Vaginal Burning: Causes and Treatment

What vaginal burning feels like

Burning can be constant, or only noticeable at certain times:

• when urine touches inflamed skin (external dysuria), common with vaginitis and herpes
• during or after sex, from dryness, infection or friction
• after washing or using products, from irritant dermatitis
• at the vaginal opening when touched, as in vulvodynia

It often comes with itching, soreness, redness, swelling, discharge or odor.

Causes of vaginal burning

Infections

Urinary tract infection

A urinary tract infection causes burning inside as urine passes, frequency, urgency and sometimes blood, but not usually vaginal discharge. Burning from vaginitis tends to be felt on the outer skin as urine flows over it.

Irritation and allergy

Contact dermatitis from scented soaps, bubble bath, douches, feminine sprays, wipes, spermicides, lubricants, latex condoms, scented pads or laundry detergent causes burning, itching and redness with no infection. Over-the-counter anti-itch creams containing benzocaine are a frequent hidden cause.

Menopause and low estrogen

After menopause, and while breastfeeding or on some medicines, low estrogen thins and dries the vaginal tissues. This is called atrophic vaginitis or genitourinary syndrome of menopause. It causes burning, dryness, soreness, pain during sex, and urinary urgency or repeated UTIs.

Skin conditions

• Lichen sclerosus: white, thin, fragile skin on the vulva with itching, burning and tearing.
• Lichen planus: raw, eroded areas inside the vagina with burning and discharge.
• Eczema and psoriasis can affect the vulva.

Vulvodynia

Vulvodynia is long-lasting burning or pain of the vulva (3 months or more) with no visible cause. It often affects the vestibule, the area around the vaginal opening, making tampon use and sex painful.

Other causes

• friction from sex without enough lubrication, cycling or tight clothing
• a retained tampon or other foreign body, usually with a strong odor
• after childbirth or vaginal surgery
• radiotherapy to the pelvis

Vaginal burning with no discharge

Burning without discharge points more toward irritation from products, low estrogen and dryness, a urinary infection, herpes, skin conditions or vulvodynia. Yeast infection can sometimes cause burning with very little discharge.

How doctors find the cause

A doctor or nurse will ask about the timing of symptoms, discharge, smell, sexual activity, new partners, products used, menstrual cycle, menopause, pregnancy and previous treatments. They will examine the vulva and usually the vagina with a speculum.

Tests may include:

• vaginal pH: above 4.5 suggests BV or trichomoniasis; normal pH suggests yeast
• microscopy of discharge (wet mount) for yeast, clue cells and trichomonas
• nucleic acid tests for trichomonas, chlamydia and gonorrhea
• swab of a sore for herpes
• urine test for UTI
• biopsy of persistent skin changes

Self-diagnosis is often wrong: many women who treat themselves for yeast actually have BV, trichomoniasis or irritation. Get tested if you are not sure.

Treatment

• Yeast infection: antifungal creams or pessaries (clotrimazole, miconazole) or a single oral fluconazole tablet. Do not use oral fluconazole in pregnancy without medical advice.
• Bacterial vaginosis: metronidazole or clindamycin tablets or gel. Avoid alcohol while taking metronidazole if your clinician advises.
• Trichomoniasis: metronidazole; partners must be treated too.
• Herpes: antiviral tablets; start within days of an outbreak.
• Atrophic vaginitis: vaginal moisturizers and lubricants, and low-dose vaginal estrogen, which is safe for most women.
• Contact dermatitis: stop the product, plain water washing, emollients and a short course of a mild steroid ointment if prescribed.
• Vulvodynia: a team approach with topical numbing creams, pelvic floor physical therapy, nerve pain medicines and counseling.

Soothing measures while you wait

• Wash the vulva with plain water only; avoid douching.
• Wear loose cotton underwear and avoid tight clothing.
• Apply a cool compress for comfort.
• Pour water over the vulva while peeing to dilute urine, or pee in a warm bath.
• Use a plain, unscented emollient as a barrier.
• Avoid sex until symptoms settle.

Frequently asked questions

What causes vaginal burning?

The most common causes are yeast infections, bacterial vaginosis, trichomoniasis and herpes, irritation from soaps or hygiene products, vaginal dryness after menopause and urinary tract infections. Skin conditions and vulvodynia are less common causes. A swab test helps identify the cause.

Why does my vagina burn but there is no discharge?

Burning without discharge is often caused by irritation from soaps, wipes or products, vaginal dryness from low estrogen, a urinary tract infection, herpes, skin conditions such as lichen sclerosus, or vulvodynia. A doctor can examine the area and test for infection.

Why does it burn after sex?

Burning after sex can come from friction and too little lubrication, an allergy to latex, spermicide or lubricant, vaginal dryness after menopause, or an infection such as yeast, BV, trichomoniasis or herpes. Using a water-based lubricant may help; persistent burning should be checked.

Can a UTI cause vaginal burning?

A UTI causes burning as urine passes, along with frequency and urgency, which can feel like vaginal burning. Vaginal infections typically add discharge, itching or odor. A urine test can tell the difference, and the two can occur together.

How do I stop vaginal burning at home?

Stop scented products and wash with plain water, wear loose cotton underwear, use a cool compress and avoid sex until it settles. Over-the-counter antifungals help only if yeast is the cause. If symptoms persist beyond a few days or you are unsure of the cause, get tested.