Vulval Care Advice Sheet

This leaflet aims to give you some general advice about looking after your vulval skin. This can help to treat symptoms and also to prevent a flare up of symptoms.

The vulva refers to a woman’s external genital organs, which include the inner and outer ‘lips’ (labia) and clitoris. The urethra (the tube through which you pass urine) and vagina open onto this area.

As the vulva is covered in skin just like the rest of your body, this means you can suffer from a variety of skin conditions in this area. This means that the problem may solely affect the vulva or may affect other areas of your body. You may have heard of some skin conditions such as eczema (dermatitis), psoriasis and perhaps other conditions such as lichen sclerosis or lichen planus. All these conditions can affect the vulva causing many different symptoms.

Symptoms may include:

• Itching
• Soreness
• Redness
• Broken/cracked areas
• Ulcerated areas that are not healing
• Pain on passing urine
• Pain on intercourse
• Lumps

Treatment

You may have had some of the symptoms listed above for some time without seeking help, but now that you have, we shall try to find the best treatment for you. You may have tried different creams and tablets, without any benefit and may be feeling low. We may need to try many different treatments to find one that is right to deal with your problem so please try to be patient with your treatment.

The vulva can require a number of weeks of treatment to control your symptoms. We cannot always offer a cure, but hopefully we can help to ease the symptoms and control the problem.

Washing

One of the most common problems is the use of soap and bubble baths (even those that are advertised as dermatologically friendly). They can be very harsh on the skin and can strip it of its natural protection. Water alone is enough to clean the area but often you may find a soap substitute can be helpful as it stops the drying effect of the water, eg, Diprobase cream or Aqueous cream.

Contrary to what is generally believed, the healthy vulva does not smell, so you do not need to use perfumed or scented products on this area, nor do you need to use soap.

Moisturisers

Applying moisturisers to the vulval area prior to bathing/showering and then rinsing off with water will be helpful for both itching and dryness. Putting the moisturiser on again soon afterwards will also be soothing and will act as a barrier cream to protect the vulva.

You can use these moisturisers as often as you like to soothe the skin. You may find it easier to apply the moisturiser to a panty liner and place that against your vulva. It can also be helpful to apply the moisturiser before you go to the toilet or, if you skin is very sore, to put some on the toilet paper used to wipe yourself after passing urine or having a bowel movement. Some moisturisers can be bought over the counter at a pharmacy, such as aqueous cream, but we may recommend a different one that is available on prescription (such as Cetraben).

Bath oils

Unperfumed bath oil/emollients such as Hydromol or Oilatum are also helpful to decrease the dryness and itching of the vulva.

Steroid preparations

Some conditions require treatment with a topical steroid applied to the vulva, these come as creams or ointments (you will find the one that works for you simply by using them).

The steroid should be applied on a regular basis, as instructed by a doctor, usually once daily but occasionally twice daily for the first 2 weeks. As your vulval condition improves you will be able to decrease the usage to alternate days, then to once or twice a week. If the condition worsens again you will need to use the steroid ointment more regularly again until you feel more comfortable. Do not be alarmed if the instruction leaflet states that it is not to be used on this area — it is safe to do so under medical supervision.

Anti-itching tablets

These may be prescribed for you to take, especially at night time as the itching is often worse at that time.

Anti-depressant tablets

A low dose of some tablets more traditionally used to treat depression can be used to treat some vulval problems, both to decrease the itching and control the pain.

Further treatment or tests

It may be necessary for the doctor to take a biopsy from the area to obtain a diagnosis; this will involve a local anaesthetic in the form of an injection. A small sample of skin will be taken and sent to the laboratory for examination under the microscope. You will have stitches in this area which will be dissolvable and do not need to be removed. The doctor who takes the biopsy will inform you how and when you can expect to get the results of the biopsy. This will depend on the reason for taking the biopsy.

Blood tests are sometimes necessary and these may be checked at intervals.

We may check the functioning of your thyroid gland, whether or not you have high glucose levels, which may indicate you have diabetes and also whether or not you are anaemic.

Self help

We are ultimately here to help both medically and psychologically but many women will ask, what can I do to help myself? The answer is many things, but do not be too despondent if no immediate relief occurs. It has probably taken a number of months or even years for your vulva to be at its present state, so changes you make to your lifestyle take time to make a difference to how you feel.

Clothing

100% white cotton pants are best. You could try double-rinsing when washing underwear. Try to find a washing detergent that suits you – non-biological liquids tend to be the best tolerated. Do not use bleach. Try to avoid wearing tights or tight clothing as much as possible, as these may encourage a moist environment in which bacteria can grow.

Hygiene

Wash only with warm water (not hot) and soap substitutes (as described earlier). Avoid all fragrances and deodorants on the vulval skin. If you have vulval pain try spraying the vulva with clear luke warm water and patting dry after passing urine. Some women dry the vulva with a cool hair dryer. Use white unscented toilet tissue. Do not wash your hair whilst you are having a bath as the products used can irritate you; wash it over a sink or bath or in the shower.

Menstruation

Avoid tampons if possible. If used, try to avoid those which contain fragrances or scents. Avoid switching brands frequently. Try all-cotton menstrual pads and change them frequently to minimise moisture. If you require more information about where to buy cotton pads please discuss this with a member of staff in clinic. Consider alternative menstruation aids such as period pants or moon cups.

Sexual contact

You and your partner should wash your hands before and after engaging in sexual contact or touching the vulval area. Allergic reactions to contraceptive gels, foams, creams, spermicide and condoms may affect your condition. Consider returning to the method of contraception that you used before the problem began. A water based lubricant such as yes can be used during intercourse to ease discomfort.

Comfort measures and suggestions

Avoid exercise if that aggravates your symptoms. Eat a healthy diet to avoid possible vitamin and mineral deficiencies. Deep breathing and relaxation techniques can help you to cope with the pain, as well as decreasing its occurrence and intensity.

Should you have any concerns once you have returned home, please do not hesitate to contact the Oscopy administration team on 01274 364542 and they will direct you to the appropriate health care professional.