The Vulvar Disorders You Didn't Know About (and How to Treat Them)
Treating any medical condition is a process, but managing a disorder in an area of the body that few people can name is a trial.
The vulva is a key part of female genitalia, yet our general knowledge on the subject is sparse. While many of us have picked up an understanding of sexually transmitted infections (STIs), malfunction in this area of the body is often a little harder to navigate.
Finding something wrong in a body part of which you have little knowledge can be distressing. There is no need to panic, though. Never let fear take over when education has the power to soothe.
"Vulvar dysfunction is a really broad term," said Rugilė Kančaitė, M.D., an OB-GYN resident based in Lithuania and a medical advisor to Flo Health. "It can be due to skin conditions, vulvovaginitis, vaginal dryness, vulvodynia and, finally, a precancerous condition called vulvar dysplasia or vulvar intraepithelial neoplasia, and vulvar cancer. These conditions are triggered by very different factors."
An array of potential causes for vulvar dysfunction makes consulting a medical professional crucial. For now, however, here is a breakdown of some of the most common disorders that can affect vulvas.
Folliculitis is the medical term bestowed on those pesky ingrown hairs that most women who have shaved a mons pubis know all too well. Unsurprisingly, it is caused by hair removal procedures, such as waxing or shaving.
The condition is caused by the inflammation of your hair follicles, resulting in red, tender spots, sometimes with pustules on the surface of the skin.
"To avoid folliculitis, it's recommended to wash the skin with warm water before shaving and shave in the direction of the hair growth using a sharp, new personal razor," Kančaitė said. "If folliculitis tends to come back, it would be smart to try other hair removal methods."
Generally, folliculitis does not require medical attention, however, if the bumps get swollen or grow in size, treatment might be necessary.
"Treatment includes avoiding irritation to that area, especially shaving," explained Stanislaw Miaskowski, M.D., an OB-GYN at Orlando Health Winnie Palmer Hospital for Women & Babies. "Warm compress with a heated, wet cloth helps with irritation and drainage. If symptoms persist, your provider may prescribe you an antibacterial ointment, cream or solution."
Contact dermatitis, or in this case, vulvar dermatitis, appears anywhere on the vulva but is especially common around the soft folds at the opening of the vagina.
"Contact dermatitis is a type of rash that occurs as a result of your skin touching something that irritates it or is allergic to," Miaskowski explained. "Symptoms include red, dry and itchy skin. In darker individuals, it can appear purple, brown, gray or black. If the rash occurred due to an allergy, it can also appear swollen or have blisters."
Potential triggers include perfume, synthetic underwear, pantyliners, food allergens, scented soaps, detergents and jewelry. The cause varies between patients, so finding yours can lessen flare-ups.
"Allergic contact dermatitis often causes an itchy or sometimes painful rash at the area that was exposed to the substance, but it may take a few days for the rash to show up," said Alicia Little, M.D., a dermatologist and the director of the Vulvar Dermatology Clinic at Yale Medicine in New Haven, Connecticut. "Allergic contact dermatitis of the vulva, or anywhere else on the body, can also take a few days to develop. Irritant contact dermatitis usually develops within hours or days of the exposure and is caused by irritants such as soaps that irritate the vulvar skin."
Warm or cool baths or showers can help alleviate symptoms, but the best treatment is to avoid scratching. Cold compresses ease the need to itch and, in severe cases, medication may need to be prescribed.
The Bartholin's glands surround the opening of the vagina and produce lubrication during penetrative intercourse, Kančaitė said. A Bartholin's cyst is a fluid-filled lump in this area.
"The Bartholin gland is a structure just below the opening of the vagina that produces a small amount of fluid for lubrication," Miaskowski explained. "When the gland is blocked, fluid can build up, leading to redness, swelling, irritation and pain. This usually happens to only one side of the vagina. If a lump is felt in the vagina, you should see your provider."
Certain STIs such as gonorrhea or chlamydia can cause Bartholin's cysts, so using condoms and dental dams is important, according to Kančaitė.
'As our bodies age, so does the vulva, so there may be some surprising changes to account for, such as genitourinary syndrome, which is triggered by decreasing levels of estrogen.'
At home, a Bartholin's cyst can be soothed with a sitz bath or warm compress to open up the blockage and drain the fluid.
"If this fails, your provider will drain the cyst under local numbing medicine," Miaskowski said. "In certain situations, they will place a catheter with a balloon in the cyst to help the draining and healing process. This catheter will remain in place for two to four weeks. Antibiotics may be considered if the area appears to be infected. If treatment fails, surgery under anesthesia is, at times, needed."
"Vulvodynia is constant burning, stinging, irritating pain and the sensation of rawness surrounding the entire vulva or certain parts of it," Kančaitė said. "The pain does not have an identified cause, it can come and go, and can be triggered by an attempt to insert a tampon or have sex."
Unfortunately, there is no clear trigger for the disease, meaning prevention is not an easy conversation. However, scientists are beginning to believe it is caused by a variety of factors, including pelvic floor dysfunction, past vaginal infections, genetics, nerve injuries and psychological disorders, according to Kančaitė.
"With vulvodynia, the answer is not as straightforward," she said. "A whole variety of methods are used to treat vulvodynia, including medications, diet changes, physical therapy, sexual counseling, surgery and self-care measures."
Granted its name by the fact that it typically affects both body parts, vulvovaginitis is the inflammation or irritation of the vagina and vulva. Mild vulvovaginitis is a common problem, and some people have it frequently during childhood.
Once puberty begins, the condition is usually triggered far less often, but it may reoccur for a variety of reasons. Candidiasis—a yeast infection or thrush—bacterial vaginosis and trichomoniasis can all cause vulvovaginitis. Symptoms include vaginal dryness, unusual vaginal discharge, pain when urinating or having sex, and an itchy or sore vagina.
'Facing a vulva-associated medical problem is not unusual and should never be a source of embarrassment. Every part of our body and mind needs to be taken care of, and sometimes that demands consulting a doctor.'
"Vulvovaginitis is treated by its cause," Kančaitė said. "As thrush is a fungal infection, it's treated with antifungals, creams or pills. Bacterial vaginosis and trichomoniasis are both treated with antibiotics."
Other vulvar disorders
"There are many infections that can affect the vulva, including yeast infections, some bacterial infections and some sexually transmitted infections," Little said. "Common STIs that affect the vulva include the viral infections herpes and genital warts [caused by HPV]. There is a vaccine against HPV that can help prevent genital warts caused by some of the HPV subtypes."
"It's important to note that barrier contraceptives reduce the risk of genital herpes transmission, but as it can be given through skin-to-skin contact, it cannot be totally prevented," Kančaitė added. "Also, let's not forget STD testing."
As our bodies age, so does the vulva, so there may be some surprising changes to account for, such as genitourinary syndrome, which is triggered by decreasing levels of estrogen. Symptoms may include painful intercourse, dryness, burning, itchiness and frequent urinary tract infections (UTIs).
Speaking with your physician
"It can be utterly scary to experience any unpleasant symptoms affecting the vulva, since many people tend to keep their complaints to themselves. This keeps them away from getting treatment and reaching for support," Kančaitė said. "There's a certain stigma surrounding vulvar disorders, just like any other gynecologic condition, and some people with vaginas are even afraid that acknowledging these disorders may affect their own perception of womanhood and how others see them as women."
Facing a vulva-associated medical problem is not unusual and should never be a source of embarrassment. Every part of our body and mind needs to be taken care of, and sometimes that demands consulting a doctor, no matter how awkward it may feel.
"There are many things not yet known about female reproductive health," Kančaitė added. "When people speak up, it not only reduces the stigma around a problem but also draws the much needed attention of researchers in this field. Therefore, new and better diagnostic abilities and treatment options can be offered, which can lead to better outcomes."
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