Vulvar Symptoms

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DEFINITION

• Itching or dryness of external female genital area (vulva)
• Rashes of external female genital area including: sores, redness, blisters, lumps

Causes of Vulvar Symptoms

• Any preexisting skin disorders/rashes can also occur on the vulva (e.g., psoriasis, eczema, drug rashes)
• Bartholin's cyst
• Candidal vulvovaginitis (aka "yeast infection") 
• Contact dermatitis (e.g., soaps, feminine hygiene products)
• Irritation after sexual intercourse (e.g., inadequate lubrication, latex-condom allergy)
• Poison Ivy
• Skin cancer
• Skin dermatoses (e.g., lichen sclerosis, squamous hyperplasia)
• STD's (e.g., Herpes simplex, Syphilis, pubic lice, genital warts)

Common Causes of Vulvar Itching

• Contact Dermatitis - Irritant: There are two different types of vulvar contact dermatitis: irritant and allergic. Products like soaps, detergents and douches can cause local irritation. Urinary incontinence can result in the vulva being irritated by constant moisture. The treatment for irritant contact dermatitis is to avoid irritating products and to keep the vulvar area clean and dry (maintain good genital hygiene).
• Contact Dermatitis - Allergic: Women can develop an allergic skin reaction to a number of different OTC products. These products include: benzocaine (in Vagisil anti-itch cream), neomycin (antibiotic ointment), latex condoms, nail polish, and perfumes. The treatment for allergic contact dermatitis is to avoid allergic products and to keep the vulvar area clean and dry (maintain good genital hygiene).
• Menopause: At menopause the ovaries stop functioning, and as result the body produces less estrogen. Without estrogen, the skin in the genital area can become thin and women notice increased dryness. There are estrogen-based vaginal crèmes or lubricants that the physician can prescribe to reduce this itching and dryness.
• Yeast Vulvovaginitis (Yeast Infection):  Sometimes itching can be caused by a yeast infection (candida). Often there is a new or increased vaginal discharge (thick, white, cottage cheese-like, non-odorous discharge). There are a number of over the counter medications for the treatment of vaginal yeast infections.

See More Appropriate Topic (instead of this one) If

• PUBIC LICE
• URINATION PAIN, FEMALE
• If vaginal discharge is the main symptom, see VAGINAL DISCHARGE

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Severe pain
• Fever and genital area looks infected (e.g., draining sore, ulcer, rash is painful to touch)

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think you need to be seen
• Itching that is moderate-severe (i.e., it interferes with school, work, or sleep)
• Genital area looks infected (e.g., draining sore, ulcer, rash is painful to touch)
• Rash with painful tiny water blisters

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• You are worried you might have a sexually transmitted disease
• Antibiotic treatment for 3 or more days for a Sexually Transmitted Disease (STD) and you are not improving
• Home treatment for 3 or more days for a "yeast infection" and you are not improving
• All other vulvar symptoms (EXCEPTION: feels like prior yeast infection, or painless rash present less than 24 hours)

Self Care at Home If

• Symptoms of a yeast infection (i.e. itchy, white discharge, not bad smelling), which feels like prior vaginal yeast infections, and you don't think you need to be seen
• Painless rash (e.g. redness, tiny bumps, sore) of genital area present less than 24 hours, and you don't think you need to be seen
• Mild itchiness, and you don't think you need to be seen

HOME CARE ADVICE FOR VULVAR SYMPTOMS

1. Cleansing: Wash the area once thoroughly with un-scented soap and water to remove any irritants.
2. Genital Hygiene:
   • Keep your genital area clean. Wash daily.
   • Keep your genital area dry. Wear cotton underwear or underwear with a cotton crotch.
   • Do not douche.
   • Do not use feminine hygiene products.

3. SITZ Bath:

   • Sit in some lukewarm water for 10-15 minutes once or twice a day (or apply moist washcloth). This will help soothe the irritated skin.
   • Gently dry the area by patting the area with a towel.
   • Afterwards apply a small amount (1/2 tsp) of ointment or cream to help seal in the moisture. Good choices for this are vaseline ointment or Eucerin.
4. Antifungal Medication for Yeast Infection: There are a number of over the counter medications for the treatment of yeast infections.
   • Available in the U.S.:  Femstat-3, miconzale (Monistat-3), clotrimazole (Gyne-Lotrimin-3, Mycelex 7), butoconazole (Femstat-3)
   • Available in Canada: miconazole (Monistat-3) and clotrimazole (Canesten-3, Myclo-Gyne)

   • If you are pregnant, speak with your doctor before using.

   • Do not use yeast medication during the 24 hours prior to a physician appointment (Reason: interferes with examination).

   • Read and follow the package instructions closely.

5. Expected Course: If there is no improvement within 3 days, then you will need to be examined.
6. Pregnancy test, when in doubt:
   • If there is any possibility of pregnancy, obtain and use a urine pregnancy test from the local drug store.
   • Follow the instructions included in the package.
7. Call Your Doctor If:
   • Pregnancy test is positive; or if you have difficulties with the home pregnancy test.
   • Rash lasts longer than 24 hours
   • Rash spreads or becomes worse
   • Fever occurs
   • No improvement after 3 days
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

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