Vulvar Swelling: Why the Vulva Swells and What to Do

What vulvar swelling looks and feels like

The vulval skin is thin and has a rich blood supply, so it swells easily. Swelling may involve both labia, one side only, or just the area around the vaginal opening. Depending on the cause you may also notice itching, burning, soreness, redness, discharge, a lump or pain with walking, sitting, peeing or sex.

Pattern matters:

• Both sides, itchy: irritation, allergy or yeast infection
• One side, painful lump: Bartholin's cyst or abscess, an infected hair follicle or a hematoma
• Swelling with blisters or ulcers: herpes or another infection
• Slow, painless enlargement: varicose veins (in pregnancy), cyst, lymphedema, or rarely a tumor

Common causes

Yeast infection

A vaginal yeast infection is one of the most frequent causes of a swollen vulva. Expect intense itching, redness, burning, swelling and thick white "cottage cheese" discharge without a strong smell. It is more common after antibiotics, in pregnancy, and with diabetes.

Contact dermatitis

Contact dermatitis is irritation or allergy to something that touches the vulva. Common culprits:

• scented soaps, bubble bath, shower gels and douches
• wet wipes, feminine sprays and deodorants
• scented pads, panty liners and laundry detergents
• latex condoms, spermicides and lubricants
• benzocaine and some over-the-counter anti-itch creams

It causes itching, burning, redness and puffiness, sometimes within hours. It settles once the trigger stops.

Friction and sex

Vigorous or prolonged sex, especially with too little lubrication, and cycling or tight clothing can cause temporary swelling and soreness. It normally fades within 1 to 2 days.

Bartholin's cyst and abscess

The two Bartholin's glands sit at about the 4 and 8 o'clock positions at the vaginal opening and make lubricating fluid. If a duct blocks, fluid builds into a cyst: a painless or mildly tender round lump on one side. If it becomes infected it turns into an abscess: a hot, very painful, rapidly enlarging lump that can make sitting and walking difficult.

Pregnancy

Increased blood flow and pressure from the growing uterus can cause puffiness and vulvar varicose veins, especially in the third trimester. These are not dangerous and usually go after birth.

Other infections

• Genital herpes: painful clusters of blisters that burst into sores, with swelling, burning and sometimes fever, especially in a first episode.
• Bacterial vaginosis and trichomoniasis: discharge with a fishy smell or frothy yellow-green discharge; trichomoniasis can make the vulva red and swollen.
• Folliculitis and boils: infected hair follicles, often after shaving or waxing.
• Cellulitis: spreading red, hot, tender swelling that needs antibiotics.

Skin conditions

Lichen sclerosus causes itching, white patches and fragile skin, and lichen planus causes sore, eroded areas. Both can lead to swelling and need specialist treatment.

Injury

A straddle injury, assault or childbirth tear can cause marked swelling and a collection of blood under the skin (vulvar hematoma). Large hematomas need medical assessment.

Rare causes

Lymphedema, Crohn's disease affecting the vulva, and vulvar cancer, which usually presents in older women as a persistent itchy or sore lump, ulcer or thickened patch rather than sudden swelling.

How causes compare

How a doctor finds the cause

A doctor or nurse will ask about itching, discharge, pain, new products, sexual activity, pregnancy, recent antibiotics and previous episodes, then examine the vulva and sometimes the vagina. Tests may include:

• a vaginal swab for yeast, bacterial vaginosis and trichomoniasis
• tests for chlamydia, gonorrhea and herpes when relevant
• blood sugar testing if yeast keeps returning
• a skin biopsy for persistent patches, ulcers or lumps, especially after menopause

Treatment and home care

Home care

• Stop any new or scented products. Wash with plain water or a simple emollient soap substitute.
• Wear loose cotton underwear; avoid tight jeans and leggings.
• Apply a cool compress (a clean cloth soaked in cool water) for 10 to 15 minutes.
• A warm sitz bath (sitting in a few inches of warm water) several times a day helps a Bartholin's cyst drain.
• Avoid sex until swelling and soreness settle.

Medical treatment

• Yeast infection: antifungal creams, pessaries or a single oral tablet. See a doctor if it is your first episode, you are pregnant, or it recurs 4 or more times a year.
• Dermatitis: a short course of a low-strength steroid ointment may be prescribed.
• Bartholin's abscess: drainage in clinic, often with a small catheter (Word catheter) left for several weeks, or marsupialization for recurrences. Antibiotics if there is cellulitis.
• Herpes: antiviral tablets, ideally started within a few days.
• BV and trichomoniasis: antibiotics; partners need treatment for trichomoniasis.

Frequently asked questions

Why is my vulva swollen and itchy?

The most common reasons are a yeast infection and irritation or allergy from soaps, wipes, pads, detergents or condoms. Yeast usually adds thick white discharge. If itching and swelling do not improve within a few days of stopping irritants or using an antifungal, get checked.

Why is one side of my labia swollen?

Swelling on one side is often a Bartholin's cyst, a blocked gland at the lower edge of the vaginal opening. If it becomes hot, red and very painful, it may be an abscess that needs drainage. An infected hair follicle or an injury can also cause one-sided swelling.

Can sex cause a swollen vulva?

Yes. Friction from sex, especially without enough lubrication, can cause mild swelling and soreness that settles in a day or two. Allergy to latex, spermicide or lubricant can cause itching and puffiness. Swelling with sores, unusual discharge or pain may suggest an infection.

Is vulvar swelling normal in pregnancy?

Some swelling is common in late pregnancy because of increased blood flow and pressure from the uterus. Vulvar varicose veins may appear and usually go after birth. Sudden swelling with headache, vision changes or swelling of the face and hands needs urgent review for preeclampsia.

How can I reduce vulvar swelling at home?

Stop scented products, wear loose cotton underwear, use cool compresses, and avoid sex until it settles. Do not use over-the-counter anti-itch creams with numbing agents, which can make irritation worse. See a doctor if swelling is painful, one-sided, or lasts more than a few days.