Vulvar and Vaginal Health

Vulvar and vaginal conditions can be annoyingly hard to understand or pin down. Especially since “normal” is such a spectrum. But there’s nothing normal—even if common—when it comes to irritation or pain.

Primarily vulvar skin conditions
While highly resilient, vulvar skin can be extra sensitive and just as prone to reactions as the skin on other parts of your body. Many of the most common vulvar skin conditions can be treated (and prevented) at home.

• Contact dermatitis: Presenting as redness and itching, this one’s triggered by soaps, laundry detergents, condoms, lubricants and other irritants and allergens.
• Lichen simplex chronicus: Repeated vulva scratching—often from chronic irritation caused by allergens—can lead to skin that becomes thick, dry or darker in color.
• Folliculitis: After shaving or waxing, you may notice small, irritable bumps courtesy of inflamed hair follicles.
• Sebaceous cysts: These pop up when a hair follicle or skin pore gets blocked from clothing friction, too much moisture or as a reaction to shaving.
• Milia skin bumps: These tiny white or yellowish bumps are caused by protein trapped under the skin surface, usually from irritation or thick creams that block pores.
• Lichen sclerosus: Most common after menopause, this chronic inflammatory skin condition causes thin, white, fragile patches of skin that might be itchy or painful.

Primarily vaginal conditions, sometimes with vulvar symptoms

• Yeast infections: You’ll first notice a yeast infection as a burning and/or itching sensation during urination or simply when walking around. Despite what you may know, they don’t always include a cottage cheese-like discharge.
• Bacterial Vaginosis (BV): Though confused with yeast infections, BV is when the “good” and bacterias get imbalance, leading to vaginal discharge that’s thin, gray and fishy smelling, accompanied by itching or burning.
• Atrophic Vaginitis / Genitourinary Syndrome of Menopause (GSM): When estrogen levels drop (especially during and after menopause), vaginal tissues can become thin, dry, and less flexible. This can cause dryness, burning, and pain with sex (dyspareunia).
• Common sexually transmitted infections (STIs)
  • Herpes: This common viral STI can cause painful sores or blisters on the vulva or around the vagina.
  • Trichomoniasis: Caused by a parasite, this STI often leads to itching, burning, and a frothy, yellow-green discharge with a strong odor.
  • Human Papillomavirus (HPV): Certain low-risk strains of HPV can cause genital warts. These typically appear as painless, skin-colored or whitish bumps on the vulva, in or around the vagina, or on the cervix. They can be flat or raised, single or in groups, and sometimes have a cauliflower-like texture.
  • Chlamydia & Gonorrhea: These common bacterial STIs are often asymptomatic, which is why appropriate screening is so important. When they do cause symptoms, they can include an increase in vaginal discharge, a change in its color (often to yellow or green), and burning or pain with urination. Left untreated, they can lead to more serious issues like Pelvic Inflammatory Disease (PID).

Conditions involving pain and other symptoms
Vulvar pain varies by the cause, and may only show up during certain activities (like sex or while urinating). Other times, it’s always there (but doesn’t have to be). Here are some of the common vulvar pain conditions we treat:

• Urinary Tract Infections (UTIs): UTIs usually feel like a burning sensation near the urethra or show up as a constant urge to go.
• Vulvodynia: There isn’t always a clear cause of this chronic vulvar pain issue. It may feel raw or sensitive, and be extra painful with penetration.

It’s normal to question if vulvar discomfort might be a sign of something serious. If you experience swelling, unusual discharge, bleeding, any vulvar pain symptoms or sores that spread or don’t heal, make an appointment with a provider.

Our goals for treating vulvar and vaginal health conditions are pretty simple: relieve symptoms and help you feel comfortable in your body again. So don’t stress about finding the right words to describe what’s going on when you make an appointment. Your provider will simply want to chat through your symptoms, ask about your health history and maybe take a swab, urine test or biopsy depending on what we suspect is happening.

When in doubt, the best way to prevent and treat any vulvar irritation and maintain healthy vulvar and vaginal hygiene is gentle, fragrance-free care. Be mindful of the products you choose (for periods, sex and otherwise), opt for breathable clothing and skip douching or any internal products promising ‘freshness.’ A healthy vaginal microbiome is self-cleaning and essential for preventing infections.

If you develop a vulvar or vaginal condition or infection, your provider might recommend:

• Topical medications: We might use a steroid or estrogen cream to calm inflammation and treat conditions like contact dermatitis or a prescription estrogen cream to restore tissue health.
• Oral medications: Antifungal treatments for a yeast infection, antibiotics for infections like bacterial vaginosis, chlamydia, gonorrhea, or trichomoniasis, and antivirals to manage herpes outbreaks.
• Vaginal moisturizers and lubricants: For symptoms of dryness or pain with sex caused by hormonal changes, these non-hormonal options can provide significant comfort and relief.
• Lifestyle changes: If products are to blame, we’ll suggest avoiding scented soaps, adjusting your shaving routine or even trying new underwear to ease any irritation.

If your symptoms point to it, we may also suggest:

• In-office procedures or prescription creams for genital warts: If you are diagnosed with genital warts from HPV, treatment might include prescription creams you apply at home or simple in-office procedures like cryotherapy (freezing) to remove the warts.
• Pelvic floor physical therapy: This is best for pain tied to nerve sensitivity or tight pelvic floor muscles, like with vulvodynia.
• Long-term condition management: If symptoms are related to perimenopause or low estrogen, we can talk about vaginal estrogen or other hormone-based therapy to support your comfort.

No matter what it is, we’ll help treat it and, hopefully, prevent it in the future, too. The vulva and vagina are mighty workers, so they’re bound to go through some ups and downs. When you need care, seek it. You should never feel embarrassed by looking out for your body.