The Nu Guide: Understanding common vulvo-vaginal conditions

Let's get real — how often do we talk about problems that affect the vulva?

This incredible part of the female body is so vital to our health and wellbeing but so many of us have a poor understanding of anatomy, function and — most importantly — what the common conditions are that can affect the vulval region. By now we should all be using the term ‘vulva’ when we are talking about the structures that make up the external female genitalia, so the bits on the outside (see anatomy 101 for a refresher). 

Vulval health is an important aspect of overall wellbeing, yet it is often overlooked. Many women or AFAB experience discomfort or changes in the vulval area, especially as they age or go through different life stages. This article aims to give you a quick overview of  common conditions that affect the vulva, what symptoms you might experience and how they can be managed.

Lichen Sclerosus

Lichen sclerosus is a chronic skin condition that usually affects the vulva. It is most common in postmenopausal women, but it can occur at any age (and can also affect men). The exact cause is unclear, though it may be linked to immune system dysfunction or hormonal changes.

Symptoms:

• Itching, often severe

• Thin, white patches of skin on the vulva

• Pain, especially during intercourse

• Skin that bruises or tears easily

Treatment:

Lichen sclerosus is usually treated with regular use of topical strong steroid ointment or creams that reduce inflammation and help manage symptoms. Early treatment is essential to prevent scarring, and regular follow-ups are important because untreated lichen sclerosus can increase the risk of vulvar cancer, though this is rare.

Vulvodynia

Vulvodynia refers to chronic pain or discomfort in the vulva or entrance to the vagina (vestibule) that lasts for more than three months, without an obvious cause. The pain can be constant or triggered by touch, such as during sex, exercise, or even while sitting. The cause is not well understood, but it could be related to nerve irritation, hormonal changes, or previous injuries.

Symptoms:

• Burning, stinging, or rawness in the vulval area

• Pain during intercourse, smear test or insertion of tampons

• Sensitivity to touch, even from clothing

Treatment:

Managing vulvodynia can be complex and may involve multiple approaches, including medications for pain relief, pelvic floor physiotherapy, and lifestyle changes. Cognitive behavioral therapy and mindfulness techniques can also help manage the psychological effects of chronic pain.

Vulvo-Vaginal Atrophy (Genitourinary Syndrome of Menopause)

Vulvo-vaginal atrophy is a condition caused by the thinning and drying of the tissues of the vulva and vagina due to lower estrogen levels, particularly after menopause. This can affect all the organs and skin in the pelvic area which are packed full of estrogen receptors. Women may not experience any symptoms but urinary symptoms, dryness and pain with vaginal insertion are common.

Symptoms:

• Vaginal dryness, discharge and irritation

• Pain during sex

• Burning sensation

• Increased risk of urinary tract infections

Treatment:

Moisturisers, lubricants, and hormone replacement therapy (HRT), including low-dose topical estrogen creams, are effective in managing vulvo-vaginal atrophy.  Reference GSM guide for a complete run down on this super common condition.

When to seek help

If you experience persistent itching, pain, or changes in the vulva, it’s important to review how you are caring for your genital skin. It is not necessary to wash the vulva more than once a day. Do not wash the vagina. Do not use wipes, deodorants, douches, nor other cosmetic and cleansing products. Oil based barriers, emollients and lubricants are ideal for sensitive skin and can be used alongside treatments prescribed by your healthcare provider.

If simple measures don't solve the issue then you should consult a healthcare professional that you trust, and request a physical examination. While these conditions can be uncomfortable and affect your quality of life, there are effective treatments available. Regular check-ups and open communication are key to maintaining vulval health. We encourage you to take action when something doesn’t feel quite right, or if the symptoms you’re experiencing are affecting your quality of life.

Viva la vulva!