Itchy or sore vulval skin: common conditions

Vulval skin can feel sore even when it looks much as it always has. Vulvodynia, a persistent vulval pain condition, often causes discomfort without a visible change. Itching, dryness or white patches can have other explanations that need an examination.

The vulva is the area around the outside of the vagina. When describing symptoms, say where you feel them: on the outer skin, near the vaginal opening or in a particular patch. You do not need to know the name of a condition before asking for help.

Irritation and contact dermatitis

Contact dermatitis is a form of eczema triggered by something touching the skin. Soaps and detergents are common irritants. The skin may feel itchy and become dry, cracked or blistered. Colour changes can look red on lighter skin or brown, purple or grey on darker skin.

Finding and avoiding the trigger can help. A clinician or pharmacist may suggest an emollient to moisturise the skin, and sometimes a prescribed steroid cream or ointment for more severe symptoms. Ask which product is suitable for the affected area.

White patches and lichen sclerosus

Lichen sclerosus can cause itchy white patches that look smooth or crinkled. The skin can be damaged easily and may bleed or hurt with rubbing. Over time, affected skin can become scarred or tight. It is not caused by poor hygiene and cannot be passed on through sex.

A strong prescribed steroid ointment usually helps relieve symptoms, although there is no cure. Follow the clinician’s instructions about how to use it. Ask what follow-up is planned and what changes you need to report between appointments.

Sore patches and lichen planus

Lichen planus can affect the vulva and other parts of the body, including the mouth. Possible changes include sore red vulval patches and white patches or burning inside the mouth. Mention symptoms in both places rather than assuming they are unrelated.

You cannot catch lichen planus from someone else. A GP can prescribe creams or ointments to control the rash and itching. Ask how to treat the vulval symptoms and what to do if discomfort continues.

Pain without a clear skin cause

Vulvodynia means vulval pain lasting at least 3 months without a specific cause. It can affect a small area or the whole vulva. The pain may be constant or come and go, and can occur with touch, sex or inserting a tampon.

You can seek help before then. NHS advice is to see a GP for pain that persists or returns, or makes sex or inserting a tampon difficult. A clinician may gently touch the area with a cotton bud and take a swab to check for infection.

Treatment may involve a gynaecologist, physiotherapist or pain specialist. Medicines can include local numbing cream or tablets for nerve pain. ACOG also describes physical therapy that relaxes pelvic floor tissues and releases muscle tension. Your clinician can advise on the options.

Care while you arrange an appointment

Avoid scented products and cleaning inside the vagina. Ask a pharmacist about an emollient or soap substitute suitable for sore skin. Keep emollient-contaminated clothes and bedding away from smoking and naked flames, because the fabric can catch fire more easily.

Changes to get checked

Book a GP appointment in the UK, or see your doctor or gynaecologist in the US and elsewhere, for persistent itching, returning pain or white patches. You can ask for someone to accompany you during the examination.

Arrange an appointment for a new lump, thickening or an ulcer that does not heal, especially with lichen sclerosus. The associated cancer risk is low, but these changes need checking. Ask your clinician how to check your skin between appointments.