (lace, G-strings), latex (condoms,
diaphragm), over-the-counter medication (thrush
treatments) or bodily fluids.
The main initial symptom of dermatitis is itching.
Scratching the area can result in broken skin,
burning or stinging and pain during sex. Treatment
for dermatitis usually involves the use of a weak,
topical corticosteroid cream. Cool compresses and
antihistamines may be used to bring relief from
symptoms. If the dermatitis is thought to be due to
an allergy or irritant, it is important that attempts are
made to identify the source.
Some general tips are:
• Switch to hypoallergenic versions of products
like toilet paper and laundry detergent as these
products have no or limited perfume and
colourings known to cause irritation.
• Avoid soap or use a soap substitute.
• Take showers instead of baths and do not use
douches, feminine hygiene products and talc in the
• Wear cotton underwear and avoid tight-fitting
trousers, pantyhose and G-strings.
• When showering, avoid getting shampoo or
conditioner residue on the vulval area. Alternatively,
wash hair in the basin.
• Use cotton tampons rather than sanitary pads,
where possible. If pads are preferred, consider
using washable cloth sanitary pads (available from
some health food stores). Avoid the use of panty
liners between periods.
• Avoid the repeated use of over the counter anti-
fungal preparations for thrush. If symptoms of
thrush continue after an initial treatment women
should consult their doctor as these preparations
are a common cause of irritation.
It can take some time for symptoms to resolve as the
skin of the vulva generally takes longer to heal than
in other areas of the body. If a woman’s symptoms
persist she should return to her doctor as women with
vulval dermatitis may develop secondary infections
such as thrush.
The exact cause of this condition is unknown,
although an overactive immune system or genetic
predisposition may play a role. The main symptom
of lichen sclerosus is severe itching. Scratching can
result in broken skin, burning or stinging, pain during
sex and/or urination. On inspection, the skin is dry,
shiny, finely wrinkled and may have white patches.
If left untreated, lichen sclerosus can cause severe
scarring of the vulva (including the shrinking of the
labia and narrowing of the vaginal entrance). It is also
associated with a small increased risk of vulval cancer.
Treatment involves the use of a topical steroid and
is often life-long. Once a woman is diagnosed with
lichen sclerosus she should undergo regular reviews,
even if asymptomatic, to ensure the condition is under
control and no cancerous changes have occurred.
This skin condition affects a number of areas of
the body including the vagina and vulva. As with
lichen sclerosus, the exact cause is unknown, but an
GYNAECOLOGICAL HEALTH 2.08
overactive immune system or genetic predisposition
may play a role. Symptoms can include small
lesions, a red-purplish colour to the skin, soreness
and burning, bleeding and/or painful sex. Vaginal
discharge may be heavier, sticky and/or yellow. If left
untreated, lichen planus can cause scarring of the
vagina and vulva. Treatment involves topical or oral
steroids. Lichen planus may be associated with a small
increased risk of vulval cancer.
Women with psoriasis of the vulva often have the skin
condition elsewhere on their body. Symptoms include
scaly, red plaques (although on the vulva these are
generally less well defined than on other areas of
the body). Other signs which may point to psoriasis
include nail pitting, scalp scaling and a family history
of the condition. Treatment includes the use of topical
steroids and a low dose coal tar cream.
Ingrown hairs/sebaceous cysts
Ingrown hairs can develop in the vulva, particularly
following waxing or shaving. The trend towards
Brazilian waxing (where all hair in the vulval region
is removed) has made this problem more common.
An ingrown hair can result in the development of a
pimple or cyst on the skin’s surface. Gentle exfoliation
of the skin can help with ingrown hairs. Sebaceous
cysts are caused by a blocked sebaceous gland (oil
gland in the skin). They occur quite commonly in
the vulva and appear as a small, hard lump which
is generally painless. Sebaceous cysts require no
treatment unless they cause discomfort.
Thrush and sexually
Thrush is caused by an overgrowth of yeast-like fungi
called Candida. It is not considered to be a sexually
transmitted infection. Symptoms include: itchiness
or redness of the vagina and vulva; a thick white,
creamy vaginal discharge; and discomfort and/or
pain during sex. A simple thrush infection is treated
with an anti-fungal cream. Sometimes if the thrush
has been longstanding (months to years) it can be
associated with chronic vulval pain, and longer term
thrush suppression treatment may be required. It is
important to note that other vulval conditions (eg.
dermatitis) are often initially mistaken for thrush.
Therefore, if symptoms persist following treatment
for thrush, women should see their doctor. For more
information on thrush see our Thrush and other
vaginal infections factsheet.
Genital herpes is a sexually transmitted infection
caused by the herpes simplex virus. It is transmitted
through vaginal, anal or oral sex. Symptoms include
flu-like symptoms and painful blisters in the genital
area, within 2-14 days of exposure. For some people
this will be their only outbreak, while others may have
several more. A minority of those infected experience
There is no cure for genital herpes but antiviral
medications can help reduce the duration and severity
of an outbreak and prevent frequent recurrences.
Keeping the area clean and dry and bathing with a
saline solution will help relieve discomfort and assist
healing. It is important to remember that genital
herpes can be transmitted to a partner even when
there are no blisters present.
Genital warts are caused by particular types of the
human papillomavirus (genital HPV). Genital HPV is
transmitted through vaginal, anal or oral sex. Warts
can be found on the vulva, clitoris, cervix, inside the
vagina or urethra and in or around the anus. They
can be flesh coloured or pink and come in a variety
of sizes and shapes, occurring singularly or in clusters.
The warts do not usually cause pain. Warts can be
treated with chemical applications, ablation (freezing,
burning or use of laser to remove warts) or a cream
that enhances the body’s immune response to the
viral infection. For more information on genital warts
see our Genital HPV factsheet.
The term vulvodynia, literally means pain of the vulva.
The International Society for the Study of Vulvovaginal
Disease (ISSVD) provides a more precise definition:
vulval discomfort, most often described as burning
pain in the absence of visible or neurological findings.
Numerous factors have been suggested as causing
vulvodynia, however, no single factor has been
proven to be the cause.
The pain experienced by women with vulvodynia
varies in intensity from mild to severe and may
be constant or intermittent. Certain activities can
exacerbate pain with the most common being
penetrative sex. Wearing tight clothing, riding
a bicycle, inserting a tampon, having a pelvic
examination or sitting for long periods of time can
also cause pain.
Often, women experience the pain for a number of
years and consult a number of practitioners before
being diagnosed. The chronic pain of vulvodynia,
coupled with difficulty in obtaining an accurate
diagnosis can lead women to suffer mental and
emotional health problems such as depression.
Women may also experience sexual and relationship
Treatment for vulvodynia is focused on relieving the
discomfort experienced. Symptoms may be reduced
by following the general vulval care tips listed under
the dermatitis section. Women should also avoid
constipation or a full bladder and activities like bike
riding or sitting for long periods of time as these all
place pressure on the vulva.
Biofeedback and physical therapy appear to be
effective conservative treatments for vulvodynia. They
can assist women in strengthening and relaxing the
pelvic floor muscles (pelvic floor muscles that are not
relaxed can cause spasms and pain). Biofeedback
involves the use of sensors which provide feedback
to the woman so she can learn to control and relax
the pelvic floor muscles. Physical therapy involves a
number of techniques including therapeutic exercises,
pelvic floor rehabilitation, trigger-point pressure/
massage, electrical stimulation, ultrasound and
Women may also benefit from cognitive behaviour
therapy (CBT) to help manage chronic pain. CBT
helps patients understand that their thoughts and
behaviours may affect the way they experience pain.
It also involves a variety of coping strategies including:
progressive relaxation; pleasant activity scheduling;
and distraction techniques to assist people to identify
and challenge overly negative pain-related thoughts.
Another conservative measure is a low oxalate diet
combined with calcium citrate supplementation. It is
thought that a high concentration of oxalate crystals
in the urine may irritate the vulva. Calcium citrate,
taken before meals, binds to the oxalates preventing
their absorption. Foods high in oxalates include tea,
coffee, spinach, celery, sweet potatoes, most berries,
purple grapes, tangerines, nuts and chocolate.
There is, however, limited evidence to support the
effectiveness of this approach.
Some women find a mild local anaesthetic ointment
applied to the area provides relief. Medications like
antidepressants and anticonvulsant medications are
also used. It is important that women understand that
antidepressants are prescribed in the treatment of
vulvodynia for their pain-relieving properties.
If other treatment options have been unsuccessful and
a woman’s symptoms are very severe and localised
to the vestibule, surgery may be considered. Surgery
involves removing the area which causes the pain.
The use of surgery for vulvodynia is still controversial.
It is important that a woman consults a surgeon who
is experienced in the area.
Pre-cancerous and cancerous
Vulval intraepithelial neoplasia (VIN)
Like a woman’s cervix, the tissue of the vulva can
undergo abnormal cell changes. These changes are
referred to as vulval intraepithelial neoplasia (VIN).
Some cases of VIN are associated with the human
papilloma virus (HPV), while other are thought to be
due to irritation. If VIN persists for many years cancer
of the vulva can develop.
Symptoms of VIN may include: itching and burning
in a specific area of the vulva; raised brown, red, pink
or white lesions; warty lesions or persistent erosions or
ulcers. Treatment for VIN depends on the stage of the
condition but may involve monitoring the area as VIN
can disappear on its own. In some cases removing the
abnormal tissue by surgery or laser may be required.
Other treatments are being trialled and a vaccine
against some types of HPV will hopefully decrease the
incidence of HPV-related VIN in the future.
Vulval cancer is relatively uncommon, with just over
200 cases diagnosed in Australia each year. The
majority of these cancers occur in women 50 and
over. There are two main types of vulval cancer, those
associated with lichen sclerosus (see lichen sclerosus
section) and those related to VIN (see VIN section).
Symptoms of vulval cancer include: itching, burning
or pain in the vulva; vulval skin that looks white,
feels rough or has a lump; bleeding or discharge not
related to menstruation.
Treatment for vulval cancer depends on how
advanced the cancer is when diagnosed, the person’s
age and their overall medical condition. Early
detection of vulval cancer is important as it improves
the chances of successful treatment.
Surgery is the most common treatment for vulval
cancer. Radiation therapy and/or chemotherapy may
also be used.
A vaccine for some types of HPV (which are linked
to VIN and, therefore, vulval cancer) will hopefully
reduce the incidence of vulval cancer in the future.
Other vulval conditions
While varicose veins are usually thought of as
occurring in the legs, they can also affect the vulva.
Vulval varicose veins or vulval varices, as they are
often known, most commonly arise during pregnancy
but can also affect non-pregnant women. Symptoms
may include itching, pain in the vulva and the
sensation of prolapse (feeling as though something
has fallen down). Vulval varices during pregnancy
usually improve once the baby is born, but if they
are still symptomatic three months after childbirth,
treatment should be considered. For symptom relief
women can use ice packs on the area, ensure periods
of rest lying down and avoid constipation.
Treatment for vulval varices consists of sclerotherapy,
which involves injecting the vein with a saline
solution. The saline solution irritates the lining of
the vein causing it to collapse and be reabsorbed. A
compression garment needs to be worn following
sclerotherapy. If sclerotherapy is unsuccessful surgery
may be required.
Bartholin’s glands cyst
The Bartholin’s glands are tiny glands located on
each labia minora, near the vaginal opening. These
glands are responsible for producing a small amount
of fluid to lubricate the entrance to the vagina.
The glands can become blocked, causing a cyst to
develop. The cyst can become tender and, if large,
can cause discomfort when walking/sitting. If the cyst
is small and is asymptomatic it can just be monitored.
Sometimes the cyst can become infected and an
abscess develops. In these cases, the cyst or abscess
can be drained by a doctor.
Diagnosis of vulval
Women experiencing a vulval condition should visit
their doctor. As some vulval conditions are not widely
understood, women can experience delays in being
correctly diagnosed and treated. It is, therefore,
important that a woman’s initial consultation is
thorough. A detailed history taking and examination
at this stage will assist in achieving a more accurate
It may be helpful for women to take along a list of the
following information to their doctor’s appointment
to assist in their diagnosis.
• Type of symptoms (burning, itching)
• How long the symptoms have been present
• When the symptoms occur (ie. do they change
according to different phases of the menstrual
• Factors that exacerbate symptoms (eg. sex,
• If the symptoms began around a particular time
(ie. following treatment for a vaginal infection or
STI, surgery, new sexual partner, pregnancy)