Vulvar Dermatitis

What is vulvar dermatitis?

Vulvar dermatitis is a common skin condition that causes an irritated, itchy vulva. “Vulva” is another name for your genitals, which includes the folds of skin that surround your vagina. It’s common with vulvar dermatitis to develop dry, itchy skin in these folds. Dermatitis may also appear on the skin near your anus or in the skin in between your butt cheeks, a condition called perianal eczema.

Vulvar dermatitis includes atopic dermatitis (vulvar eczema) and contact dermatitis. With both, you may find that your vulva’s itchy because something in your environment damaged your skin or triggered an allergic reaction.

Who is affected by vulvar dermatitis?

Anyone with a vulva can be affected by vulvar dermatitis. You may be more likely to have it if you haven’t gone through puberty yet or if you’re postmenopausal. People in these groups have lower levels of estrogen than people who get their periods. Lower estrogen levels may make the skin on your vulva dryer, thinner and more susceptible to injury and irritation.

What are the symptoms of vulvar dermatitis?

Vulvar itching (vulvitis) is the most common symptom of vulvar dermatitis. The itching may range from mild to severe. Other symptoms may include:

• Skin that feels as if it’s burning, stinging or raw.
• Skin patches that feel thicker than the surrounding skin.
• Skin patches that look red or darker than the surrounding skin (depending on your skin tone).
• A wet feeling in your vulva from damaged skin with fluid seeping out (weeping).
• Vulvar pain when you have intercourse, insert a tampon or when your healthcare provider inserts a speculum during a pelvic exam.

Your symptoms may get worse at specific times:

• At night.
• During intercourse.
• When you’re on your period.
• When you’re hot or sweating.

What causes vulvar dermatitis?

The skin on your vulva is susceptible to damage. Compared to other body parts, the skin on your vulva provides a fragile barrier to irritants and allergens that may aggravate your skin. The skin on your vulva may itch if you came into contact with a product that irritated your skin or caused an allergic reaction.

Substances that may cause vulvar dermatitis include:

• Soap, bubble bath, shampoo and hair conditioner.
• Deodorant, perfume, douches, talcum powder.
• Underwear made of synthetic materials, like nylon.
• Laundry detergent and dryer balls.
• Pads, panty liners and tampons.
• Food preservatives.
• Toilet paper.
• Tea tree oil.
• Spermicides.
• Medications.
• Nickel.
• Dyes.

You’re more likely to have vulvar dermatitis if fecal or urinary incontinence makes it difficult to control when you pee or poop. Urine and feces can collect on your skin, irritating it.

How is vulvar dermatitis diagnosed?

Vulvar dermatitis shares many symptoms with other conditions, so it’s important that your healthcare provider rules out other disorders or diseases that may be causing your itching. Conditions that may also cause vulvar itching, irritation and inflammation include:

• Lichen planus.
• Lichen sclerosus.
• Psoriasis.
• Seborrheic dermatitis.
• Vaginal atrophy.
• Vaginitis.
• Vulvar cancer.
• Vulvitis.
• Vulvodynia.
• Yeast vulvitis.

Your provider will ask you about your medical history and symptoms to diagnose vulvar dermatitis. They may also conduct tests to find out what’s causing your itching.

• Medical history & symptoms: Your provider will ask about your family history of skin conditions, asthma and autoimmune diseases. They’ll ask about your symptoms, including when they occur and when they’re most severe. Finally, they’ll ask you about any medications you’re taking and your lifestyle, including habits related to caring for your vulva.
• Physical exam: Your provider will inspect your vulva and vagina, looking for signs of skin damage and inflammation. They may test your vaginal discharge. Often, an itchy vulva is a sign of an infection. Testing your discharge allows your provider to rule out yeast infections or bacteria-related infections that may be causing your symptoms.
• Patch testing: During a patch test, your provider will expose your skin to specific allergens to see if you have a reaction. A patch test can help identify whether an allergen in your environment is causing your dermatitis.
• Biopsy: Your provider may request a biopsy of the area if the clinical picture is changing rapidly or becoming worse despite treatment. You may need a biopsy to rule out vulvar cancer, cervical dysplasia or other conditions with similar symptoms.

How is vulvar dermatitis treated?

Often, you can get rid of vulvar dermatitis by avoiding the substances that are causing your itching and practicing better vulvar care. Medicines can help with the pain and itching while your dermatitis clears.

Lifestyle changes

Steer clear of any substances that may cause an allergic reaction or skin irritation. In the meantime, make sure to care for your vulva with gentle cleaning. Choose clothes that allow your skin to breathe.

For instance, you should:

• Wash your vulva with mild, unscented soap and warm water no more than once a day.
• Wash your vulva with your hands and fingers instead of a washcloth.
• Pat your vulva dry with a clean towel instead of rubbing.
• Wear 100% cotton underwear or no underwear instead of synthetic fabrics.
• Wear loose-fighting cotton clothing instead of tight-fitting underwear or jeans.
• Wash your clothes with mild, unscented detergents.
• Avoid douching or using feminine hygiene products that are scented or that contain chemicals that may irritate your skin.

One of the most important things you can do is adopt a less-is-more approach to cleaning your vulva. Frequent washing, aggressive scrubbing and overusing products on your vulva can worsen your dermatitis.

Medications

Your provider may prescribe pills, creams or ointments that can help keep your itching under control so that you don’t damage your skin by scratching. These may include:

• Anti-itch medications that can help you sleep: hydroxyzine, doxepin.
• Corticosteroid ointments: hydrocortisone, desonide, triamcinolone, clobetasol propionate, betamethasone dipropionate.
• Anti-itch emollients: Balneum Plus®, E45 Itch® or Dermacool®.

If you have an additional condition contributing to your itching, like an infection, your provider can prescribe other medications that can get your symptoms under control.

How can I reduce my risk?

If you’re genetically predisposed to developing vulvar eczema, there’s little you can do to reduce your risk. Everyone, however, can prevent flare-ups related to contact with irritants or allergens by practicing proper vulvar care.

What can I expect if I have this condition?

The time it takes for your dermatitis to improve depends on the specific cause. For instance, contact dermatitis may take a couple of weeks or up to one month to resolve once you remove the offending substance. If you have an infection along with your dermatitis, the recovery period may be longer.

When should I see my healthcare provider?

Schedule a visit with your healthcare provider before using any over-the-counter (OTC) treatments to relieve your itching. Vulvar itching is a common symptom of many conditions that require different treatments. Without a diagnosis, you may choose a treatment that contains the irritant you need to avoid.

What does vulvar inflammation look like?

Your labia, the skin folds surrounding your vaginal opening, may appear swollen, red or darker than the surrounding skin. You may have patches of skin that look thicker than the surrounding skin.

What does vulvar eczema look like?

With vulvar eczema, your vulva may appear swollen, red or darker than the surrounding skin — similar to vulvar inflammation. You may also have bumpy skin or scaly white patches of skin that are irritated.

Which cream is best for itching in private parts?

Your healthcare provider may prescribe a corticosteroid to control your itching and an antihistamine to help you sleep at night. The specific medicine you need depends on what’s causing your itching. See your provider to find out what’s causing your symptoms.

A note from Cleveland Clinic

You may feel embarrassed to see a healthcare provider about an itchy and irritated vulva, but you shouldn’t be. It’s a common symptom that leads many people to schedule an appointment. Once you identify the offending substance that’s causing your itching, you can take steps to avoid it. Just don’t try to treat your dermatitis on your own. Using the wrong over-the-counter cream or ointment may actually make things worse. It’s worth it to receive an accurate diagnosis so that you can receive the treatment (and relief) you need as soon as possible.