Vaginal Rash: Causes and What to Do

What counts as a vaginal rash

The vagina is the internal canal, and rashes rarely affect it directly. What most people mean is a rash on the vulva: the labia, the clitoral hood, the area around the vaginal opening, and the skin of the groin and pubic mound. Vulvar skin is thin, moist and sensitive, and products and friction irritate it easily.

Causes of a vaginal rash by appearance

Yeast infection

A vaginal yeast infection (candidiasis) causes a red, itchy, sometimes swollen vulva, with soreness and burning when you pass urine or have sex. Discharge is usually thick, white and odorless, like cottage cheese. Small red "satellite" spots may appear at the edges of the rash. It is more likely after antibiotics, in pregnancy and with poorly controlled diabetes.

Contact dermatitis

Contact dermatitis is very common on the vulva. Irritants include scented soaps, bubble baths, wipes, feminine sprays, spermicides, pad and liner materials, laundry detergents, and urine or sweat. Allergic reactions can follow fragrances, preservatives, latex condoms and topical medicines, including some anti-itch creams. The rash is red, burning or stinging, and appears where the product touched.

Shaving rash and folliculitis

Shaving or waxing can leave small red bumps, ingrown hairs and pustules on the pubic area and outer labia. This is irritation or a mild infection of the hair follicles (folliculitis). Most settle within a week if you stop hair removal.

Intertrigo and psoriasis

Intertrigo is a red, moist rash in skin folds from friction, heat and sweat, often colonized by yeast. Psoriasis in the genital area appears as smooth, bright red, well-defined patches without the usual silvery scale.

Genital herpes

Genital herpes starts with tingling or burning, then small painful blisters that burst into shallow sores. The first outbreak can come with fever, aches, swollen groin glands and pain passing urine. Later outbreaks are usually milder. A swab of a fresh sore confirms it.

Lichen sclerosus

Lichen sclerosus causes intensely itchy, white, thin, shiny or crinkled patches, often in a figure-of-eight around the vulva and anus. Skin tears and bruises easily. It is most common after menopause but can occur at any age, including in girls. It needs long-term treatment with a strong steroid ointment, because untreated it can scar and slightly raises the risk of vulvar cancer.

Other causes

• Scabies and pubic lice: very itchy, spread by close contact.
• Genital warts, syphilis and molluscum contagiosum: sexually transmitted causes of bumps or sores.
• Lichen planus: painful red erosions with white lace-like streaks.
• Hidradenitis suppurativa: recurrent painful lumps and abscesses in the groin.
• Vulvar cancer or precancer (VIN): rare, but suspect it with a persistent sore, lump, or white, red or dark patch, especially after age 50.

How doctors find the cause

A primary care doctor, gynecologist, sexual health clinic or dermatologist will ask about itching, pain, discharge, products, hair removal, new partners and past episodes. They examine the vulva and may:

• take a vaginal swab for yeast, bacterial vaginosis and trichomonas
• swab any blisters or sores for herpes
• test for chlamydia, gonorrhea, syphilis and HIV
• take a small skin biopsy under local anesthetic if a rash persists, looks unusual, or lichen sclerosus or precancer is suspected

Avoid using antifungal or steroid creams for a few days before your appointment if you can, because they can make tests less accurate.

Treatment

What you can do now

• Wash the vulva with plain warm water or a fragrance-free emollient instead of soap. Do not douche.
• Wear loose cotton underwear and avoid tight leggings. Sleep without underwear if comfortable.
• Stop scented products, wipes and new detergents. Use unscented pads, or switch to cotton pads or a menstrual cup.
• Use a plain barrier ointment such as petroleum jelly to protect sore skin.
• Cool compresses ease itching and burning.

Medical treatment by cause

• Yeast: over-the-counter antifungal creams or pessaries, or a single prescription tablet. See a doctor if this is your first episode, you are pregnant, or you get 4 or more episodes a year.
• Contact dermatitis: remove the trigger. A mild steroid ointment for a short time may be prescribed.
• Herpes: antiviral tablets, ideally started within 72 hours of a first outbreak.
• Lichen sclerosus: potent steroid ointment as directed, plus long-term follow-up.
• Bacterial or sexually transmitted infections: specific antibiotics. Partners may also need treatment.

Avoid repeated self-treatment for "yeast" without a diagnosis. Many rashes that do not respond are actually dermatitis or lichen sclerosus.

Frequently asked questions

What causes a rash around the vagina?

The most common causes are yeast infections, irritation from soaps, pads, wipes or detergents, and shaving bumps. Others include genital herpes, warts, psoriasis, lichen sclerosus and scabies. Blisters, sores or a rash lasting more than 2 weeks should be checked.

Is a vaginal rash an STD?

Most vaginal rashes are not sexually transmitted. But painful blisters or sores, painless ulcers, and wart-like bumps can be STIs such as herpes, syphilis or genital warts. If you have a new partner or notice sores, get tested at a doctor's office or sexual health clinic.

Can I use hydrocortisone cream on a vaginal rash?

A short course of mild hydrocortisone can calm irritant dermatitis on the outer vulva. It does not treat yeast, herpes or infections and can make some worse. Do not use it inside the vagina or for more than a week without advice.

How long does a vaginal rash last?

Irritation and shaving rashes usually settle within a few days to a week once the trigger is removed. A treated yeast infection clears within a week. Rashes from lichen sclerosus or psoriasis are long-term and need ongoing treatment to stay controlled.

Why do I get a rash on my vulva after my period?

Pads and liners trap moisture and heat and can contain irritating materials or fragrances, causing contact dermatitis. Hormone changes before a period also make some women prone to yeast infections. Unscented cotton pads, a menstrual cup and changing pads often can help.