Vulval conditions

The vulva is the area around the opening of the vagina. It includes the labia (inner and outer vaginal lips) and the clitoris. 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. 

Vulval symptoms are common in women of all ages. These include itching, pain, soreness or a change in the skin colour and texture. There are some simple things you can do to look after your vulva, but if you have symptoms, you should see your GP and be referred to see a Gynaecologist.

Irritation

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:

• redness

• swelling

• burning

• itching

Causes of vulva irritation

Vulval irritation can be caused by any of the following:

• sweating

• vaginal secretions

• skin conditions such as:

• dermatitis

• eczema

• lichen sclerosus (skin is often pale or whitish)

• fungal, bacterial or viral infections such as:

• candidiasis (thrush)

• trichomonas

• genital herpes

• some medications, preservatives and local anaesthetics

Lichen sclerosus 

What is lichen sclerosus?

Lichen sclerosus (LS) is a skin condition. It may involve any part of the skin, but most often it is found on the genital area.

It can start at any age, most commonly around menopause, but also occurs in young children. Unfortunately once LS starts, it usually continues for life in a relapsing and remitting pattern.

What are the symptoms?

Most often LS is very itchy, but it can also cause pain, soreness and pain with sex. It is not uncommon for the skin to split open easily.

What does LS look like?

The typical appearance is of whitened skin around the vulva, perineum and anus. There may also be lesions that look like blisters and bruises.

LS may cause scarring, resulting in loss of the labia minora (inner lips of the vagina) and reduction in size of the vaginal opening if the condition has not been treated for a long time.

How is it diagnosed?

Many cases of LS can be diagnosed on sight, but if there is any doubt a test called a skin biopsy will confirm the diagnosis. This involves cutting a tiny piece of skin from the involved area under local anaesthetic and having it examined by a pathologist.

Do other problems occur in association with LS?

There are two important ones:

• LS increases your risk of cancer of the vulva.

• People with LS may suffer from “autoimmune” diseases like systemic lupus erythematosus and thyroid disease.

Both these associations are not common but you should be aware. Cancer of the vulva is diagnosed by just examining the vulva at your checkup and is confirmed by a vulval biopsy.

Can it be treated?

LS cannot be cured, but can be very successfully controlled with steroid cream. You may have heard that this treatment is dangerous but this is not true. It is more dangerous to leave it untreated. Treatment is for life.

Once LS is under good control, it is possible to feel normal again. If scarring has occurred and is causing problems with intercourse, a simple surgical procedure can be done to widen the vagina.

What does the future hold?

The prognosis for most patients with LS is very good. It nearly always responds quickly to treatment and if this is kept up, with time, you will need less and less to remain symptom free.