Any itching or irritation in the vulva (labia, clitoris, vaginal opening) is not normal and requires attention from your healthcare provider. Genital itching is not an emergency, but an infection should be treated with a prescription antibiotic.
Changes in hormones, friction or allergies can all cause vaginitis. The sooner you and your doctor can diagnose the cause, the quicker you can find a solution.
Causes
Pain in and around the vulva (or vagina) can be caused by a wide range of things. It is important to visit your GP and have them examine the area to correctly diagnose what is causing it. They may use tests to check for certain conditions, such as a transvaginal ultrasound to look at endometriosis.
Other conditions that can cause vulva pain include viral infections, such as bacterial vaginitis and yeast infections. These can cause irritation and sometimes painful itching and burning. Other causes of pain include a trauma to the vulva, such as a sexual assault or a fall. It is also common for women to have pain after childbirth, or as part of the menopause transition.
A painful vulva can also be caused by using soaps or wipes that are heavily perfumed, wearing tight-fitting underwear and swimming in chlorine. Douching can disrupt the normal balance of bacteria in your vulva, making it more likely to get an infection. It is recommended that you wear loose cotton underwear, avoid washing with scented products and use only mild soaps around the area. It is also recommended that you do not douche, unless advised by your doctor.
Many of the causes of a sore vagina, such as infection and STIs are preventable. Always use a condom or barrier when having sex and ensure you are tested for STIs regularly. It is also a good idea to change your tampon or pad at least every two hours, and wash your genitals often. If you are concerned about your vulva and vaginal health, visit your GP or a sexual health clinic that specialises in women’s health.
Symptoms
The vulva and vagina can be sensitive for many reasons. Infections, health conditions, pregnancy, childbirth and menopause can make them sore. Pain or itching is often the first sign of a problem. Abnormal discharge or odor is another symptom. The color, consistency, amount and odor of the discharge can help your healthcare provider diagnose what kind of vaginitis you have. It is also important to let your healthcare provider know about any sexually transmitted infections you have had or may be having, such as chlamydia and herpes.
Some kinds of vaginal irritation are not caused by an infection, but by a change in the normal balance of bacteria and yeast in your vulva. These include bacterial vaginosis, which causes a grayish-white, fishy-smelling discharge; candida (yeast) infections, which can also affect other moist areas of your body; and trichomoniasis, which is caused by a parasite and is sexually transmitted.
Some women feel a general soreness or itching in the vulva, and others are only sensitive when the area is touched (provoked). This is called vulvodynia and occurs at any age, but is more common in peri- and postmenopausal women because of the drop in estrogen levels. You may also experience painful sex, which is called vaginismus and occurs when the pelvic floor muscles tighten excessively and narrow the opening of the vagina.
Treatment
The vulva skin is more sensitive to irritation than the rest of your body’s skin, because it’s less protected by fat and hair. Often, irritation comes from long-term habits. Your vulva may be irritated by perfumed soaps or feminine products, douches, sprays and spermicidal products. It can also be irritated by scented laundry detergents or fabric softeners, and by clothing such as underwear that has been washed in them. It can even be irritated by the normal species of yeast (candida) that live in most people’s bodies, or by a strain that needs special treatment.
Many women think vaginal itching means they have a yeast infection, and treat them with antifungal creams. But that’s not always the case. If you have a mild itchy, red or swollen vulva and the right tests show you don’t have a yeast infection, your clinician will treat the symptoms instead.
Some conditions can make vulvar skin drier, especially after menopause, and that makes it more vulnerable to irritation. These include lichen sclerosus, which looks like a small, crusty patch of skin that stings and burns. Treatment includes applying a high-potency corticosteroid ointment for several weeks, then tapering the dose. Women with this condition also need regular exams and biopsies, so any new lesions or nonhealing sores can be treated quickly to prevent progression to more serious problems. Some women with dry vulva skin may benefit from estrogen, which can be given vaginally in rings or tablets, or systemically as a pill.
Prevention
Yeast infections and bacterial vaginosis can be prevented by wearing looser cotton underwear, washing with unscented bathing products and not using scented soaps, shower gels or perfumes. Avoid prolonged moisture and friction by not wearing tight pants or exercise clothes, and make sure to dry the area thoroughly after a shower. Avoid long hot tubs or whirlpool spas, and use non-irritating lube for sex. Change tampons and pads regularly, and be sure to wipe from front to back after using the toilet to reduce bacteria from the anus spreading to the vagina. Lastly, don’t douche the vulva as it can cause irritation.
Some types of vaginitis are caused by sexually transmitted infections, such as trichomoniasis (which spreads through unprotected sex) and chlamydia. But other types, like yeast infections and bacterial vaginosis, aren’t sexually transmitted at all. Infections can also be caused by too much friction or roughness during sex, over-washing, using a new type of soap or body wash, the wrong types of lube, or an allergy to tampons, douches, shampoos, cleaning products or certain types of fabric.
The best way to prevent these problems is to get to know your genitals. Learn what normal smells and discharge look like for you, and how they change during your menstrual cycle, so you can tell if something isn’t right.
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