Many women suffer from vulval soreness and itching.  This can be due to skin conditions, such as eczema, infections such as thrush (candidiasis), or just to sensitivity of the skin or nerve cells.  This leaflet gives general advice on how to care for your vulval skin.

What causes vulval skin problems?
The vulva is the name given to the external genital organs of women, which includes the inner and outer “lips” (labia) and clitoris.

The vulva skin is very sensitive and can react to many beauty products and dyes.  It can also be affected by:

  • skin conditions, such as eczema, psoriasis and lichen sclerosus;
  • infections such as thrush and warts;
  • nerve sensitivity (called vulvodynia);
  • lack of oestrogen following the menopause.

If you have a diagnosed skin condition, you will usually be given specific treatment for it.  However, the advice given in this leaflet will be helpful to all women with vulval soreness, itching or sensitivity.

What should I avoid?
You should avoid all contact of the vulva with:

  • soaps (even unperfumed soaps such as Simple Soap) as these dry and irritate the skin;
  • perfumed products such as bubble baths and feminine hygiene wipes and deodorants, which can irritate the skin;
  • antiseptics used in the bath or directly on the skin;
  • flavoured condoms;
  • facial moisturisers and body lotions.

How should I wash my vulva?

  • Wash the vulval area only once a day.  Cleaning too often can dry the skin.
  • Wash just with your hand.  Avoid using a flannel as this can scratch the skin.
  • Avoid contact with soaps.  Washing the vulva with water only is perfectly adequate.
  • Using an emollient moisturiser* as a soap substitute can improve the condition of the skin.  Apply it before betting into the bath or shower and then rinse it off after washing the rest of your body.
  • You should only use those emollients that are recommended for eczema:
    • Ointments such as Cetraben are very effective but some find them too greasy.
    • Dermol 500 is a good (and less greasy) alternative, especially if the skin is very inflamed.
    • We do not recommend Aqueous cream as it can irritate the skin.
  • Try to avoid shampoo from coming into contact with the vulva skin.  If you cannot wash your hair in the sink, protect the vulva with an emollient.

*Emollients/moisturisers can cause a fire hazard.  They are not directly flammable but build-up of dried products on clothing/bedding means they can catch fire easily.  Caution with smoking and naked flames.

What else can I do?

  • Use a bland moisturiser on the vulval skin as often as possible.  Try applying using toilet paper each time you pass urine.  Moisturising can help relieve symptoms and more importantly, when you don’t have symptoms, can prevent them returning.
  • We recommend Cetraben cream, Doublebase Dayleye gel or Dermol 500 but not Aqueous cream as this can irritate.
  • Use soft, white, non-recycled toilet paper and cotton pads or tampons.

What clothes should I wear?
Tight clothing and man-made materials can cause friction and overheating so are best avoided.

  • 100% cotton underwear is best.  Avoid thongs and synthetic materials.
  • Go without underwear as often as possible – at home in the day, wearing just a skirt, and at night.
  • Wear stockings or hold-ups rather than tights.
  • Avoid leggings, cycling shorts and tight jeans, which put pressure on the vulva.

How should I wash my clothes?

  • Avoid detergents which contain dyes, enzymes (these will be called biological) and perfumes.  Use detergents labelled dermatologically approved, non-biological or recommended for babies.
  • Avoid fabric conditioners, bleach and tumble-dryer sheets.
  • Double-rinse underwear.

Can I exercise?
Yes, but:

  • Try to avoid exercises such as cycling or horse riding which put direct pressure on the vulva.  Padded shorts or cycle seats can help.
  • Limit intense exercises that create a lot of friction in the vulva area.
  • Avoid swimming in highly chlorinated pools and avoid hot tubs.
  • Remove swimming costumes and exercise clothes as soon as possible.
  • Some women find it helpful to protect the vulva with Cetraben ointment or Vaseline before exercising or swimming.

What about sex?
Many women with vulva conditions have problems with their sex life.  There are several possible reasons for this:

  • pain during sex due to the vulva condition;
  • lack of desire to have sex due to pain;
  • dryness due to tension and lack of desire;
  • involuntary spasm of the vaginal muscles due to anticipation of pain, which further increases pain;
  • avoidance of sex due to lack of desire and fear of pain;
  • relationship difficulties due to avoidance of sex – which further reduces desire.

Strategies which can help include:

  • using a lubricant before starting to have sex; KY jelly is absorbed very quickly; we recommend trying lubricants such as TLC (Pasante), Sylk and Yes WB, which are water-based and non-irritant, but last longer than KY;
  • oil-based lubricants such as Yes OB are event more long lasting, but can damage latex condoms; these may sometimes be obtained more cheaply and easily from the internet than a pharmacy;
  • Replens which is a vaginal lubricant that provides moisture for the vagina for up to 3 days;
  • a topical anaesthetic such as Instillagel which may help; apply this a little while before sex to allow it to be absorbed so that it numbs you but not your partner and use additional lubricant as well;
  • not using flavoured condoms or perfumed lubricants, as these can irritate.

If it is just the penetration that causes pain, keeping to “outersex” (mutual masturbation and oral sex) until you feel less sore, will reduce tension and avoidance of sexual activity, while ensuring that you and your partner keep close.

If you need more help, speak to your doctor or nurse.  You can be referred to a specialist in sexual medicine; they are very experienced in helping people with physical, as well as psychological, difficulties with sex.

Where can I get more information?

  • The Vulval Pain Society provides information on vulval conditions, advice and self-help for sufferers and links to other website and support groups. www.vulvalpainsociety.org    
  • The National Eczema Society provides helpful information about skin care, particularly the use of emollients. http://www.eczema/org/

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