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Vulval Pain and Discomfort

Many women experience vulval pain or itching at some time in their lives. Some women have to deal with vulval pain for many months or years because of mis-diagnosis and incorrect treatments. There are many different causes for pain, itching and inflammation of a woman's genital area. These webpages give an overview of the different types of vulval pain and discomfort and also looks at two forms of vulval pain for which no specific cause has been found: vulval vestibulitis and dysaesthetic vulvodynia.

What does the term 'vulva' mean?

The term 'vulva' refers to a woman's external genitals and includes:

• The skin directly around the vaginal opening known as the vestibule. Above the vaginal opening, also in the vestibule, is a second smaller opening which is the urethra through which you urinate.
• Two sets of lips or labia. The inner lips (labia minora) are hairless and directly surround the vestibule, vaginal and urethral openings. The outer lips (labia majora) surround the inner lips and are covered in pubic hair.
• The clitoris, which is nestled just inside where the labia minora join at the front of the genital area.
• The perineum which is the area of skin below the vaginal opening, between the point where the labia and the anus meet.

It is difficult for a woman to see her own vulva, therefore many women may not know what their vulvas look like, or what is normal for them. This in turn makes it more difficult to be alert to any changes in appearance of the vulval skin that may be a sign of a problem. As with all parts of your body, the more familiar you are with your vulva, the easier it is to know when something seems not quite right.

All organisations supporting women with vulval problems suggest you check your vulva whenever you feel a problem occurring, such as thickening of the skin, itchiness, soreness and pain on penetration. They also suggest you check your vulva at regular intervals, even when there are no problems. To do this, prop yourself up on a bed or a couch. Holding a mirror in one hand, use the other hand to gently open the vulval lips and look at the areas indicated in the diagram of the vulval area.

Once you are familiar with the appearance of your own vulval skin, you can check for any colour changes (such as whitening or reddening). You should also check for any areas of thickening skin, small hard lumps such as warts and patches of sore or cracked skin, especially those that won't heal. Consult your doctor or attend a Genito-Urinary Medicine (GUM) clinic if you experience any of these changes.

What can cause vulval pain and itching?

Pain, itching, burning and irritation of the vulval area can be the result of an infection such as thrush or bacterial vaginosis, or the result of a non-infectious skin problem such as dermatitis, eczema or lichen sclerosis. There are also forms of vulval problems where the exact cause of the pain is unknown. In addition, women suffering from interstitial cystitis, a form of cystitis that appears to have no infection as its cause, also have vulval pain and tenderness as part of their symptoms.

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Written by Ingrid Smit and published in printed format (2001) by Women's Health

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