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Causes of vulval pain and discomfort — vaginal infections Vaginal infections often affect not only the vagina but also the vaginal opening and the skin around it causing itching and pain. Getting a prompt diagnosis and treatment will alleviate symptoms and may reduce the amount of treatment you need. It is important to remember that not all women get all the symptoms associated with an infection. Also, symptoms may vary between different bouts of the same infection. The most common infections with symptoms of vulval discomfort are thrush, bacterial vaginosis, trichomonas vaginalis and herpes simplex. Thrush This is usually caused by a fungal organism called candida albicans which lives in our bodies but can grow out of control in our genital area causing symptoms of thrush. These include a white, thick, yeasty smelling vaginal discharge, and a very itchy, sore and red vulval area. Sometimes the anal opening can become itchy and sore, too. |
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Thrush is treated with a range of antifungal drugs available as vaginal creams, vaginal pessaries and tablets to be swallowed. The creams and pessaries, which you put inside your vagina, may sometimes cause burning and skin irritation similar to the thrush infection itself. This may make it hard to tell the difference between the side effects of the treatment and the symptoms of the infection. You can also get cream to put on the vulval skin to ease the soreness and itching. Many women prefer to take tablets by mouth either as a single dose or two doses on the same day. These may cause more side effects compared to vaginal creams or pessaries and should not be taken if you are pregnant, breastfeeding or taking certain other medicines. Treatment for thrush can be bought over the counter or prescribed by your doctor. Because you can buy these medications over the counter, it is possible to mis-use the treatment for itching and soreness that is not actually thrush. If the treatment you are using is not working, if you have any doubts about the cause of your symptoms, or if you are pregnant, see your doctor or attend a clinic to get an accurate diagnosis. Inappropriate use of thrush treatments may lead to long-standing vulval problems or make other infections worse. Thrush is not a sexually transmitted infection, but if women suffer repeated attacks, especially after penetrative sex, it is possible they are being re-infected by their partners. Michele Goldsmith, author of the book Painful Sex, suggests using condoms for a few months to see if the attacks stop. If they do, it may be a good idea for your partner to be examined or tested, and if necessary, treated for thrush before you stop using condoms. Thrush infection does not always cause symptoms in men and may present as balanitis or a non-specific urethritis (NSU). For more information on thrush, including information on prevention and self-help remedies, see our online leaflet on thrush. Bacterial Vaginosis This vaginal infection, like thrush, causes soreness, burning and itching of the vulva but little or no redness or swelling. Symptoms also include a grey or white vaginal discharge with a strong, fishy smell. Bacterial Vaginosis (BV) occurs when the 'good' bacteria normally living in the vagina are wiped out and replaced by 'bad' bacteria. Because of the similarity of symptoms, it is easy to think you have thrush when you may have BV. For an accurate diagnosis visit your doctor or a clinic where an examination and tests can be carried out to determine what infection is causing your symptoms. BV, unlike thrush, can lead to a more serious internal infection called pelvic inflammatory disease (PID) [Women's Health have an online leaflet on PID]. This can happen under certain circumstances, such as gynaecological surgery. BV may also cause complications during pregnancy. Treatment for BV consists of a course of antibiotics taken by mouth or an antibiotic cream to be used inside the vagina. BV is not a sexually transmitted infection, and there is no reason to treat your sexual partner. However, if you are having sex with a man, you may want to consider using condoms, as ejaculate may upset the balance between the good and bad bacteria in your vagina. Trichomonas Vaginalis Also known as Trichomoniasis or Trich, this vaginal infection can cause the vulva to become sore, red and inflamed. The most notable symptom is a foamy, yellow greenish vaginal discharge. In some women it also hurts to urinate. The organism that causes these symptoms is a parasite in the vaginal mucus. It spreads through penetrative vaginal sex and the exchange of vaginal fluid, for example, through sharing sex toys. Treatment is usually antibiotics taken by mouth. To prevent re-infection, your sexual partner(s) should also be treated. Infection in men often does not cause any symptoms, so testing, treatment and the use of condoms is advised. Avoid sharing sex toys during treatment and always clean them thoroughly. Herpes Simplex Usually known as just herpes, this infection is caused by a virus. Women with herpes have often been made to feel guilty or bad about it. This means they have to deal with the psychological effects of the infection as well as with the physical symptoms. The virus exists in two types. Herpes simplex type 1 is usually the cause of recurring cold sores around the mouth, and herpes simplex type 2 is usually the cause of symptoms in the genital area. However, type 1 can cause genital infection and type 2 can cause infection around the mouth. This crossover is usually the result of the virus being passed on during oral sex. During the first outbreak of the infection, painful sores appear on the vulva and vagina and sometimes also on the top of the thighs and buttocks. It may hurt to urinate as urine is acidic and stings when it touches the sores. The sores, also called blisters or lesions, usually heal after seven to twelve days but in some women healing can take up to six weeks. Other symptoms include a tingly and itchy vagina (this is the first sign of the start of an attack in 50% of women with herpes), swollen glands in the groin and general flu-like symptoms. Subsequent outbreaks of the infection are usually milder and shorter than the first outbreak, and the sores tend to heal more quickly. The time between outbreaks can vary from weeks to years and some people only ever get one attack. Swollen glands or flu-like symptoms only happen during the first attack. Herpes is spread through direct skin contact between the sores and the mouth or genital skin of another person. You risk passing the virus on from the first sign of infection until the sores have healed and the current advice is not to have intercourse or oral sex during this time. A doctor may be able make a diagnosis by looking at the affected skin but a swab is sometimes taken to be absolutely sure. Treatment consists of antiviral drugs aimed at reducing the severity and length of the attack and should be taken as soon as the first signs of an outbreak are felt. Painkilling creams can help to ease the vulval symptoms. As with many viral infections, there is no permanent cure for herpes and its recurrence can be very upsetting. More information on genital herpes is available from the Herpes Viruses Association, see Resources.
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Written by Ingrid Smit and published in printed format (2001) by Women's Health
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