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Vulval Dermatoses
Vulval dermatoses refer to skin conditions affecting the external female genitalia (the vulva). While often mistaken for gynaecological infections like "thrush," many persistent vulval issues are actually inflammatory skin diseases such as eczema, psoriasis, or Lichen Sclerosus. Because this area is sensitive and often embarrassing for patients to discuss, diagnosis is frequently delayed. However, the vulva is skin—just like the rest of the body—and requires specialist dermatological care to manage symptoms and prevent long-term complications.
Key Points
- Vulval skin conditions are common and are not usually caused by poor hygiene.
- The most common symptom is chronic itching, pain, or burning.
- Many cases are misdiagnosed as recurrent thrush or urinary tract infections.
- Conditions like Lichen Sclerosus require long-term treatment to prevent scarring.
- These conditions are rarely contagious and are generally not sexually transmitted.
What are vulval dermatoses?
These are non-infectious skin disorders affecting the vulva. Unlike temporary infections, dermatoses are often chronic inflammatory conditions. They involve the skin barrier and immune system, leading to changes in the texture, colour, and comfort of the skin in the genital area.
Who gets vulval dermatoses?
These conditions can affect females of any age, including children. However, specific conditions like Lichen Sclerosus are most commonly seen in post-menopausal women and prepubertal girls. Contact dermatitis is common in young women due to the use of irritants like sanitary pads, shaving, or soaps.
Contact Smooth Skin Clinic for a confidential and professional assessment.
Clinical features
The clinical presentation depends on the specific condition, but the hallmark symptom is almost always a persistent itch that disturbs sleep or daily activities. Patients often report burning, soreness, or pain during intercourse (dyspareunia). Visibly, the skin may appear pale or white (leukoderma), thickened and leathery due to scratching, or raw and red. Fissures (small paper-cut-like cracks) are common in the skin folds. In advanced cases of scarring conditions, there may be architectural changes, such as the shrinking of the labia or narrowing of the vaginal opening.
Diagnosis and differential diagnosis
Diagnosis is primarily based on clinical examination. Because the vulva is modified mucous membrane, skin diseases look different here than elsewhere.
Examination: We examine the skin to distinguish between inflammatory rashes, hormonal changes, and infections.
Swabs: To rule out Candida (thrush) or bacterial infection.
Biopsy: A small sample of skin under local anaesthetic is often necessary to confirm diagnoses like Lichen Sclerosus and to rule out pre-cancerous changes (VIN).
Impact and complications
The impact on quality of life is profound. Chronic itch causes sleep deprivation and anxiety. Pain can make sitting, walking, or sexual intercourse impossible, leading to relationship strain. Complications: Untreated inflammatory conditions (specifically Lichen Sclerosus and Lichen Planus) can cause permanent scarring, fusion of the labia, and a slightly increased risk (approx. 4-5%) of developing Vulval Squamous Cell Carcinoma (skin cancer).
Causes and triggers
Autoimmune: The body’s immune system attacks the skin (Lichen Sclerosus, Lichen Planus).
Irritants: Excessive washing, soap, wet wipes, and tight clothing can cause or worsen dermatitis.
Genetics: Psoriasis and eczema often run in families.
Hormonal: Low estrogen states (menopause) can thin the skin (atrophy), making it more susceptible to irritation.
Treatment Options
- Topical Corticosteroids Ultra-potent steroid ointments are the gold standard treatment for Lichen Sclerosus and Lichen Planus. They are safe and essential for preventing cancer risk.
- Soap Substitutes Switching from soaps/washes to derm-approved emollients to wash.
- Barrier Creams Protecting the skin from urine/moisture irritation.
- Oral Medications Antihistamines for itch, or immunosuppressants for severe Lichen Planus.
- Surgery Only used to correct scarring/fusion in stable disease; not used for active inflammation.
Expectations and Outcomes: Conditions like Lichen Sclerosus are life-long but can be excellently managed. With regular use of ointment, the skin can return to normal appearance and function, and the risk of cancer is significantly reduced.
Frequently Asked Questions
Have questions about scheduling or what to expect? Here are answers to common inquiries to help you feel fully prepared.
No. Neither Lichen Sclerosus nor Lichen Planus is contagious. You cannot pass it to a partner, and it is not caused by sexual activity.
Most over-the-counter creams are for fungal infections (thrush) or mild irritation. Vulval dermatoses like Lichen Sclerosus require prescription-strength anti-inflammatory ointments that are much stronger than standard preparations.
This is a common fear, but in the case of Lichen Sclerosus, the disease itself causes the skin to become thickened and scarred. The steroid ointment actually softens the skin and returns it to a more normal texture. When used correctly under specialist supervision, these strong ointments are very safe.