Gynecologic Problems
FAQ088, February 2019



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Disorders of the Vulva: Common Causes of Vulvar Pain, Burning, and Itching

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 professional about vulvar symptoms?

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

What will my health care professional check?

Your health care professional 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 gynecologist or other health care professional. 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 professional’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 may cause different types of pain. This pain is often described as burning, stinging, irritation, and rawness. Other words that may be used include aching, soreness, throbbing, and swelling. Pain may be felt over the entire vulva or only in one place, such as the clitoris or vestibule.

Symptoms of vulvodynia may be constant or they may come and go. Symptoms can start and stop without warning, or they may occur only when the area is touched. Inserting a tampon, having sex, or wearing snug underwear can be triggers for some women.

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 genitourinary syndrome of menopause?

Genitourinary syndrome of menopause (GSM) is a group of signs and symptoms caused by a decrease in estrogen and other sex hormones. This decline happens during perimenopause and menopause. Symptoms can include vaginal dryness, pain with sex, bladder problems, frequent urinary tract infections (UTIs), burning, itching, and irritation. Some women also may have pain during sexual intercourse. The vulva can become more sensitive to irritants. Infections may occur more easily.

How is genitourinary syndrome of menopause treated?

There are several treatments for GSM. Vaginal moisturizers and lubricants can help relieve vaginal dryness and painful sexual intercourse. You can buy these without a prescription. Estrogen therapy comes as a vaginal cream, ring, or tablet. You need a prescription for this therapy.

Selective estrogen receptor modulators (SERMs) are drugs that stimulate certain tissues that respond to estrogen while not stimulating other tissues that respond to estrogen. One SERM has been approved to treat painful intercourse in postmenopausal women. If you are interested in SERMs, talk with your gynecologist about their risks and benefits.

What is vulvar intraepithelial neoplasia?

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.

What are the signs and symptoms of vulvar intraepithelial neoplasia?

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 vulvar intraepithelial neoplasia treated?

VIN can be treated with a cream that is applied to the skin, laser treatment, or surgery. The HPV vaccine may help prevent VIN.

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 infections (STIs), such as genital herpes, can cause vulvar signs and symptoms (see FAQ009 How to Prevent Sexually Transmitted Infections and FAQ054 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 found in tissue or an organ.

Bartholin Glands: Two glands located on either side of the vaginal opening that make a fluid during sexual activity.

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

Chemotherapy: Treatment of cancer with drugs.

Clitoris: A female sex organ found near the opening of the vagina.

Cyst: A sac or pouch filled with fluid.

Estrogen: A female hormone produced in the ovaries.

Genital Herpes: A sexually transmitted infection (STI) caused by a virus. Herpes causes painful, highly infectious sores on or around the vulva and penis.

Genitourinary Syndrome of Menopause (GSM): A collection of signs and symptoms caused by a decrease in estrogen and other sex hormones. Signs and symptoms can include vaginal dryness, pain with sex, bladder symptoms, frequent urinary tract infections (UTIs), burning, itching, and irritation.

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 when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Perimenopause: The time period leading up to menopause.

Radiation Therapy: Treatment with radiation.

Selective Estrogen Receptor Modulators (SERMs): Drugs that stimulate certain tissues that respond to estrogen while not stimulating other tissues that respond to estrogen

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Urinary Tract Infection (UTI): An infection in any part of the urinary system, including the kidneys, bladder, or urethra.

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

Vestibule: The tissue surrounding the opening of the vagina.

Vulva: The external female genital area.

Vulvodynia: Pain in the vulva that does not go away or keeps coming back and does not have a specific cause.

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

FAQ088: This information was designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Please check for updates at www.acog.org to ensure accuracy.

Copyright February 2019 by the American College of Obstetricians and Gynecologists

American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998