This is an overview of 10 common vulval problems. But, let’s start with a definition.
What is the Vulva?
The vulva is all the external female genitalia. This includes the fleshy outer lips, the smaller inner lips, the clitoris, the urinary opening (urethra), and the vaginal opening (part of perineum). Vulvas are completely distinct from the vagina, which is the internal muscular canal
What it is: A very common yeast infection caused by an overgrowth of the Candida fungus, which naturally lives in the vagina and vulval area.
Common signs: Intense itching, soreness, irritation, and a thick, white, odourless discharge (often resembling cottage cheese).
When to Worry:
Symptoms do not clear up with over-the-counter antifungal treatments
Frequent, recurrent episodes (more than four times a year)
Cracking, bleeding, or severe swelling of the vulval skin
When to See a Doctor:
Promptly. To confirm the diagnosis, rule out other infections, or obtain stronger, prescription-strength treatments if it is recurrent.
What it is: A common bacterial imbalance in the vagina that can cause inflammation and irritation of the surrounding vulval tissues.
Common signs: A thin, watery, greyish-white vaginal discharge accompanied by a distinct, strong, fishy odour that is often more noticeable after sex.
When to Worry:
Symptoms occur during pregnancy (as untreated BV can increase the risk of complications)
Severe discomfort or if the discharge becomes yellowish-green
When to See a Doctor:
Soon. Antibiotics are typically required to clear the imbalance and resolve the symptoms.
What it is: A chronic inflammatory skin condition that primarily affects the vulval and anal areas, most common in postmenopausal women.
Common signs: Porcelain-white patches of skin, severe itching (often worse at night), soreness, and thin, fragile skin that tears easily.
When to Worry:
Architectural changes, such as the fusing or shrinking of the labia
Pain during sexual intercourse or urination
Non-healing sores or ulcers developing within the white patches
When to See a Doctor:
Soon. Early diagnosis and management with prescription steroid creams are vital to prevent scarring and monitor for long-term changes.
What it is: Inflammation of the vulval skin triggered by an allergic reaction or irritation from everyday products like soaps, perfumes, fabrics, or laundry detergents.
Common signs: Redness, burning, swelling, dry or flaky skin, and persistent itching.
When to Worry:
The skin becomes intensely painful, raw, or starts oozing fluid
Signs of a secondary bacterial infection develop (e.g. increased warmth, pus, or fever)
When to See a Doctor:
Routinely. To help identify the specific trigger, rule out infections, and obtain appropriate topical treatments to soothe the skin.
What it is: A blockage of the Bartholin’s glands (located on either side of the vaginal opening), which can fill with fluid or become infected.
Common signs: A painless, fluid-filled lump on one side of the vaginal entrance; if infected (an abscess), it becomes rapidly swollen, red, and intensely painful.
When to Worry:
The lump grows quickly or becomes intensely painful
Sitting, walking, or moving causes severe discomfort
The swelling is accompanied by a fever
When to See a Doctor:
Urgently for an abscess to arrange for drainage and antibiotics; routinely if it is a small, painless, uninfected cyst.
What it is: A common sexually transmitted infection caused by the herpes simplex virus, leading to periodic outbreaks of painful sores.
Common signs: Small, painful blisters that burst to leave raw, tender ulcers; often preceded by a tingling or burning sensation and flu-like symptoms during the first outbreak.
When to Worry:
The first episode, which is typically the most severe and distressing
Difficulty passing urine due to severe pain from the open sores
When to See a Doctor:
Promptly. Early treatment with antiviral medications within the first few days of symptoms can significantly reduce the severity and duration of the outbreak.
What it is: A precancerous condition where abnormal cell changes occur in the surface layer of the vulval skin, often linked to high-risk strains of Human Papillomavirus (HPV).
Common signs: Persistent vulval itching, burning, or soreness; the skin may display raised, thickened patches that appear white, red, or dark.
When to Worry:
Any longstanding vulval itch or irritation that does not respond to standard treatments
Noticeable, persistent changes in the colour or texture of the vulval skin
When to See a Doctor:
Soon. A specialist referral to a Consultant in Obstetrics and Gynaecology (O&G; leading to a small skin biopsy) are required to accurately diagnose VIN and implement appropriate monitoring or treatment.
What it is: A rare type of cancer affecting the external female genitalia, most commonly presenting in older women but possible at any age.
Common signs: A persistent lump, growth, or open sore on the vulva; unexplained bleeding or discharge; and a long-term itch or burning sensation.
When to Worry:
An ulcer or open sore that fails to heal within a few weeks
A new, hard, or growing lump on the vulva
Unexplained bleeding or a mole on the vulva that changes shape, size, or colour
When to See a Doctor:
Soon. Any persistent, unexplained vulval lesion must be promptly evaluated by a doctor to definitively rule out malignancy.
What it is: A chronic, unexplained pain syndrome affecting the vulva where no specific underlying cause, infection, or skin condition can be identified.
Common signs: A persistent burning, stinging, or rawness that can be constant or triggered by touch (such as inserting a tampon, intercourse, or tight clothing).
When to Worry:
Severe, unremitting pelvic or vulval discomfort that disrupts daily life, sleep, or intimate relationships
When to See a Doctor:
Routinely. For a comprehensive evaluation to rule out identifiable conditions and to discuss specialised long-term pain management strategies.
What it is: An injury to the vulva, often caused by direct physical impact (such as a straddle injury, sports accident, or childbirth), leading to blood collecting under the skin.
Common signs: Immediate pain, rapid swelling, visible bruising, and localized tenderness following an accident.
When to Worry:
Rapidly expanding, tense swelling or severe, unmanageable pain
Inability to urinate due to the swelling or local trauma
Visible tearing of the skin or active, continuous bleeding
When to See a Doctor:
Urgently. Severe trauma or expanding haematomas require immediate medical evaluation to ensure there is no internal damage or need for surgical repair.
Regular self-examination – using a mirror are vital for noticing early visual changes in the vulval skin.
Do not ignore rapid, severe pain or rapidly expanding swelling – it requires immediate medical attention.
Most vulval issues are benign and highly treatable – but getting an early, accurate diagnosis prevents complications.
Vulval symptoms are routine medical concerns – never let embarrassment or self-consciousness delay seeing a doctor.
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