Vulvar Symptoms

Vulvar Symptoms (Female Genital Symptoms)

DEFINITION

  • Itching or dryness of external female genital area (vulva)
  • Rashes of external female genital area including: sores, redness, blisters, lumps

General Information

Common Causes of Vulvar Itching

  • Contact Dermatitis - Soaps/detergents, douches, and perfumed toilet products can cause local irritation. The treatment for this is to avoid these products and maintain good genital hygiene.
  • Menopause - At menopause the ovaries stop functioning, and as a result the body produces less estrogen. Without estrogen, the skin in the genital area can become thin and women notice increased dryness. There are estrogen-based vaginal cremes or lubricants that your physician can prescribe to reduce this itching and dryness.
  • Yeast Infection: Sometimes itching can be caused by a yeast infection (Candida). Often there is a new or increased vaginal discharge (thick, white, cottage cheese-like, non-odorous discharge). There are a number of over the counter medications for the treatment of vaginal yeast infections.

Other Causes of Vulvar Symptoms

  • Any preexisting skin disorders/rashes can also occur on the vulva (e.g., psoriasis, eczema, drug rashes)
  • Bartholin's cyst
  • Irritation after sexual intercourse (e.g., inadequate lubrication causing friction abrasion, latex-condom allergy)
  • Skin cancer and skin dermatoses (e.g., lichen sclerosis, squamous hyperplasia)
  • Sexually Transmitted Diseases (e.g., STD's like Herpes simplex, Syphilis, pubic lice, genital warts)

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WHEN TO CALL YOUR DOCTOR

Call your doctor now (night or day) if:

  • You feel weak or very sick
  • Severe pain
  • Fever and genital area looks infected (e.g., draining sore, ulcer, rash is painful to touch)

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think you need to be seen
  • Itching that is moderate-severe (i.e., it interferes with school, work, or sleep)
  • Genital area looks infected (e.g., draining sore, ulcer, rash is painful to touch)
  • Rash with painful tiny water blisters

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • You are worried you might have a sexually transmitted disease
  • Antibiotic treatment for 3 or more days for a Sexually Transmitted Disease (STD) and you are not improving
  • Home treatment for 3 or more days for a "yeast infection" and you are not improving
  • All other vulvar symptoms (exception: feels like prior yeast infection, or painless rash present less than 24 hours)

Self care at home if:

  • Symptoms of a yeast infection (i.e. itchy, white discharge, not bad smelling), which feels like prior vaginal yeast infections, and you don't think you need to be seen
  • Painless rash (e.g. redness, tiny bumps, sore) of genital area present less than 24 hours, and you don't think you need to be seen
  • Mild itchiness, and you don't think you need to be seen
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HOME CARE ADVICE

  • Cleansing: Wash the area once thoroughly with un-scented soap and water to remove any irritants.
  • Genital Hygiene:
    • Keep your genital area clean. Wash daily.
    • Keep your genital area dry. Wear cotton underwear or underwear with a cotton crotch.
    • Do not douche.
    • Do not use feminine hygiene products.
  • Antifungal Medication for Yeast Infection: There are a number of over-the-counter medications for the treatment of yeast infections.
    • Available in the U.S.: Femstat-3, miconazole (Monistat-3), clotrimazole (Gyne-Lotrimin-3, Mycelex-7), butoconazole (Femstat-3)
    • Available in Canada: miconazole (Monistat-3) and clotrimazole (Canesten-3,
      Myclo-Gyne)
    • If you are pregnant, speak with your doctor before using.
    • Do not use yeast medication during the 24 hours prior to a physician appointment (Reason: interferes with examination).
    • Read and follow the package instructions closely.
  • Expected Course: If there is no improvement within 3 days, then you will need to be examined.
  • Pregnancy test, when in doubt:
    • If there is any possibility of pregnancy, obtain and use a urine pregnancy test from the local drug store.
    • Follow the instructions included in the package.
  • Call Your Doctor If:
    • Pregnancy test is positive; or if you have difficulties with the home pregnancy test.
    • Rash lasts longer than 24 hours
    • Rash spreads or becomes worse
    • Fever occurs
    • No improvement after 3 days
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR Recomm Rep. 2006;55(RR-11):1-94.
  2. Eckert LO. Clinical practice. Acute vulvovaginitis. N Engl J Med. 2006;355(12):1244-52.
  3. Goldenberg RL, et.al. Sexually transmitted diseases and adverse outcomes of pregnancy. Clin in Perinatology. 1997;24(1):23-41.
  4. Margesson LJ. Vulvar disease pearls. Dermatol Clin. 2006; 24(2): 145-55, v.
  5. Miller KE. Women's health. Sexually transmitted diseases. Prim Care.1997;24(1):179-93.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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