Vulval skin conditions

Vulval skin problems are far more common than most women realise, and they are one of the areas where women most often suffer in silence. Persistent itching, soreness or changes in the skin are not something you should have to live with, and they are not something to feel embarrassed about.

Why these conditions are missed

Vulval symptoms are frequently assumed to be thrush and treated repeatedly without improvement. Many women have symptoms for years before a proper diagnosis is made.

A careful examination by someone who looks at vulval skin regularly often identifies the problem quickly. This is an area of particular interest in my practice, and I was a Principal Investigator for our unit in a national research trial into lichen sclerosus.

Conditions commonly seen

Several distinct conditions affect the vulval skin, and they are treated differently:

• Lichen sclerosus — causing itching, pale or thickened skin and, over time, changes in the shape of the vulva
• Lichen planus
• Eczema and contact dermatitis, sometimes caused by soaps or products
• Psoriasis affecting the genital skin
• Recurrent thrush or bacterial infection
• Vulval pain conditions where the skin looks normal
• Pre-cancerous changes, which are uncommon but important to identify

How it is assessed

Assessment involves a careful history and examination of the skin. In some cases a small biopsy under local anaesthetic is recommended to confirm the diagnosis — this is a straightforward outpatient procedure.

Identifying the specific condition matters, because treatments that help one problem can make another worse.

Treatment and follow-up

Most vulval skin conditions respond well to treatment, though several are long-term conditions that need ongoing care rather than a one-off cure. Treatment often involves prescribed ointments, together with practical advice on skin care and avoiding irritants.

Some conditions, including lichen sclerosus, carry a small increased risk of skin cancer over many years, which is why regular review is recommended. With proper treatment and monitoring, that risk is reduced and symptoms are usually well controlled.