Vulva is the name for the female outer genitals. (Many people say vagina when they actually mean vulva.) The vulva is made up of flaps of labia. Labia majora are the outer lips that are covered with pubic hair. The inner lips, or labia minora, do not have any hair. Labia minora come in various shapes and sizes, and all are normal. Some labia minora can be bigger and extend outside of the labia majora. Others are small and completely covered by the outer lips. The vulva also includes the urethra (through which urine passes), the clitoris (which plays a role in sexual arousal and stimulation), and the opening to the vagina. The cervix, uterus, ovaries and fallopian tubes are internal reproductive organs, and are not part of the vulva. The vagina is the connecting canal between the vulva and the internal reproductive organs.
To care for the vulva, wash it daily with warm water and non-irritating soap. The spaces between the labia can gather debris, secretions, menstrual blood and urine, which can produce an odour. The vagina is self-cleaning. It stays healthy by making secretions and sending out unwanted debris with the vaginal discharge. Douching (flushing the vagina) is not necessary. It can upset the natural balance of good bacteria that help to keep the vagina healthy.
Kegel exercises are pelvic floor clenching exercises to strengthen the muscles around the urethra, vagina and anus. They are recommended to prevent and treat minor pelvic floor concerns such as peeing when coughing, which is called stress urinary incontinence. (For more information on incontinence, search Bladder Health at menopauseandu.ca.)
Family doctors can identify and treat many genital concerns. If a problem is more complex or needs further tests or treatments, your family doctor will refer you to a gynecologist. Gynecologists specialize in female genital organs including the vulva. Obstetricians are gynecologists that also specialize in pregnancy and delivery.
Recent fads like vaginal steaming have not been proven to be medically beneficial. They are more likely to irritate and burn the vulva. Medical doctors advise against this practice. Another trend suggests that inserting a jade egg into the vagina could improve health. These claims have no scientific basis, and doctors recommend against them.
Culture and fashion trends do play a role in the question of whether to remove pubic hair. However, pubic hair does have a purpose. It protects the vulva from trauma like friction (during sex for example). When the skin of the vulva is covered by hair, it is less likely to get scraped. Scratches or scrapes can allow bacteria, fungi and viruses that cause disease inside the skin. That can cause problems. Various hair removal techniques, such as waxing, shaving or depilatory creams, can irritate or even damage the skin. Pubic hair removal remains a personal preference. It is not needed to keep this area clean and healthy. And no, your doctor truly does not care whether you choose to keep or to remove your pubic hair (or any other body hair for that matter).
Many, but not all, sexually transmitted infections of the vulva and vagina caused by bacteria or viruses can be prevented by using condoms when having sex.
The HPV vaccine has been available since 2006. It is part of the standard set of provincially funded vaccines for children. The HPV vaccine teaches your immune (defence) system to fight off infections caused by nine strains of the human papilloma virus that are most likely to cause diseases. These diseases include cancer of the cervix, vagina, vulva, anus, mouth and throat.
The National Advisory Committee on Immunization (NACI) is the Canadian authority that makes recommendations for the use of vaccines. They recommend that adult Canadians also consider getting the HPV vaccine to lower their chances of cancer and pre-cancerous growths.
The vulva is a sensitive area. Symptoms of itching, burning, discomfort, changes in vaginal discharge, various rashes, skin growths, and lumps and bumps are common. Although some symptoms may come from irritation, others can result from disease.
Common concerns of itching and discomfort may be caused by irritation from soaps or laundry detergent and fabric softeners used to wash underwear. Tampons, panty liners, and menstrual and incontinence pads can also be irritating. Irritation may lead to redness, swelling, itching and pain.
If itching and burning is an issue, first eliminate anything that might irritate the area. Look for feminine products that are hypoallergenic, unscented and unbleached, or produced from natural fibres. If appropriate, your doctor may prescribe several days of treatment with a mild steroid cream.
Yeast is part of the natural flora of the vulva in many women. Sometimes it can overgrow and cause Candida vulvovaginitis (yeast infection). This causes itching, discomfort, redness of the vulva, and clumpy, whitish discharge from the vagina. Women can be more prone to a yeast infection after taking antibiotics, which may upset the natural balance of good bacteria in the vagina. Your family doctor can diagnose a yeast infection by performing an exam and doing a vaginal swab. Yeast infections are common and treatments are available at pharmacies without a prescription.
Infections with bacteria may cause similar symptoms of vaginal discomfort, unpleasant vaginal discharge and odour, as well as discomfort when passing urine. A common vaginal condition is bacterial vaginosis. It’s not a specific infection but an imbalance of natural vaginal bacterial flora and overgrowth of certain bacteria that cause a copious discharge and odour that has a fishy smell. Being sexually active is known to trigger bacterial vaginosis. Bacterial vaginosis diagnosis can be confirmed by a swab done by your doctor who will prescribe antibiotics that can be applied directly to your vagina or in a pill form.
Some infections, such as chlamydia, gonorrhea and trichomoniasis, are sexually transmitted. To help with diagnosis, your doctor may examine the vulva and take a swab of the area, or ask you to do a urine test. These infections need to be treated with antibiotics. If left untreated, they can be passed on to sexual partners and can cause complications that can affect other organs as well as fertility and pregnancy complications. For this reason, all pregnant women are screened for these sexually transmitted infections.
Once confirmed by a test, chlamydia and gonorrhea infections require that the sexual partner be tested and treated as well. As these two infections can be troublesome, they are reported to Public Health to help limit the spread. To protect privacy, partners can be confidentially notified by a healthcare worker.
Vulvar itch, especially at night in children, may mean pinworms. More commonly, pinworms cause a typical relentless itch of the anus (where bowel contents leave the body). However, such itch of the vulva warrants a check for these little worms. Pinworms spread easily. Usually the person with pinworms, as well as anyone living in close contact, will need treatment prescribed by their doctor. Children may also develop redness and itching because of a strep infection. Your doctor will guide you through figuring out the correct diagnosis and treatment.
Lumps and bumps of the vulva can have many causes. Skin cysts and ingrown pubic hair are common. Although these bumps may not be painful, they can become very uncomfortable when infected. A bump sometimes needs an antibiotic cream or minor surgery to help it heal.
Bartholin glands are situated in the labia majora, and produce lubrication for the vulva. These glands are common sites where a cyst can form and become infected (abscess). An infected abscess can cause a large lump and can be an especially painful condition of the vulva. To relieve the pressure, the pus-filled infected gland may need to be surgically drained by a gynecologist. Cancer of the Bartholin glands can also occur, although it is uncommon.
Viruses that affect the vulva include the herpes simplex virus (HSV), which causes genital herpes. This is a painful outbreak of blisters and ulcers. Currently, there is no vaccine for the HSV virus. The human papilloma virus (HPV) causes genital warts (fleshy skin growths). This virus can also cause pre-cancer abnormalities and cancers of the vulva, vagina and cervix. Even if you do not have any symptoms, it is still possible to have the HPV or HSV virus. Bring concerns about the vulva to your doctor, who can help you to manage them appropriately.
Sometimes a patch of a rash on vulvar skin can discolor or thicken. This could be a benign irritation or an easily treated infection, and may or may not be uncomfortable. However, it may also be a start of a pre-cancer or a cancer. Vulvar intraepithelial neoplasia (VIN) is a precancerous growth. It can turn into cancer of the vulva if it is not treated. Your family doctor may do a biopsy of the concerning growth or refer you to a gynecologist for treatment.
Lichen sclerosus is a chronic condition of the vulvar lining that causes itching, pain, thinning and wrinkling of the skin, as well as whitish discoloration. It is not exactly clear why it occurs. Lichen sclerosus is usually treated with steroids in ointment or cream form as a prescription from your family doctor, gynecologist or dermatologist.
Both the HPV virus and lichen sclerosus may lead to precancerous changes that can grow into cancer.
Although rare, the vulva can be a location for melanoma, a type of skin cancer. Your doctor inspects your vulva during routine Pap tests and will check for any such growths.
A lymph node can sometimes be felt as a lump in the groin. Based on size and whether or not it is painful, your doctor will be able to judge if it is normal or a concern for infection or cancer.
Another common and sometimes painful lump in the vulva can be caused by varicose veins in the labia. Just like varicose veins in the legs, veins in the labia can balloon out, become painful and even clot. These bumps are usually bluish in colour. Some women experience vulvar varicose veins during pregnancy. Most varicose veins in the vulva resolve soon after delivery. Some women need compression garments, or should be seen by a vein specialist for sclerotherapy and other varicose vein treatments.
As women enter perimenopause and menopause, the reduced level of estrogen hormone can affect the vulva. Both the vulva and vagina can become dry and thin, and lose suppleness and lubrication. This can make intercourse uncomfortable, as well as the screening speculum exam and Pap test in the doctor’s office. The chance of bladder infection also increases. Reduced estrogen can cause vulva tissue to atrophy (waste away). Moisturisers and lubricants that do not contain hormones can help, and are applied directly on the tissue. These are available over-the-counter. Your doctor may also talk to you about prescribing estrogen replacements in the form of vaginal tablets, gels and creams.
Although it is very normal to feel shy about these concerns, chances are your doctor has heard them before and will be able to help. You can also learn more from the sexualityandu.ca and menopauseandu.ca websites by the Society of Obstetricians and Gynaecologists of Canada (SOGC). They contain reliable information on the health of the vulva and many other topics.