Vaginal Redness: Causes and Treatment

Why the vulva and vagina turn red

The vulvar skin is thin and moist, and the vaginal lining depends on estrogen and a healthy balance of lactobacilli bacteria. Infection, an allergic or irritant reaction, low estrogen or a skin condition all cause inflammation, which widens small blood vessels and makes the area red, swollen, itchy or sore.

Common causes of vaginal redness

Yeast infection

The most common cause of a red, itchy vulva. Risk is higher after antibiotics, in pregnancy, with diabetes, with high-estrogen contraceptives and in people with weakened immunity.

Irritation and contact dermatitis

Common culprits include:

• scented soaps, bubble baths, douches and feminine washes
• scented pads, panty liners and wipes
• laundry detergents and fabric softeners
• spermicides, lubricants and latex condoms
• shaving, waxing and hair-removal creams
• tight synthetic underwear, leggings and sweat
• urine or stool leakage
• over-washing

Vaginal redness with no discharge

Redness without discharge usually points to irritation, contact dermatitis, skin conditions such as eczema, psoriasis or lichen sclerosus, early herpes, or menopause-related thinning. Infections like yeast often, but not always, cause discharge.

Other causes

• Psoriasis and eczema on the vulva, often without scale because the area is moist
• Lichen planus: can cause raw, red erosions in the vagina
• Vulvodynia: burning and pain with normal-looking or slightly red skin
• Desquamative inflammatory vaginitis: a rare inflammatory condition with red vaginal walls and yellow discharge
• Group A strep vulvovaginitis: in children, bright red vulvar skin and soreness
• Poor hygiene, pinworms or bubble baths: common in young girls (vulvovaginitis)
• Vulvar cancer: rare; a persistent red, white or raised patch, sore or lump, mostly in older women

Vaginal cuff redness after hysterectomy

After a hysterectomy, the top of the vagina is stitched closed, forming the vaginal cuff. During healing, a doctor may see redness there at a check-up. Common reasons:

• Normal healing: mild redness for the first 6 to 8 weeks.
• Granulation tissue: red, raw-looking, fleshy tissue at the cuff that may cause spotting or discharge. It is common and usually treated simply in the office with silver nitrate.
• Cuff cellulitis or abscess: redness with fever, worsening pelvic pain and discharge, usually within a few weeks of surgery. It needs antibiotics and sometimes drainage.
• Vaginal atrophy: after removal of the ovaries or at menopause, the cuff and vaginal walls may look red and thin.

Contact your surgeon if you have fever, increasing pain, heavy bleeding or foul-smelling discharge after a hysterectomy. A sudden gush of fluid or a feeling of something protruding after sex or straining could mean the cuff has opened, which needs urgent care.

How the cause is diagnosed

Your doctor or nurse will ask about itching, burning, discharge, odor, new products, sexual activity, contraception, antibiotics, menopause and skin conditions. They will examine the vulva and, if needed, use a speculum to look at the vagina. Tests may include:

• vaginal pH: above 4.5 suggests bacterial vaginosis, trichomoniasis or atrophy; normal pH with symptoms suggests yeast
• microscopy and swabs for yeast, BV and trichomoniasis
• STI tests for chlamydia, gonorrhea and herpes
• skin biopsy for persistent patches or suspected lichen sclerosus

Treatment

Self-care

• Wash the vulva with plain water or a fragrance-free soap substitute once a day. Do not douche.
• Wear loose cotton underwear and avoid tight clothing; sleep without underwear.
• Use unscented pads and fragrance-free detergent; skip fabric softener.
• Pat dry after washing and urinating.
• A cool compress or a thin layer of petroleum jelly soothes irritated skin.
• Stop shaving or waxing until the skin settles.

Medical treatment

• Yeast infection: antifungal vaginal creams or suppositories (over the counter) or a single-dose oral tablet (prescription). Avoid self-treating if it is your first infection, you are pregnant, or symptoms keep coming back.
• Bacterial vaginosis and trichomoniasis: prescription antibiotics; sexual partners need treatment for trichomoniasis.
• Herpes: antiviral tablets.
• Vaginal atrophy: vaginal moisturizers and lubricants; low-dose vaginal estrogen is effective and safe for most.
• Dermatitis, lichen sclerosus or psoriasis: steroid ointments prescribed by a doctor.

Frequently asked questions

What causes redness in the vaginal area?

The most common causes are yeast infections, irritation from soaps, pads, detergents or tight clothing, and contact dermatitis. Other causes include bacterial vaginosis, trichomoniasis, genital herpes, low estrogen after menopause, and skin conditions such as lichen sclerosus and psoriasis.

Why is my vulva red and itchy but no discharge?

Redness and itching without discharge are often caused by irritation or contact dermatitis from products, shaving or sweat. Eczema, psoriasis and lichen sclerosus are other possibilities. Yeast infections sometimes cause little discharge. If it lasts more than a week or two, see a doctor.

What does vaginal cuff redness mean?

After a hysterectomy, mild redness at the vaginal cuff is part of normal healing. Red, fleshy granulation tissue is common and easily treated. Redness with fever, worsening pain or foul discharge may mean infection and needs prompt review by your surgeon.

How do I soothe a red, irritated vagina?

Stop any new products, wash only with water, wear loose cotton underwear, and use a cool compress. A thin layer of petroleum jelly protects irritated skin. If you have itching with thick white discharge, an antifungal treatment may help. See a doctor if it does not settle.

Is vaginal redness a sign of an STD?

It can be. Trichomoniasis and genital herpes commonly cause redness and irritation, and other infections can cause discharge with inflammation. Most vaginal redness, however, comes from yeast or irritation. Get tested if you have sores, unusual discharge, or a new sexual partner.