Vulvar Irritation: Causes and Relief

What vulvar irritation feels like

Symptoms may include itching, burning, stinging (especially when urine touches the skin), rawness, redness, swelling, small cracks, and pain during sex or when sitting. The vulva includes the labia majora and minora, the clitoris and the area around the vaginal opening (vestibule). Irritation here is different from vaginal symptoms, though they often occur together.

Common causes

Irritants and allergy

Vulvar skin is thin, moist and easily irritated. Contact dermatitis is very common, caused by:

• scented soaps, bubble baths, body washes and douches
• wet wipes, scented pads and panty liners
• laundry detergent and fabric softener
• spermicides, lubricants and latex condoms
• topical medicines, including over-the-counter anti-itch creams with benzocaine
• urine leakage, sweat and staying in damp clothes
• shaving and waxing

Yeast infection

Vaginal yeast infection causes intense itching, redness and swelling, with a thick white "cottage cheese" discharge that has little smell. Risk is higher after antibiotics, in pregnancy, with diabetes and with a weakened immune system.

Menopause

Falling estrogen thins the vulvar and vaginal tissues, causing dryness, burning, irritation and pain with sex. See atrophic vaginitis, also called genitourinary syndrome of menopause. It also occurs during breastfeeding.

Infections

Skin conditions

• Lichen sclerosus: long-term itching with white, shiny, crinkled skin, tearing, and later scarring. It is most common after menopause and in prepubertal girls. It needs treatment because it can change the shape of the vulva and slightly raises the risk of vulvar cancer.
• Eczema and lichen simplex chronicus: thickened, leathery itchy skin from repeated scratching.
• Psoriasis: smooth red patches in the folds, often without scale.
• Lichen planus: soreness, erosions and white lacy patches.

Less common causes

• Vulvodynia: chronic burning or pain without visible cause.
• Vulvar intraepithelial neoplasia and vulvar cancer: persistent itch with a lump, ulcer, or thickened white, red or dark patch, mostly in older women.
• Diabetes: recurrent yeast infections.

How doctors find the cause

A doctor or gynecologist will ask about symptoms, products you use, discharge, sexual history, menstrual and menopausal status, and skin conditions elsewhere. They examine the vulva and, if needed, the vagina. Tests may include:

• vaginal pH and microscopy of discharge
• yeast culture, especially for recurrent infections
• STI tests (nucleic acid amplification tests)
• swab of any sore for herpes
• skin biopsy of a persistent patch
• blood sugar testing for recurrent yeast infections

Treatment and relief

Gentle vulvar care

• Wash the vulva once a day with plain lukewarm water, or a soap-free emollient. Do not douche.
• Pat dry, and avoid wipes, sprays, powders and scented products.
• Wear breathable cotton underwear, avoid tight pants, and sleep without underwear.
• Change out of wet swimwear and gym clothes promptly.
• Use unscented, cotton pads or a menstrual cup if pads irritate.
• Apply a thin layer of plain petroleum jelly as a barrier against urine and moisture.
• Cool compresses ease burning. Avoid scratching.

Treating the cause

• Yeast: over-the-counter antifungal creams or suppositories, or a prescribed oral tablet. See a doctor if it is your first episode, you are pregnant, or it does not clear.
• Bacterial vaginosis and trichomoniasis: prescription antibiotics. Partners of people with trichomoniasis are treated too.
• Menopause-related irritation: vaginal moisturizers and lubricants, and low-dose vaginal estrogen, which is very effective and has minimal absorption.
• Lichen sclerosus and eczema: prescription-strength steroid ointment, with long-term follow-up for lichen sclerosus.
• Herpes: antiviral medicines.

Avoid repeatedly self-treating with antifungal creams if it is not clearly yeast. Overuse can itself irritate the skin and delay the correct diagnosis.

Frequently asked questions

What causes vulvar irritation?

Common causes are yeast infections, irritants like scented soaps, wipes, pads and detergents, friction from tight clothing, sweat, and thinning skin after menopause. Bacterial vaginosis, STIs, herpes and skin conditions such as lichen sclerosus and eczema are other causes.

How do I soothe an irritated vulva?

Stop using scented products and wash with plain water only. Wear loose cotton underwear, use cool compresses, and apply plain petroleum jelly as a barrier. If irritation lasts more than a week, comes with discharge or sores, or keeps returning, see a doctor.

Is vulvar itching always a yeast infection?

No. Many people who think they have a yeast infection actually have irritant dermatitis, bacterial vaginosis, an STI, menopause-related changes or a skin condition. If an over-the-counter antifungal does not clear it, or it keeps coming back, get examined and tested.

Can stress cause vulvar irritation?

Stress does not directly cause infections, but it can worsen eczema and lichen simplex, intensify itch, and lead to an itch-scratch cycle. It may also contribute to recurrent yeast infections. A physical cause should still be ruled out.

What does lichen sclerosus look like?

Lichen sclerosus causes white, shiny, thin or crinkled patches on the vulva and around the anus, often in a figure-of-eight pattern, with intense itching. The skin tears and bruises easily. It needs diagnosis by a doctor and long-term treatment with strong steroid ointment.