05/14/2012 10:36 am ET Updated Jul 14, 2012

Vulvar Pain and Painful Sex

Painful sex affects 20 million women. It hurts, it affects relationships and it keeps on causing a problem until it's treated. That's why I want to tell you about a group of painful conditions that cause irritation of the skin around the vagina -- the area called the vulva. These conditions are known as vulvar dermatosis. Vulvar skin is usually protected and a little different than skin on more exposed areas of the body. It's susceptible to some of the same skin conditions as the rest of the skin, and a few that typically only occur "down there."

Most women and a lot of doctors are not familiar with vulvar dermatosis. Many women don't realize how common these problems are and as a result, feel isolated and embarrassed. They may fear they have a sexually transmitted disease or other problems and stop having sex. All of this can lead to depression and frustration. It's not helped by the fact that vulvar skin problems are in that gray area between what gynecologists and what dermatologists typically treat. So it's important to find a doctor familiar with the problem.

Here are some of the common vulvar symptoms that you should be aware of:

  • Itchy
  • Redness
  • Swollen
  • Painful

It's not about relaxing, it's not normal, and it's something that usually can be improved with treatment.

Your doctor may ask you questions about:

  • Your sexual practices
  • Any history of sexually transmitted diseases
  • Whether or not you use over-the-counter medications on the vulva
  • If you've had surgery on your labia (the lips around the vagina)
  • Trauma to your vulva
  • Your exercise history
  • How you care for your vulva

He or she will exam the vulvar skin carefully and look for areas of discoloration, paleness, redness, ulcers and other skin changes. The doctor might offer you a mirror to look at your vulva during the exam. They may also touch the skin with a cotton swab to see it there are any particularly tender spots.

They will also use a speculum to look inside the vagina for any abnormalities or discharge and check the pH, a measure of the level of acidity. The doctor may also do a more general exam, including looking at the rest of your skin and your eyes and mouth, because some vulvar conditions are associated with more general health conditions.

Here are the most common causes of vulvar dermatosis.

Contact Dermatitis
Some products and substances used on the vulvar skin can be irritating to those tissues and cause inflammation. Here is a list of things to be aware of.

Things that can cause vulvar irritation:
  • Soaps and detergents
  • Sweat
  • Urine
  • Feces
  • Douches
  • Spermicide
  • Panty liners and menstrual pads
Things that can cause an allergic response on the vulvar tissues:
  • Benzocaine (Vagisil)
  • Neomycin (Neosporin)
  • Chlorhexidine (KY)
  • Perfume
  • Lanolin
  • Nail Polish
  • Latex Condoms
  • Nickel from piercings

Lichen Simplex Chronicus

Lichen simplex chronicus is a very different condition than contact dermatitis, but many of the symptoms are similar: red, inflamed and intensely itchy skin. The cause isn't entirely clear but irritants contribute. It's more likely in people with eczema and psoriasis. The symptoms can get really intense with this condition and cause loss of vaginal lubrication, and loss of sexual arousal, desire and orgasm. All of this can understandably lead to demoralization, depression, anxiety and sleep disturbances. The doctor may take a small circle of skin (called a skin or "punch" biopsy) about the diameter of a pencil eraser to make the diagnosis and to be sure there is no skin cancer.

Lichen Sclerosus

Lichen sclerosis is a chronic inflammation of the vulva that affects one in 70 women. It usually affects young girls before puberty and menopausal woman. Sometimes it can be a very mild disease and other times the itching can be maddening. As with the Lichen Simplex Chronicus, there can also be an associated risk for skin cancer of the vulva. The problem can also lead to chronic pain in the vulva.

Lichen Planus

Lichen planus is an autoimmune disease of the vulvar tissue that affects about 1 percent of women between the ages of 30 and 60. Again, the common symptoms are redness, itching, burning and painful sex.

One of the important organizations for you to know about with these types of problems is the National Vulvodynia Association.


For each of these conditions, there will be slightly different treatments. For contact dermatitis, the primary goal is to find out what is causing the allergy. This may take some investigation, but getting rid of contact with that material is a key part of treatment. The good thing is that once you stop using the irritating substance, the problem will stop. More treatment may be needed (see below).

For the other conditions, treatment will depend in part on how bad the inflammation is. Sometimes there may be a crack in the skin called a fissure or even a small ulcer. Sometimes the doctor may prescribe you a topical steroid ointment twice a day such as 1 percent triamcinolone. For worse cases, your doctor may suggest a stronger steroid such as clobetasol 0.05 percent. Ice packs and antihistamines can help reduce the itching. One of the big problems is that the itching is so intense that many women will scratch the area while asleep, which makes it worse. To help prevent that, your doctor might prescribe a low-dose antidepressant such as a tri-cyclic antidepressant.

Each case is different, but with the proper diagnosis, most women will get the relief they need and be able to eliminate the pain and put the joy back into her sex life.

Since stress is often associated with vulvar dermatosis, I'd like to offer my readers a FREE Stress-Busters eBook to help with this and other sources of stress.

For more by Mache Seibel, MD, click here.

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