Gynecologic Problems
FAQ088, July 2014



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Disorders of the Vulva

What is the vulva?

The external female genital area is called the vulva. The outer folds of skin are called the labia majora and the inner folds are called the labia minora.

When should I contact my health care provider about vulvar symptoms?

If you see changes on the skin of the vulva, or if you have itching, burning, or pain, contact your health care provider.

What will my health care provider check?

Your health care provider may examine you, ask you questions about the pain and your daily routine, and take samples of vaginal discharge for testing. In some cases, a biopsy is needed to confirm diagnosis of a disease.

What are some skin disorders that can affect the vulva?

Some of the skin disorders that affect the vulva include folliculitis, contact dermatitis, Bartholin gland cysts, lichen simplex chronicus, lichen sclerosus, and lichen planus.

What is folliculitis?

Folliculitis appears as small, red, and sometimes painful bumps caused by bacteria that infect a hair follicle. It can occur on the labia majora. This can happen because of shaving, waxing, or even friction. Folliculitis often goes away by itself. Attention to hygiene, wearing loose clothing, and warm compresses applied to the area can help speed up the healing process. If the bumps do not go away or they get bigger, see your health care provider. You may need additional treatment.

What is contact dermatitis?

Contact dermatitis is caused by irritation of the skin by things such as soaps, fabrics, or perfumes. Signs and symptoms can include extreme itching, rawness, stinging, burning, and pain. Treatment involves avoidance of the source of irritation and stopping the itching so that the skin can heal. Ice packs or cold compresses can reduce irritation. A thin layer of plain petroleum jelly can be applied to protect the skin. Medication may be needed for severe cases.

What is a Bartholin gland cyst?

The Bartholin glands are located under the skin on either side of the opening of the vagina. They release a fluid that helps with lubrication during sexual intercourse. If the Bartholin glands become blocked, a cyst can form, causing a swollen bump near the opening of the vagina. Bartholin gland cysts usually are not painful unless they become infected. If this occurs, an abscess can form.

If your cyst is not causing pain, it can be treated at home by sitting in a warm, shallow bath or by applying a warm compress. If an abscess has formed, treatment involves draining the cyst using a needle or other instrument in a health care provider’s office.

What is lichen simplex chronicus?

Lichen simplex chronicus may be a result of contact dermatitis or other skin disorder that has been present for a long time. Thickened, scaly areas called "plaques" appear on the vulvar skin. These plaques cause intense itching that may interfere with sleep. Treatment involves stopping the "itch-scratch" cycle so that the skin can heal. Steroid creams often are used for this purpose. The underlying condition should be treated as well.

What is lichen sclerosus?

Lichen sclerosus is a skin disorder that can cause itching, burning, pain during sex, and tears in the skin. The vulvar skin may appear thin, white, and crinkled. White bumps may be present with dark purple coloring. A steroid cream is used to treat lichen sclerosus.

What is lichen planus?

Lichen planus is a skin disorder that most commonly occurs on the mucous membranes of the mouth. Occasionally, it also affects the skin of the genitals. Itching, soreness, burning, and abnormal discharge may occur. The appearance of lichen planus is varied. There may be white streaks on the vulvar skin, or the entire surface may be white. There may be bumps that are dark pink in color.

Treatment of lichen planus may include medicated creams or ointments, vaginal tablets, prescription pills, or injections. This condition is difficult to treat and usually involves long-term treatment and follow-up.

What is vulvodynia?

Vulvodynia means "vulvar pain." The pain can occur when the area is touched or it can occur without touch. There are two types of vulvodynia: generalized and localized (see the FAQ Vulvodynia). With generalized vulvodynia, the pain occurs over a large area of the vulva. With localized vulvodynia, the pain is felt on a smaller area, such as the vestibule.

What are the signs and symptoms of vulvodynia?

Vulvodynia usually is described as burning, stinging, irritation, or rawness. The skin of the vulva usually looks normal.

How is vulvodynia treated?

A variety of methods are used to treat vulvodynia, including self-care measures, medications, dietary changes, biofeedback training, physical therapy, sexual counseling, or surgery.

What is vulvar atrophy?

Vulvar atrophy is the thinning of the skin of the vulva. It usually occurs in response to the decreased estrogen levels that occur in perimenopause and menopause.

What are the signs and symptoms of vulvar atrophy?

Signs and symptoms include soreness, irritation, and dryness. Pain may occur during sexual intercourse. The vulva becomes more sensitive to irritants. Infections may occur more easily. In severe cases, vulvar skin may crack and bleed.

How is vulvar atrophy treated?

This condition is treated with medications containing estrogen that are applied to the skin or inserted into the vagina.

What is vulvar intraepithelial neoplasia (VIN)?

Vulvar intraepithelial neoplasia (VIN) is the presence of abnormal vulvar cells that are not yet cancer. VIN often is caused by human papillomavirus (HPV) infection (see the FAQ Human Papillomavirus (HPV) Infection).

What are the signs and symptoms of VIN?

Signs and symptoms include itching, burning, or abnormal skin that may be bumpy, smooth, or a different color like white, brown, or red. VIN should be treated to prevent the development of cancer.

How is VIN treated?

VIN can be treated with a cream that is applied to the skin, laser treatment, or surgery. The HPV vaccine that protects against HPV types 6, 11, 16, and 18 is approved to prevent VIN caused by these four types of HPV.

What is cancer?

Cancer is the growth of abnormal cells.

What causes vulvar cancer?

Vulvar cancer can be caused by infection with HPV. Other forms of cancer that can affect the vulva include melanoma (skin cancer) or Paget disease. Paget disease of the vulva may be a sign of cancer in another area of the body, such as the breast or colon.

What are the signs and symptoms of vulvar cancer?

Signs and symptoms may include itching, burning, inflammation, or pain. Other symptoms of cancer include a lump or sore on the vulva, changes in the skin color, or a bump in the groin.

How is cancer treated?

The type of treatment depends on the stage of cancer. Surgery often is needed to remove all cancerous tissue. Radiation therapy and chemotherapy also may be needed in addition to surgery.

What other disorders can affect the vulva?

There are a number of disorders that may affect the vulva. Infections (such as yeast infection) and sexually transmitted diseases, such as genital herpes, can cause vulvar signs and symptoms (see the FAQ How to Prevent Sexually Transmitted Diseases and the FAQ Genital Herpes). Crohn disease is a long-term disease of the digestive system. It can cause inflammation, swelling, sores, or bumps on the vulva.

What self-care measures can help prevent or clear up vulvar problems?

The following self-care measures may help prevent or clear up certain vulvar problems:

  • Keep your vulva clean by rinsing with warm water and gently patting, not rubbing, it dry.
  • Do not wear tight-fitting pants or underwear. Wear only cotton underwear.
  • Do not wear pantyhose (unless they have a cotton crotch).
  • Do not use pads or tampons that contain a deodorant or a plastic coating.
  • Do not use perfumed soap or scented toilet paper.
  • Do not douche or use feminine sprays or talcum powders.

Glossary

Abscess: A collection of pus located in tissue or an organ.

Bartholin Gland: One of two small organs that are located just under the skin at the entrance to the vagina and produce some of the lubrication during sexual excitement.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Chemotherapy: The treatment of cancer using certain drugs to destroy malignant cells.

Cyst: A sac or pouch filled with fluid.

Estrogen: A female hormone produced in the ovaries.

Genital Herpes: A sexually transmitted disease caused by a virus that produces painful, highly infectious sores on or around the sex organs.

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cervical changes and cancer of the cervix, vulva, vagina, penis, anus, and throat.

Inflammation: Pain, swelling, redness, and irritation of tissues in the body.

Labia Majora: The outer folds of tissue of the external female genital area.

Labia Minora: The inner folds of tissue of the external female genital area.

Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for 1 year.

Perimenopause: The period before menopause that usually extends from age 45 years to 55 years.

Radiation Therapy: Treatment with high-energy radiation.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vestibule: The space within the labia minora into which the vagina and urethra open.

Vulva: The external female genital area.

Vulvodynia: Long-lasting pain of the vulva that is not caused by an infection or skin disease.

If you have further questions, contact your obstetrician–gynecologist.

FAQ088: Designed as an aid to patients, this document sets forth current information and opinions related to women’s health. The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate.

Copyright July 2014 by the American College of Obstetricians and Gynecologists