When it’s not a yeast infection

  • Obstetrician/gynecologist Melanie Greenman

For the Gazette
Published: 4/8/2019 2:23:35 PM

Over the course of a lifetime, most women will have some occasional issues with their vulva. A smaller group will have severe, or lifelong problems that most people know little about; I see many of these women in my practice and reassure them that they are not alone and that there are people who care.

The outer portion of a woman's genitals, or vulva, is the area containing the labia (lips), clitoris and around the vaginal opening. Just like a face, each vulva is unique, and there is no one way that it “should” look. Various lengths, thicknesses, colors and shapes are all normal.  Asymmetry, freckles and textures are common.

In addition to all the normal variations, there are lots of different skin conditions that can cause discomfort or changes in the vulva’s appearance.  Many women have experienced the common “yeast infection,” which may cause itching and soreness, and red swollen skin. But what if it’s not yeast? 

Another common cause of irritation is “irritant dermatitis,” or “contact dermatitis.” This is usually caused by something new that has been in contact with the vulva. Common irritants include the chemicals and perfumes in pantyliners, menstrual or urinary pads, over the counter medications and female hygiene products and soaps, lotions and creams. Often, the cause of irritant dermatitis is not obvious. When this is the case, I ask my patients to tell me everything that touches the vulva. In addition to the above, this includes toilet paper, laundry detergents and dryer sheets, lubricants, prescription medications and body fluids. People can even develop new skin sensitivities to products that were previously well tolerated. Because of this, when there is a new rash or irritation of unknown cause, I recommend doing a vulvar review and eliminating all unnecessary potential irritants. Switching to perfume-free and sensitive-skin soaps, detergents, paper and pads can be helpful. Avoiding soap altogether on the vulva may also avoid irritating and overdrying sensitive skin.

Another piece of advice: Whatever the underlying cause of itching or irritation may be, the vulva does not like to be scratched Repeated scratching and friction on the skin will increase inflammation and skin coarsening, and cause more itching and irritation. To safely soothe this fragile skin, use cool or warm compresses, plain water or baking soda baths and emollients such as petroleum jelly or coconut oil.

Although yeast infections and irritant dermatitis are the most common causes of vulvar discomfort, there are many other potential causes including eczema, psoriasis, infections, allergy, atrophy, and autoimmune skin conditions such as lichen sclerosis and lichen planus. Pre-cancerous or cancerous growths can also present as irritation, itch, or rash.

So, how can you know what it is? Should you see someone?  

It is definitely OK to take over-the-counter medications to treat what you think is a yeast infection, or review irritants yourself and take soothing measures.However, if things don’t improve over a few weeks, I recommend making an appointment with your gynecologist. For more complicated conditions, evaluation by a gynecologist or dermatologist experienced in vulvar skin disorders can make a big difference for the health and happiness of the vulva. 

A few online resources that may interest you include labialibrary.org.au which, in picture form, highlights the variety of normal vulvas. You can search for “vulvar skin care” for more details on skin care. For some great patient information on vulvar disorders, I recommend the website of the dermatologist Libby Edwards, MD midcharlottedermatologyresearch.com/patient-handouts.html

Melanie Greenman, MD, is an obstetrician/gynecologist with Cooley Dickinson Medical Group Women’s Health.




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